The Effectiveness of Laboratory Parameters in Predicting the in-Hospital Mortality of Iranian Patients with Coronavirus Disease 2019 (COVID-19).

Background: The novel coronavirus 2019-nCoV (now SARS-CoV-2) has spread globally and affected healthcare systems worldwide. Due to lack of long-term immunization and effective specific treatments for the COVID-19 disease, there is a need of identifying the patients who are at the risk of a fatal outcome, according to the available epidemiological data and laboratory parameters. Objective: Thus, we aimed to evaluate the prognostic value of epidemiological data and laboratory para-meters for in-hospital case fatality in patients with COVID-19. Materials and Methods: A retrospective cohort of patients with COVID-19 admitted to the Shahid Mostafa Khomeini Hospital of Ilam University of Medical Sciences from February 29 until March 29, 2020 was performed. Epidemiologic data and laboratory results were collected. Univariate and multivariate logistic regression models were performed to evaluate the prognostic value of the laboratory parameters for in-hospital death. Results: A total of 256 Iranian COVID-19 patients were included in the evaluation; 38 of them died, resulting in a in-hospital case-fatality rate of 14.8%. The univariate analysis showed that advanced age [OR=1.04, 95% CI: 1.02, 1.06, P=0.001], smoking [OR=4.041, 95% CI: 1.546-10.563, P=0.004], white blood cells [OR=0.941, 95% CI: 0.904-0.980, P =0.003] and hematocrit [OR=1.060, 95% CI: 1.009-1.113, P=0.020] were positively associated with the risk of a fatal outcome. Multivariate logistic regression analysis revealed that COVID-19 patients with an elevated white blood cell count and elevated hemoglobin level had 1% and 9% greater risk of an in-hospital death for each elevated unit [OR=1.07; 95 %CI: 1.024-1.088, P =0.002 and OR=1.379; 95% CI 0.064-1.788, P =0.015, respectively]. Conclusions: An increase in white blood cell count and an increase in hemoglobin level might be indepen-dent risk factors for in-hospital death in Iranian patients with COVID-19. Further studies are necessary in order to conferm the prognostic value of the variables discussed.

Characteristics of Clostridioides difficile colonization in Ilamian children.

Background: The increasing colonization with Clostridioides difficile in paediatric hospitalized population is a well known event; however, its prevalence in Iranian children has not effectively been identified yet. Objective: The objective of this study was to determine the intestinal-carriage rates of C. difficile and molecular characterization of C. difficile in the Ilamian pediatric population from May 22, 2018, until September 22, 2018. Materials and Methods: Eighty samples were obtained from 40 children aged <5 years, at day 0 of their hospitalization (N=40 samples), to determine community-associated colonization, and then at day 5 days after hospitalization (N=40 samples), to determine healthcare associated colonization. The stool samples were examined for C. difficile, and isolated strains were evaluated for production of Clostridial toxins A/B and molecular characterizations. Results: The colonization rates of C. difficile and toxigenic C. difficile were 10% (8/80) and 3.75% (3/80), respectively. Based on the age group, the intestinal-carriage rates of C. difficile were 37.5, 50, and 12.5% in children ≤ 1, 1-3, and 3-5 years old, respectively. Our findings have revealed eight distinct ribotypes. Our findings have revealed eight distinct ribotypes of C. difficile isolates. Three out of 8 (37.5%) of C. difficile isolates were considered as community-associated colonization and belonged to ribotypes 7, 8, and 9. Conclusion. Our findings suggest the need of confirmation by further epidemiological studies in Iranian children. Given that the 37.5% of cases observed were community-associated, estimates of the incidence of C. difficile infections, that include only hospitalized children, may largely underestimate the burden of disease in children.