Malnutrition risk frequency and independent risk factors associated with mortality in hospitalized elderly patients with COVID-19 in Turkey.

BACKGROUND AND OBJECTIVES: Malnutrition is common in elderly patients and is an important geriatric syndrome that increases mortality. We aim to examine the frequency of malnutrition and independent risk factors associated with mortality in hospitalized elderly patients with COVID-19. METHODS AND STUDY DESIGN: Patients aged 65 years and older with COVID-19, who were hospitalized between 15th March and 30th April 2020, were included. Demographic characteristics of the patients, their comorbid diseases, medications, malnutrition, and mortality status were recorded. Nutritional Risk Screening-2002 was used as a malnutrition risk screening tool. The factors affecting mortality were analyzed using multivariate Binary Logistic regression analysis. RESULTS: Of the 451 patients included in the study, the mean age was 74.8±7.46 and 51.2% of them were female. The mean number of comorbid diseases was 1.9±1.28. Malnutrition risk was 64.7%, polymorbidity rate was 57.6% and polypharmacy was 19.3%. Mortality rate was found 18.4%. The risk factors affecting mortality were presented as malnutrition risk (OR: 3.26, p=0.013), high number of comorbid diseases (OR: 1.48, p=0.006), and high neutrophil/lymphocyte ratio (OR: 1.18, p<0.001), C-reactive protein (OR: 1.01, p<0.001), and ferritin (OR: 1.01, p=0.041) in elderly patients with COVID-19. Malnutrition risk (3.3 times), multiple comorbid diseases (1.5 times), and high neutrophil/lymphocyte ratio (1.2 times) were independent risk factors that increased the mortality. CONCLUSIONS: The frequency of malnutrition risk and mortality in elderly patients with COVID-19 is high. The independent risk factors affecting mortality in these patients are the risk of malnutrition, multiple comorbid diseases, and a high neutrophil/lymphocyte ratio.

Thrombotic Events Related to Extracorporeal Membrane Oxygenation in COVID-19-Associated Severe Acute Respiratory Distress Syndrome.

Hypercoagulopathy associated with the novel coronavirus disease (COVID-19) is the leading cause of acute respiratory distress syndrome (ARDS), multiple organ failure, and mortality. Extracorporeal membrane oxygenation (ECMO) has been used to manage patients with COVID 19-associated severe respiratory or cardiac failure. In this report, we aim to summarise our experience with deadly thrombotic complications during venovenous ECMO (vvECMO) treatment in 6 patients with COVID-19-associated ARDS between March 19, 2020 and April 20, 2020. Based on our experience with 6 COVID-19-associated ARDS patients on ECMO, we intend to raise awareness regarding thrombotic complications leading to mortality.

Prevalence and Associated Risk Factors of COVID-19 Infection Among Healthcare Workers in a Pandemic Hospital

