Early predictors of intensive care unit admission among COVID-19 patients in Qatar.

Background: COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19. Methods: This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender. Results: A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001). Conclusion: Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.

Retrospective review of medication allergy labeling among patients admitted to a tertiary hospital in Qatar.

Background: Timely access to accurate, up-todate drug allergy information is critical to avoid potentially life-threatening adverse drug reactions (ADRs). However, the completeness and accuracy of allergy documentation remain a challenge. Inappropriate allergy documentation usually necessitates alternative treatments, increases costs, and may negatively impact patients' outcomes. Objectives: Review medication allergy labeling documentation, identify the most reported medication class, and describe allergic reactions based on the reported severity. Methods: A retrospective cross-sectional audit including all medication allergy labeling documentation for patients admitted to Hamad General Hospital (HGH) from January-December 2022 was conducted. A list of patients with medication allergies was generated from the pharmacy system, which included patients' demographics, medication names, documented allergy severity, and any other comments. The list was reviewed, and medications were categorized into different classes. Results: 2856 allergy documentation for 2431 unique patients were identified and included in the analyses. The mean age of included patients was 43 years old, with 73.2% (1780) being females. Among the reported allergic reactions, 11.8% (336) were documented as severe allergic reactions, 51.1% (1457) were moderate, and 37.1% (1060) were mild. Antibiotics were the most common documented allergens, representing 42.1% of all reported allergies, followed by non-steroidal anti-inflammatory drugs (20.7%, n=591), and paracetamol (5.3%, n=151). Of all the reported allergies, only 6 (0.21%) cases had documented confirmatory allergy tests done. Further analysis of the reported allergies revealed that 1.2% (34) of the allergies had documentation to counteract the allergy labeling through either revised patient history or re-challenging. Despite such, allergy labeling was kept in the medical profile without proper de-labeling. Conclusion: Allergy labeling documentation is a key to safe medication prescribing. However, standardized allergy documentation should be implemented to include a brief description and onset of the symptoms. Additionally, a safe de-labeling pathway should be adopted. Most of the allergy documentation was based on patients' or family/parents' reports, while actual allergies observed by a healthcare provider were limited.

Hematologic Outcomes of COVID-19 Patients with and without G6PD Deficiency: A Comparative Study.

INTRODUCTION: Patients with multiple comorbidities who have coronavirus disease 2019 (COVID-19) have high morbidity and mortality. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been shown to have an enhanced effect on coronavirus in an earlier study. METHODS: We conducted this comparative observational study to evaluate the effects of COVID-19 disease on G6PD deficiency based on the hematologic parameters, COVID-19-related hospitalizations, and mortality in the state of Qatar between January 2020 and May 2020 at four designated COVID-19 facilities. We identified 41 patients with G6PD deficiency who had documented COVID-19 infection. We compared the results with 241 patients with COVID-19 infection who tested negative for G6PD deficiency.: Results: Comparing the COVID-19 positive G6PD deficient with COVID-19 positive G6PD normal activity showed that G6PD normal group had higher white blood cell count (WBC), absolute neutrophil count (ANC), lymphocytes, eosinophils, and monocytes counts versus the G6PD deficient group (p < 0.001). CONCLUSIONS: When compared with COVID-19 patients with normal G6PD, patients with COVID-19 infection and G6PD deficiency had lower total WBC, ANC, lymphocyte, monocyte, and eosinophil counts. However, no evidence of increased hemolysis, thrombosis, morbidity, or mortality was observed in COVID-19 patients with G6PD deficiency.

Labeling of penicillin allergy in patients admitted to a tertiary hospital in Qatar: A retrospective audit.

BACKGROUND: Penicillin (PNC) allergy is a major healthcare concern that necessitates antibiotic substitution which is associated with increased costs, worse clinical outcomes, and increased risks of antimicrobial resistance. Many patients are labeled as PNC allergic; however, this has been rarely confirmed. In this audit, we aimed to determine the characteristics of PNC allergy labeling. METHODS: A list of all the patients labeled with PNC allergy who presented to the Hamad General Hospital (HGH) for any medical reason from January to December 2021 was generated from pharmacy system. Of those, 30% were randomly selected for audit review. Electronic health records of the selected patients were retrospectively reviewed to identify the allergy labeling characteristics and whether the patients had recently received an antibiotic within the PNC class without developing any allergic reaction. RESULTS: Of the 464 patients identified with labelled PNC allergy, 139 patients were randomly selected and reviewed. Of the reviewed patients, 82 (59%) were women with an average ( ± SD) age of 46 ( ± 16.5) years. Forty-six patients were categorized to have a mild PNC allergy, and only 18 were categorized as severe with the remaining patients categorized as having a moderate PNC allergy. Despite documentation of severity, an accurate description of the allergic reaction event was significantly lacking with only 30/139 (21.5%) patients having clear documentation of the event description. Twenty (14.4%) patients labeled as PNC allergic received at least one antibiotic within the PNC class (e.g., piperacillin-tazobactam, ampicillin-sulbactam, or amoxicillin-clavulanic acid) safely without any documented reactions. Interestingly, of those 20 patients, 4 were categorized as being severely allergic to PNC. However, as more than 80 patients presented to the hospital for reasons not requiring antibiotics; experiences with PNC could not be assessed effectively. CONCLUSION: Poor documentation of the details of allergic reactions may falsely affect future antibiotic decisions. The results of this audit highlight the need for standardizing the documentation process of medication allergy. In addition, reviewing the patient's experience with other drugs within the PNC class can guide healthcare providers during the PNC allergy evaluation.

Prevalence, Determinants And Associated Risk Of Potentially Inappropriate Prescribing For Older Adults In Qatar: A National Retrospective Study.

PURPOSE: To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults. METHODS: This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6-10 or >10 chronic medications, respectively. Determinants of PIP included patients' demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not. RESULTS: 3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (<0.001), respectively. MoP was associated with the risk of ED admission, bone fracture, and constipation, with adjusted OR (p-values) of 1.27 (0.012), 1.34 (0.019), and 1.47 (<0.001), respectively. MaP was associated with a higher risk of ED admission, bone fracture, falls, and constipation with adjusted OR (p-values) of 1.46 (0.001), 1.59 (0.002), 1.39 (0.023), and 2.07 (<0.001), respectively. CONCLUSION: PIP is common and is associated with an increased risk of poor clinical outcomes in older adults.