Comparison of thromboembolic risk scores for evaluating in-hospital events of COVID-19 patients.

Aim: To compare the effectiveness of thromboembolic risk scores in determining in-hospital events of COVID-19 patients. Methods: This retrospective study included a total of 410 consecutive COVID-19 patients. Scores including CHA2DS2-VASc-HS (congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack, vascular disease, sex, hyperlipidemia, smoking); modified R2CHA2DS2-VASc (CHA2DS2-VASc plus renal function), m-ATRIA (modified Anticoagulation and Risk Factors in Atrial Fibrillation score), ATRIA-HSV (ATRIA plus hyperlipidemia, smoking and vascular disease) and modified ATRIA-HSV were calculated. Participants were divided by in-hospital mortality status into two groups: alive and deceased. Results: Ninety-two (22.4%) patients died. Patients in the deceased group were older, predominantly male and had comorbid conditions. CHA2DS2-VASc-HS (adjusted odds ratio [aOR]: 1.31; p = 0.011), m-R2CHA2DS2-VASc (aOR: 1.33; p = 0.007), m-ATRIA (aOR: 1.18; p = 0.026), ATRIA-HSV (aOR: 1.18; p = 0.013) and m-ATRIA-HSV (aOR: 1.24; p = 0.001) scores were all associated with in-hospital mortality. m-R2CHA2DS2-VASc and modified ATRIA-HSV had the best discriminatory performance. Conclusion: We showed that m-R2CHA2DS2-VASc and m-ATRIA-HSV scores were better than the rest in predicting mortality among COVID-19 patients.

COVID-19 continues to be a pandemic that threatens human health all over the world. The main aim of our study was to examine the relationship between risk scores routinely used to determine the probability of clot formation in various cardiovascular diseases and in-hospital deaths of COVID-19 patients. The study comprised 410 adult patients hospitalized with a confirmed diagnosis of COVID-19. The clinical and laboratory data were obtained from the hospital registry system. All risk scores in the study were significantly greater in people who died from COVID-19 than in those who survived. Moreover, scoring systems that include kidney function outperformed the rest in determining in-hospital death. As a result, we discovered that specific risk scores used to indicate a person's likelihood of developing clot formation at a routine cardiology clinic are connected to in-hospital deaths among hospitalized COVID-19 patients.

COVID-19 Hastalarında Pulse Steroid Tedavisinin Hastane-içi Mortalite Üzerine Etkisi