Introduction: This study aimed to investigate the prevalence of Coronavirus disease-2019 (COVID-19) infection among healthcare workers in our hospital with the risk factors affecting the transmission and course of the disease and to determine the control measures. Methods: Medical records of healthcare workers diagnosed with COVID-19, confirmed by polymerase chain reaction (PCR) between 11 March and 30 April 2020, were retrospectively analyzed in our hospital in the center of Ístanbul, the city with the highest number of cases in our country. Real-time PCR detection was used to verify the diagnosis of the healthcare workers. A rapid diagnostic test kit for COVID-19 immunoglobulin M (IgM) and IgG antibodies was used in seroconversion analysis. Results: In our hospital, 4,177 COVID-19 cases confirmed by the laboratory between March 11 and April 30 2020 were followed. Of the 4177 cases, 165 (3.95%) were healthcare workers. The majority of healthcare workers with positive test results were nurses (36.3%), and 118 (71.5%) of the healthcare workers worked 40 h or more per week. Thoracic tomography examinations were performed in all infected healthcare workers, and 69 (41.8%) were diagnosed with pneumonia by the detection of ground patchy lesions. Conclusion: During the epidemic, early training of healthcare workers on the disease, use of personal protective equipment, and infection control are extremely important to reduce the risk of infection among healthcare workers. Periodic screening of asymptomatic healthcare workers can also help protect patients and hospital staff and prevent loss of workforce. (English) [ FROM AUTHOR] Amaç: Bu çalışmada, hastanemizde görev yapan sağlık çalışanlarının Koronavirüs hastalığı-2019 (COVID-19) enfeksiyonu prevalansı ile hastalığın bulaşını ve seyrini etkileyen risk faktörlerinin araştırılması ve kontrol önlemlerinin belirlenmesi amaçlanmıştır. Yöntemler: Ülkemizde olguların en fazla olduğu şehir olan Ístanbul'un merkezinde olan hastanemizde 11 Mart-30 Nisan 2020 tarihleri arasında polimeraz zincir reaksiyon (PCR) ile konfirme edilmiş COVID-19 tanısı alan sağlık çalışanlarının tıbbi kayıtları retrospektif olarak incelenmiştir. Sağlık çalışanlarının tanıları gerçek zamanlı PCR tespit yöntemi ile konulmuştur. Serokonversiyon incelemesi için hızlı test tanı kiti COVID-19 immünoglobulin M (IgM) ve IgG kullanılmıştır. Bulgular: Hastanemizde 11 Mart-30 Nisan 2020 tarihleri arasında laboratuvar tarafından konfirme edilmiş 4.177 COVID-19 olgusu takip edilmiştir. Toplam 165'i (%3,95) sağlık çalışanıydı. Pozitif olanların çoğunluğunu hemşireler (%36,3) oluşturmakta ve sağlık çalışanların 118'i (%71,5) haftada 40 saat ve üzerinde çalışmaktadır. Enfekte sağlık çalışanın tümüne toraks tomografisi çekilmiş olup 69'unda (%41,8) yamasal lezyonlar saptanarak pnömoni tanısı konulmuştur. Sonuç: Salgın sırasında sağlık çalışanlarının hastalıkla ilgili bilgilendirilme, kişisel koruyucu ekipman kullanımı ve enfeksiyon kontrolü ile ilgili eğitimlerinin erken dönemde yapılması sağlık çalışmalarında enfeksiyon riskini azaltma açısından son derece önemlidir. Asemptomatik sağlık çalışanlarının da düzenli aralıklarla taranmasının hastaların ve hastane personelinin korunması açısından faydalı olacağı ayrıca iş gücü kaybının da önüne geçileceği açıktır. (Turkish) [ FROM AUTHOR] Copyright of Istanbul Medical Journal 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.)

Working in a Pandemic Hospital during COVID-19 Outbreak: Current Conditions and Depression, Anxiety, and Stress Levels

Objective: Healthcare workers (HCW), who actively participate in combating the coronavirus disease-2019 (COVID-19) epidemic, may experience rage and anxiety due to the high performance expected from them. This study aimed to reveal how working in a pandemic hospital affects the psychological status of healthcare professionals. Methods: 446 HCW, working frontline in a pandemic hospital, were included the study. Questions including basic demographic data and exposure risks to COVID-19 and depression anxiety stress scale (DASS-21) were used as data collection tools. The forms were delivered online, and the responses were similarly collected. Results: DASS-21 scores of 384 (86.1%) HCW, who had contact with patients diagnosed with COVID-19, were found to be higher than HCW who did not have contact with the patients. When we evaluated the scores of DASS-21, the scores were higher in women (p<0.01), HCW diagnosed with COVID-19 among their colleagues (p<0.01), and HCW with relatives diagnosed with COVID-19. Anxiety scores of nurses (p<0.05) and single HCW, were also high (p<0.05). Conclusion: While the world continues to fight the COVID-19 outbreak, HCW are emotionally affected in this intense process. Providing psychosocial support and intervention to cover all healthcare professionals should be targeted by decision makers. [ABSTRACT FROM AUTHOR] Copyright of European Archives of Medical Research 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

The Importance of Healthcare Workers to Comply with Infection Prevention and Control Instructions During COVID-19 Outbreak-A Survey Study

