ABSTRACT
BACKGROUNDEfficient and early triage of hospitalized Covid-19 patients to detect those with higher risk of severe disease is essential for appropriate case management. METHODSWe trained, validated, and externally tested a machine-learning model to early identify patients who will die or require mechanical ventilation during hospitalization from clinical and laboratory features obtained at admission. A development cohort with 918 Covid-19 patients was used for training and internal validation, and 352 patients from another hospital were used for external testing. Performance of the model was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity and specificity. RESULTSA total of 363 of 918 (39.5%) and 128 of 352 (36.4%) Covid-19 patients from the development and external testing cohort, respectively, required mechanical ventilation or died during hospitalization. In the development cohort, the model obtained an AUC of 0.85 (95% confidence interval [CI], 0.82 to 0.87) for predicting severity of disease progression. Variables ranked according to their contribution to the model were the peripheral blood oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio, age, estimated glomerular filtration rate, procalcitonin, C-reactive protein, updated Charlson comorbidity index and lymphocytes. In the external testing cohort, the model performed an AUC of 0.83 (95% CI, 0.81 to 0.85). This model is deployed in an open source calculator, in which Covid-19 patients at admission are individually stratified as being at high or non-high risk for severe disease progression. CONCLUSIONSThis machine-learning model, applied at hospital admission, predicts risk of severe disease progression in Covid-19 patients.
ABSTRACT
BackgroundSome patients infected by SARS-CoV-2 in the recent pandemic have required critical care, becoming one of the main limitations of the health systems. Our objective has been to identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia. MethodsWe retrospectively collected and analyzed data from electronic medical records of patients with laboratory-confirmed SARS-CoV-19 infection by real-time RT-PCR. A comparison was made between patients staying in the hospitalization ward with those who required critical care. Univariable and multivariable logistic regression methods were used to identify risk factors predicting critical care need. FindingsBetween March 15 and April 15, 2020, 150 patients under the age of 75 were selected (all with laboratory confirmed SARS-CoV-19 infection), 75 patients requiring intensive care assistance and 75 remaining the regular hospitalization ward. Most patients requiring critical care were males, 76% compared with 60% in the non-critical care group (p<0.05). Multivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 (1.009-1.101); p=0.0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 (1.389-2.590) p<0.0001) both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA p<0.05). InterpretationPatients COVID-19 positive presenting at admission with high SOFA score [≥]2 combined with CRP [≥] 9,1 mg/mL could help clinicians to identify them as a group that will more likely require critical care so further actions might be implemented to improve their prognosis.
ABSTRACT
BACKGROUND: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode (InterStim(R), Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. METHODS: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. RESULTS: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. CONCLUSIONS: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.
