MuLBSTA score in COVID-19 pneumonia and prediction of 14-day mortality risk: A study in an Indian cohort.

BACKGROUND: The infectious agent which has caused the COVID-19 pandemic is a coronavirus named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). On one end of the spectrum, a patient suffering from COVID-19 may be asymptomatic or have mild symptoms, while on the other end of the spectrum, a patient may develop numerous life-threatening complications. The way a host responds to infection by SARS-CoV-2 depends on various host factors like hypertension, old age, etc., The MuLBSTA scoring system takes into account various clinical and laboratory parameters and tries to predict the mortality risk for a patient. Besides, the validation of MuLBSTA score for mortality because of COVID-19 has not been extensively studied in an Indian set-up. This study is aimed at finding the association between the MuLBSTA score and the 14-day mortality risk because of COVID-19 in Indian population. MATERIALS AND METHODS: This study included 122 patients who were receiving treatment for SARS-CoV-2 infection at a tertiary hospital in Ranchi, Jharkhand. The disease severity (as per the ICMR guidelines), the MuLBSTA score, and the disease outcome of all patients were noted and analyzed in this study. RESULTS: A strong association was seen between a MuLBSTA score of ≥12 and the 14-day mortality risk in COVID-19 patients. CONCLUSION: The MuLBSTA scoring system is an easy to calculate model, which predicts the 14-day mortality risk because of SARS-CoV-2 infection. This may help the primary care physicians in stratifying and referring the patients who have a higher chance of developing severe complications.

Validation of PSI/PORT, CURB-65 and SCAP scoring system in COVID-19 pneumonia for prediction of disease severity and 14-day mortality.

BACKGROUND: The unprecedented COVID-19 pandemic has put a serious burden on the healthcare system worldwide. Due to varied manifestations of SARS-CoV-2 infection, many scoring systems, which were earlier used for community acquired pneumonia (CAP) are in use to determine the disease severity and the need of ICU admissions for proper management. COVID-19 is a relatively new disease and the validity of these scoring systems in SARS-CoV-2 infection is not completely known. This study aimed to validate these scoring systems in cases of COVID-19 pneumonia in an Indian setup. The study has also tried to find the most accurate indicator of disease severity and 14-day mortality among these scoring systems. MATERIALS AND METHODS: This study included 122 SARS-CoV-2 infected patients at a tertiary hospital in Ranchi, Jharkhand. The severity of the disease according to ICMR protocol for COVID-19, the PSI/PORT score, the CURB-65 score and the SCAP score were calculated in all the patients and analysed with the disease outcome, that is, 14-day mortality. RESULTS: SCAP score, PSI/PORT score and CURB-65 criteria, all were good indicators of disease severity and 14-day mortality. However, when compared to other scoring systems, SCAP score was a more accurate marker of disease severity and 14-day mortality. CONCLUSION: The PSI/PORT scoring system, the CURB-65 criteria and the SCAP scoring system can be used to assess the COVID-19 severity and predict the 14-day mortality risk in cases of COVID-19 pneumonia.

Clinical profile and prognostic factors of alcoholic cardiomyopathy in tribal and non-tribal population.

OBJECTIVE: Alcoholic cardiomyopathy (ACM) is a leading cause of non-ischaemic dilated cardiomyopathy (DCM) in tribal and non-tribal population. However, no study has been done depicting the correlation between clinical profile and prognosis of ACM in tribal and non-tribal population. This study also defines the long-term outcome and prognostic markers of ACM. METHODS: We studied 290 patients with ACM who were evaluated in our institute between January 2013 and December 2016. The primary endpoint of the study was all-cause mortality. Statistical analysis was done by using Kaplan-Meier survival curves for the assessment of all-cause mortality and Cox regression for the assessment of risk factors. RESULTS: After a median follow-up period of 3.75 years (IQR: 3-4 years), 50 patients with ACM (37.3%) died among tribal population while 14 patients (9%) died among non-tribal population. Independent predictors of all-cause mortality in ACM identified by Cox regression were left ventricular ejection fraction (LVEF) (HR: 0.883; 95% CI 0.783 to 0.996; p=0.043), QRS duration (HR: 1.010; 95% CI 1.007 to 1.017; p=0.005) and Child-Turcotte-Pugh (CTP) Scoring (HR: 12.332; 95% CI 6.999 to 21.728; p<0.001) at admission. The Kaplan-Meier survival probability estimate was 95.1% at 1 year and all-cause mortality was found to be higher in patients with QRS>120 ms, LVEF ≤35%, CTP Grade B/C than patients with QRS≤120 ms, LVEF >35% and CTP Score A, respectively (log-rank χ²=55.088, p<0.001; log-rank χ²=32.953, p<0.001; log-rank χ²=139.764, p<0.001, respectively). CONCLUSION: Our study indicated increased morbidity and mortality in tribal population. LVEF, QRS duration and CTP Scoring at the time of presentation were found to be the independent prognostic markers of patients with ACM.

Correlation and prognostic significance of serum amylase, serum lipase, and plasma cholinesterase in acute organophosphorus poisoning.

BACKGROUND: Organophosphorus (OP) are substances that are originally produced by the reaction of alcohols and phosphoric acid. These OP compounds are the main components of herbicides, pesticides, and insecticides. These are easily available in developing country like India; there is lack of awareness about these chemicals which results in high morbidity and mortality. AIMS AND OBJECTIVES: To estimate levels of amylase, lipase, plasma cholinesterase in acute OP poisoning. To assess severity of OP poisoning by using plasma cholinesterase levels and correlating it with other two markers. Predicting the severity of acute OP poisoning by using these biochemical markers. MATERIALS AND METHODS: A hospital-based observational study was conducted on 100 subjects who were clinically diagnosed of acute OP poisoning. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, and serum lipase were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and Group III <10% of plasma cholinesterase activity. RESULTS: Among 100 patients it was seen that serum amylase and serum lipase were negatively correlated with plasma cholinesterase levels and it was statistically significant. It was seen that serum amylase had the highest diagnostic accuracy for assessing severity of poisoning, 10 deaths were there in which 6 had <10% of plasma cholinesterase activity, 8 out of these 10 patients had elevated amylase level. CONCLUSION: OP poisoning is associated with elevated amylase level. Serum amylase, lipase can be used as an additional prognostic indicator along with plasma cholinesterase levels. Serum amylase could be considered as a better predictor of severity than lipase.