Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study.

BACKGROUND: The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. METHODS: The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. RESULTS: In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively. CONCLUSION: As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study

Background: The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. Methods: The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. Results: In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively. Conclusion: As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

BACKGROUND: In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. METHODS: The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. RESULTS: The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. CONCLUSIONS: As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study.

BACKGROUND: This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs. METHODS: This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded. RESULTS: A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96-6.90), p < 0.001; OR: 4.36 (95% CI 2.52-7.53), p < 0.001; OR: 5.35 (95% CI 3.06-9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books. CONCLUSION: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Anxiety and depression in the first 24 h in COVID-19 patients who underwent non-invasive mechanical ventilation in the intensive care unit.

BACKGROUND AND AIMS: The aim of this study was to investigate the degree of anxiety and depression in the first 24 h of people who were taken to the intensive care unit (ICU) due to COVID-19 and had to use unfamiliar devices in an unfamiliar environment. MATERIAL METHOD: Sixty-two patients over 18 years of age, conscious and cooperative, who were admitted to the ICU with the diagnosis of COVID, were PCR (+), and needed non-invasive mechanical ventilation were included in the study. Age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and Hospital Anxiety Depression (HAD) A (anxiety), and HAD D (depression) scores of the patients were recorded, and the prevalence of anxiety and depression and independent factors affecting them were investigated. RESULTS: The mean age of the patients was 57.1 ± 17.6 years, and the mean APACHE II was 29.3 ± 10.4. The average HAD A score was 10.5 ± 3.5 in all patients, while the HAD D score was 10.5 ± 3.3. The prevalence of anxiety was 37.1% (23 patients), and the prevalence of depression was 43.6% (27 patients). Age and APACHE II and anxiety/depression were negatively correlated, and when age and APACHE II scores increased, anxiety and depression decreased (p < 0.05). CONCLUSION: In COVID-19 patients who underwent non-invasive mechanical ventilation in the ICU, the rate of anxiety in the first 24 h of admission was 37.1% while for depression the rate was 43.6%. In addition, advanced age and high APACHE II scores were found to be associated with low anxiety and depression. TRIAL REGISTRATION: ClinicalTrials ID: NCT04715477 (January 20, 2021).