Objective: Taking precations to prevent contamination and developing prevention programs play a key role in the outbreak. For this purpose, the use of personal protective equipment (PPE) of healthcare workers (HCWs) and their compliance with hand hygiene were investigated in the current Coronavirus disease-19 (COVID-19) outbreak. Methods: In study, 117 HCW, who were diagnosed with COVID-19 between 11 March and 18 May 2020, and 117 HCW, who did not meet the case definition, 234 HCW were included in the study, A survey consisting of 28 questions was applied to obtain the research data. The survey consisted of multiple choice questions and was prepared by the researchers using the knowledge of the literature. Results: It was determined that 65.8% of the participants were women, 41.9% were nurses, 82.1% did not have additional diseases and 62.8% did not smoke. Positivity was significantly higher in young patients aged 20-30 (p=0.05). In the use of PPE, the use of gloves as "always recommended" was found higher in infected HCW with 77.8% (p=0.012). The use of overalls/ gowns was found to be statistically significantly lower in infected healthcare workers (p=0.01). In terms of the hand hygiene application variable after touching the patient between the groups, compliance was found to be low in healthcare workers diagnosed with COVID-19 (p=0.005). Conclusion: It was observed that the risks of healthcare workers getting COVID-19 decreased significantly if the infection control measures were followed. It is thought that it would be beneficial to investigate new methods to ensure that protective measures are fully implemented by HCW. (English) [ABSTRACT FROM AUTHOR] Amaç: Salgın sürecinde sağlık çalışanlarında (SÇ) bulaşmayı önlemek açısından önlemlerin alınması ve önleme programlarının geliştirilmesi anahtar role sahiptir. Bu amaçla, halen yaşanmakta olan Koronavirüs hastalığı-19 (COVÍD-19) salgınında, SÇ'nin kişisel koruyucu ekipmanları (KKE) kullanımı ve el hijyenine uyumu araştırılmıştır. Yöntemler: Çalışmamızda 11 Mart-18 Mayıs 2020 tarihleri arasında laboratuvar tarafından doğrulanmış COVÍD-19 tanısı alan 117 sağlık çalışanı ile olası olgu tanımını karşılamayan 117 sağlık çalışanı olmak üzere 234 sağlık çalışanı çalışmaya dahil edildi. Araştırma verilerini elde etmek için 28 sorudan oluşan anket uygulanmıştır. Anket, çoktan seçmeli sorulardan oluşmuş ve araştırmacılar tarafından literatür bilgisinden yararlanılarak hazırlanmıştır. Bulgular: Katılımcıların %65,8'inin kadın, %41,9'unun hemşire olduğu, %82,1'inin ek hastalığının olmadığı, %62,8'inin sigara kullanmadığı saptanmıştır. Yirmi-30 yaş arası genç hastalarda pozitiflik anlamlı oranda yüksek saptanmıştır (p=0,05). KKE "her zaman önerildiği gibi" şeklinde eldiven kullanımı %77,8 ile enfekte SÇ'lerde daha yüksek bulunmuştur (p=0,012). Özellikle tulum/önlük kullanımı enfekte SÇ'lerinde istatistiksel açıdan anlamlı olarak düşük saptanmıştır (p=0,01). Gruplar arasında hastaya dokunduktan sonra el hijyeni uygulama değişkeni açısından COVÍD-19 tanılı SÇ'lerinde uyumun düşük olduğu saptanmıştır (p=0,005). Sonuç: Enfeksiyon kontrol önlemlerine uyulduğu takdirde SÇ'lerin COVÍD-19'a yakalanma risklerinin anlamlı olarak düştüğü gözlenmiştir. Buna rağmen, COVÍD-19 pandemisi sürecinde, SÇ'lerin KKE kullanımındaki eksikliklerini görmek, KKE protokollerini iyileştirmek ve eğitimlerini yenilikçi yöntemler kullanarak geliştirmek için detaylı araştırmalara ihtiyaç vardır. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Bezmialem Science 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Effects of adjunct treatment with intravenous immunoglobulins on the course of severe COVID-19: results from a retrospective cohort study.

OBJECTIVES: To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients. METHODS: Data from a single center was analyzed retrospectively. Patients had received preliminary standard intensive care (SIC) according to a local treatment algorithm, either alone or along with IVIG 5% at 30 g/day for 5 days. The two groups were compared regarding baseline characteristics, survival and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used. RESULTS: Out of 93 patients, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. IVIG-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, p = .066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, p = .281; SOFA: 5.0 versus 7.0, p = .006). Overall survival was 61% in the SIC + IVIG and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, p = .091 after controlling for baseline imbalances). IVIG significantly prolonged median survival time (68 versus 18 days, p = .014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = .049). CONCLUSION: Clinically relevant benefits through adjunct IVIG treatment in COVID-19 need to be confirmed in a randomized, controlled trial.

Prognostic Value of Antithrombin Levels in COVID-19 Patients and Impact of Fresh Frozen Plasma Treatment: A Retrospective Study

Objective: The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in coronavirus disease-19 (COVID-19) patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Materials and Methods: Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory-confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Results: AT activity levels at admission were significantly lower in nonsurvivors than survivors (73% vs. 81%). The cutoff level for admission AT activity was 79% and 58% was the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than that of the nonresponding group. As well as AT, admission values of D-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. Conclusion: AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival.

