Excessive weight as a risk factor for COVID-19 severity ‒ A retrospective study.

Barotrauma, invasive ventilation, and timing of tocilizumab as predictors of mortality along with inflammatory markers and comorbidities in critically ill COVID-19 patients: A retrospective study.

We conducted a systematic review of observational studies to examine the effects of body mass index (BMI) and obesity (BMI ≥ 30 kg/m2 ) on coronavirus disease 2019 (COVID-19). Medline, Embase, and the Cochrane Library were searched. Sixteen articles were finally included in the meta-analysis, and a random effects model was used. BMI was found to be higher in patients with severe disease than in those with mild or moderate disease (MD 1.6, 95% CI, 0.8-2.4; p = .0002) in China; however, the heterogeneity was high (I2 = 75%). Elevated BMI was associated with invasive mechanical ventilation (IMV) use (MD 4.1, 95% CI, 2.1-6.1; p < .0001) in Western countries, and this result was consistent across studies (I2 = 0%). Additionally, there were increased odds ratios of IMV use (OR 2.0, 95% CI, 1.4-2.9; p < .0001) and hospitalization (OR 1.4, 95% CI, 1.3-1.60; p < .00001) in patients with obesity. There was no substantial heterogeneity (I2 = 0%). In conclusion, obesity or high BMI increased the risk of hospitalization, severe disease and invasive mechanical ventilation in COVID-19. Physicians must be alert to these early indicators to identify critical patients.

Diabetes mellitus (DM) has emerged as a major risk factor for COVID-19 severity and SARS-CoV-2 infection can worsen glycemic control and may precipitate new-onset diabetes. At-admission hyperglycemia (AH) is a known predictor for worse outcomes in many diseases and seems to have a similar effect in COVID-19 patients. In this study, we aimed to assess the impact of AH regardless of pre-existing diabetes mellitus and new-onset diabetes diagnosis in the clinical severity of COVID-19 inpatients in the first months of the pandemic. A retrospective monocentric study on 374 COVID-19 inpatients (209 males) was developed to assess associations between AH (blood glucose levels in the Emergency Department or the first 24 h of hospitalization greater than 140 mg/dL) and severity outcomes (disease severity, respiratory support, admission to Intensive Care Unit (ICU) and mortality) in patients with and without diabetes. Considering diabetic patients with AH (N = 68;18.1%) there was a correlation with COVID-19 severity (p = 0.03), invasive mechanical ventilation (p = 0.008), and ICU admission (p = 0.026). No correlation was present with any severity outcomes in diabetic patients without AH (N = 33; 8.8%). All of the New-onset Diabetes patients (N = 15; 4%) had AH, and 12 had severe COVID-19; additionally, five patients were admitted to the ICU and three patients died. However, severity outcomes did not reach statistical correlation significance in this group. In nondiabetic patients with AH (N = 51; 13.6%), there was a statistically significant association with the need for oxygen therapy (p = 0.001), invasive mechanical ventilation (p = 0.01), and ICU admission (p = 0.03). Our results support data regarding the impact of AH on severity outcomes. It also suggests an effect of AH on the prognosis of COVID-19 inpatients, regardless of the presence of pre-existing diabetes or new-onset diabetes. We reinforce the importance to assess at admission glycemia in all patients admitted with COVID-19.

In-hospital clinical complications of COVID-19: a brief overview.