Amaç: Aralık 2019’da Çin’in Wuhan kentinde ortaya çıkan Koronavirüs hastalığı-2019 (COVID-19) subfebril ateş, kuru öksürük ve güçsüzlük gibi hafif semptomlardan akut solunum sıkıntısı sendromuna (ARDS) ve çoklu organ işlev bozukluğuna kadar değişen klinik tablolara sahip olup tedavisinde kortikosteroidlerin mortalite üzerine etkisine dair sonuçlar çelişkilidir. Yoğun bakımda tedavi gören COVID-19 hastalarında pulse steroid (≥250 mg metilprednisolon) tedavisinin hastane-içi tüm nedenli mortalite ve komplikasyonlar üzerine olan etkisini araştırmak. Gereç ve Yöntem: Dünya Sağlık Örgütü ve Türkiye Cumhuriyeti Sağlık Bakanlığı’nın geçici kılavuzlarına uygun olarak gerçek zamanlı polimeraz zincir reaksiyonu (PZR) yöntemi ile SARS-CoV-2 RNA tespit edilip COVID19 tanısı alan 270 ardışık hasta çalışmaya dahil edildi. Hastalar pulse steroid tedavisi alıp almamasına göre iki gruba, pulse steroid (+) (n=50) ve pulse steroid (-) (n=220), ayrıldı. Hastaların demografik verileri, ek hastalıkları, laboratuvar parametreleri ve hastane içi olayları (mortalite dahil) kaydedildi. Bulgular: Hastaların ortalama yaşı 68,4±13,2 iken;174’ü (%64,4) erkekti. Hastane takibi süresince 161 (%59,6) kişide mortalite gelişmiştir. Sistolik ve diyastolik kan basıncı pulse steroid tedavisi almayanlarda alanlara göre anlamlı olarak daha düşüktü (p<0,05). Her iki grup non-invaziv mekanik ventilasyon (NÍMV) tedavisi hariç (%96,0’a karşı %82,7, p=0,017) benzer ko-morbiditelere sahipti (p>0,05). Laboratuvar parametrelerinde;kreatinin, aspartat aminotransferaz (AST), ve troponin değerleri pulse steroid tedavisi almayanlarda daha yüksek iken;kan glikozu pulse steroid tedavisi alanlarda daha yüksekti (p<0,05, hepsi için) (Tablo 1). Major gastrointestinal sistem kanaması (%6’ya karşı %0, p=0,006) hariç hastaneiçi komplikasyonlar pulse steroid alan ve almayanlarda benzerdi (p>0,05) (Tablo 2). Pulse steroid tedavisi alanlar daha az hastane-içi mortaliteye sahip olma eğiliminde olmalarına rağmen istatistiksel anlamlılığa ulaşılamamıştır (olay oranı: %56,0’a karşı %60,5, adjusted hazard ratio (HR): 0,69, 0,45-1,06 %95 güven aralığı, p=0,091) (Şekil 1). Model, çok değişkenli cox orantılı tehlike regresyon analizine dayalı olarak yaş, cinsiyet, SKB, kreatinin, AST, glikoz, troponin ve NIMV için ayarlandı. Sonuç: COVID-19 tanısıyla yoğun bakımda tedavi edilenlerde pulse steroid tedavisi alanlar major gastrointestinal sistem kanaması hariç benzer hastane-içi komplikasyonlarla birlikte daha az hastane-içi mortalite eğilimine sahiptir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The CHA2DS2-VASc score and in-hospital mortality in patients with COVID-19: A multicenter retrospective cohort study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an infectious disease that was first reported in December 2019 in Wuhan, China, and has since spread rapidly around the world, resulting in the ongoing COVID-19 pandemic. The CHA2DS2-VASc score is a well-validated risk stratification tool for predicting stroke in atrial fibrillation (AFib), as well as morbidity and mortality in several entities. The aim of this study was to evaluate the relationship between the CHA2DS2-VASc score and in-hospital mortality in patients with COVID-19, regardless of AFib. METHODS: This multicenter, retrospective study included a total of 349 patients with COVID-19 who were hospitalized between March 15 and April 15, 2020. The CHA2DS2-VASc score of each patient was calculated. Mortality outcomes were followed up until April 25, 2020. RESULTS: The CHA2DS2-VASc score was significantly higher in non-survivor COVID-19 patients than in survivor COVID-19 patients (p<0.001). Forward stepwise logistic regression analysis demonstrated that a CHA2DS2-VASc score of ≥3 (odds ratio [OR]: 12.613, 95% confidence interval [CI]: 3.092-51.451; p<0.001), and the leukocyte count (OR: 1.327, 95% CI: 1.145-1.538; p<0.001), C-reactive protein level (OR: 1.010, 95% CI: 1.002-1.018; p=0.012), and ferritin level (OR: 1.005, 95% CI: 1.003-1.007; p<0.001) on admission were independent predictors of in-hospital mortality of COVID-19 patients. CONCLUSION: The CHA2DS2-VASc score predicted in-hospital mortality in patients with COVID-19, regardless of AFib.

Echocardiographic features of patients with COVID-19 infection: a cross-sectional study.

COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 63.3 ± 15.7 years, and 54% were male. The mean age of non-severe group (n = 46) was 49.7 ± 21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6 ± 5.9 mm vs. 33.1 ± 4.8 mm, p = 0.003; LV 47.3 ± 5.8 mm vs. 44.9 ± 3.8 mm, p = 0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0 ± 9.8% vs. 61.9 ± 4.8%, p < 0.001; RV-FAC, 41.4 ± 4.1% vs. 45.5 ± 4.5%, p < 0.001), and pericardial effusions were more frequent (23% vs. 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.