The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has quickly turned into a global pandemic with close to 5 million cases and more than 320,000 deaths. Cancer patients constitute a group that is expected to be at risk and poor prognosis in COVID pandemic. We aimed to investigate how cancer patients are affected by COVID-19 infection, its clinical course and the factors affecting mortality. METHODS: In our single-center retrospective study, we included cancer patients with laboratory confirmed COVID-19 in our hospital. Demographic, clinical, treatment, and laboratory data were obtained from electronic medical records. Logistic regression methods were used to investigate risk factors associated with in-hospital death. RESULTS: In the hospital, 4489 patients were hospitalized with COVID infection and 77 were cancer patients. The mean age of cancer patients was 61.9 ± 10.9 and 44 of them were male (62%). While the mortality rate in non-cancer patients was 1.51% (n = 68), this rate was significantly higher in cancer patients, 23.9% (n = 17). The stage of the disease, receiving chemotherapy in the last 30 days also lymphopenia, elevated troponin I, D-dimer, CRP, and CT findings were associated with severe disease and mortality. Severe lung involvement (OR = 22.9, p = 0.01) and lymphopenia (OR = 0.99, p = 0.04) are the most important factors influencing survival in logistic regression. CONCLUSIONS: The disease is more severe in cancer patients and mortality is significantly higher than non-cancer patients. These data show that it may be beneficial to develop dynamic prevention, early diagnosis and treatment strategies for this vulnerable group of patients who are affected by the infection so much.

Wide QRS Complex and Lateral ST-T Segment Abnormality Are Associated With Worse Clinical Outcomes in COVID-19 Patients.

BACKGROUND: The information on electrocardiographic features of patients with coronavirus disease 2019 (COVID-19) is limited. Our aim was to determine if baseline electrocardiographic features of hospitalized COVID-19 patients are associated with markers of myocardial injury and clinical outcomes. METHODS: In this retrospective, single center cohort study, we included 223 hospitalized patients with laboratory-confirmed COVID-19. Clinical, electrocardiographic and laboratory data were collected and analyzed. Primary composite endpoint of mortality, need for invasive mechanical ventilation, or admission to the intensive care unit was assessed. RESULTS: Forty patients (17.9%) reached the primary composite endpoint. Patients with the primary composite endpoint were more likely to have wide QRS complex (>120 ms) and lateral ST-T segment abnormality. The multivariable Cox regression showed increasing odds of the primary composite endpoint associated with acute respiratory distress syndrome (odds ratio 7.76, 95% CI 2.67-22.59; p < 0.001), acute cardiac injury (odds ratio 3.14, 95% CI 1.26-7.99; p = 0.016), high flow oxygen therapy (odds ratio 2.43, 95% CI 1.05-5.62; p = 0.037) and QRS duration longer than >120 ms (odds ratio 3.62, 95% CI 1.39-9.380; p = 0.008) Patients with a wide QRS complex (>120 ms) had significantly higher median level of troponin T and pro-BNP than those without it. Patients with abnormality of lateral ST-T segment had significantly higher median level of troponin T and pro-BNP than patients without. CONCLUSIONS: The presence of QRS duration longer than 120 ms and lateral ST-T segment abnormality were associated with worse clinical outcomes and higher levels of myocardial injury biomarkers.

Hydroxychloroquine Use on Healthcare Workers Exposed to COVID-19-A Pandemic Hospital Experience

Objective: As healthcare professionals play a role in combating the COVID-19 outbreak, the risk of disease exposure and illness increases. In our study, we aimed to measure the effectiveness of post-contact use in order to protect the healthcare professionals who work very intensively during the outbreak. Method: A total of 208 healthcare workers who applied to Employee Health Unit section between the dates 25 March-25 April 2020 with a history of contact with COVID-19 patients were included in the study. Employees were evaluated in low, moderate and high risk groups according to the Contact Risk Algorithm included in the Evaluation of Healthcare Workers Guidelines with COVID-19 theme. Three-day hydroxychloroquine treatment was initiated to 138 healthcare professionals who were considered as high risk. The treatment regimen was arranged as 2x400 mg on the first day and 2x200 mg on the 2nd and 3rd days. The COVID-19 positivity rates were analyzed according to the contact risk groups Results: There was a statistically significant difference between occupational groups according to contact risk groups (p<0.01);the rate of contact risk of nurses in the middle, and the doctors in the high risk groups was found to be significantly higher. When the COVID-19 positivity rates were analyzed according to the contact risk groups, the COVID-19 positivity rates were 9.4% in the high-, 16.3% in the moderate and 14.3% in the low-risk groups. The contact was found to be related to the COVID-19 test, and the positivity rate from contact with the patient was found to be significantly high (p<0.01). Conclusion: Recommendations about hydroxychloroquine for postexposure prophylaxis vary. Hydroxychloroquine can be a possible effective agent in postexposure prophylaxis. We think that conducting similar studies on larger samples can provide significant benefits to individuals and public health.