Background: The recent coronavirus pandemic caused systemic human disease that killed many people worldwide, and we are still witnessing the resulting conflicts. Lactate dehydrogenase (LDH) and Creatine phosphokinase (CPK), markers of muscle damage, are potentially associated with a more severe Coronavirus disease (COVID-19). This study aims to evaluate the association between elevated LDH and CPK with severity and mortality in COVID-19 patients. Methods: A retrospective single-center study that included 282 patients with COVID-19 was conducted between 2020-2021 (in Four disease waves) in Rouhani Hospital, Babol, Mazandaran (Northern Iran). Data were extracted from the medical records of all consecutive patients and followed up until death or till 9 September 2021. Univariate and multivariate Cox regression analyses were performed to investigate the associated factors with in-hospital mortality and disease severity. Additionally, logistics regression analyses and Kaplan-Meier curves were used to determine the association between LDH and CPK levels and the prognosis of COVID-19 patients. Results: The mean age of patients was 60.21 years, and the disease was severe in 31.2% of patients. About 39 (13.8%) patients died during hospitalization and 20 during the follow-up (280.63 ± 192.85 days). Significantly higher in-hospital mortality among older age patients was observed (p = 0.025), including those admitted in the first COVID wave (p = 0.015), those having longer hospital admission (p = 0.008), patients with severe disease (p &lt; 0.001), higher LDH (p = 0.004), higher CPK (p = 0.017), those needing ICU admission (p &lt; 0.001), needing NIV (p = 0.002), and those needing IMV (p &lt; 0.001). In other words, the severity of COVID-19 was significantly associated with older age (p &lt; 0.001), patients with CVDs (p &lt; 0.001), HTN (p = 0.002), DM (p = 0.02), the duration of hospital stays (p = 0.015), ICU admission (p = 0.009), need for NIV (p = 0.003), IMV (p &lt; 0.001), and mortality in long-term follow-up (p = 0.006). However, LDH (p = 0.417) and CPK levels (p = 0.091) were not significantly related to disease severity. LDH levels had a significant effect on hospitalization (p &lt; 0.001, 95%CI= 1.877 to 8.675, HR= 4.036), short-term (p = 0.011, 95%CI= 1.202 to 4.209, HR= 2.249) and long-term (p = 0.002, 95%CI= 1.427 to 4.738, HR= 2.601) mortality, as well as the length of hospital stay until intensive care unit (ICU) admission (p = 0.017, 95%CI= 1.186 to 5.490, HR= 2.551). Receiver operating characteristic curve analysis demonstrated an optimal cutoff point of LDH in the first, third, and fourth waves greater than or equal to 759.53 IU/L, 818.52 IU/L, and 840.92 IU/L, respectively. The test sensitivities were 61.1%,66.7%, and 75%, respectively; specificities were 88.2%,76.6%, and 79.7%, respectively; the AUCs were 0.722, 0.786, and 0.720, respectively, among all hospitalized patients. Comparing the areas under fitted ROC curves, serum LDH was significantly associated with mortality (p &lt; 0.05 for the mentioned cut-off points). However, the area under the curve was not significant at the aforementioned points found for CPK (p &gt; 0.05 for CPK at all waves). Conclusion: Higher levels of LDH, unlike CPK, significantly predicted severity during hospitalization and mortality in different time periods. Also, its sensitivity increased in new waves. When the COVID-19 patient is hospitalized, these results can help determine the appropriate diagnostic test.

Predictors of 90-Day Mortality after Admission to Intensive Care Unit (ICU) in Patients with Acute Myeloid Leukemia (AML): Application of a Novel, Recently Validated AML-Specific Risk Model

Objective: To compare the clinical and epidemiological outcomes of 1,266 patients hospitalized with COVID-19 in a private hospital in northeastern Brazil to identify differences according to age group. Methods: This observational, descriptive, and retrospective cohort study was carried out with patients hospitalized with COVID-19 in a private hospital in northeastern Brazil from May 2020 to March 2021. Outcomes such as length of stay, hospital stay, discharge, death, admission to the Intensive Care Unit (ICU), use of invasive mechanical ventilation (IMV), and renal replacement therapy were analyzed according to age group (731 adults and 535 older people ≥65 years old). Results: Elderly patients had a median age of 76 (70 – 83) years (p=0.000). The median length of stay was 12 (7 – 19) (p=0.000). Most outcomes, such as ICU admission (58.2%) (p=0.000), use of renal replacement therapy (81.6%) (p=0.000), use of mechanical ventilation (73.2%) (p =0.000) and death (86%) (p=0.000), occurred in the elderly. The variables age greater than or equal to 65 years (p=0.000), use of IMV (p=0.000), and ICU admission (p=0.000) were associated with mortality. Conclusion: Older people are at greater risk of hospitalization, remaining in the hospital for a more extended period, and progressing to the need for ICU admission, renal replacement therapy, and mechanical ventilation. Knowledge of the epidemiological profile of the population hospitalized for COVID-19 is an essential source of information for planning and monitoring health activities.

BackgroundCOVID-19 has significantly strained healthcare systems worldwide, particularly in resource-limited and conflict-affected regions such as Palestine. Understanding the risk factors for intensive care unit (ICU) admission is essential for effective triage and resource allocation.ObjectiveThis study aimed to identify demographic, clinical, and laboratory predictors of ICU admission among hospitalized COVID-19 patients in governmental hospitals across the West Bank, Palestine.MethodsA retrospective cohort study was conducted across six designated COVID-19 treatment hospitals from November 2020 to February 2021. Medical records of 200 adult patients with PCR-confirmed COVID-19 were reviewed. Patients were grouped based on ICU versus general ward admission. Bivariate analyses, multivariate logistic regression, and Cox proportional hazards models were employed to identify independent predictors of ICU admission and to evaluate the time to ICU transfer.ResultsOf the 200 patients, 117 (58.5%) were admitted to the ICU. Multivariate logistic regression identified obesity (OR = 66.7, p < 0.001), hospital site (p = 0.001), white blood cell count (OR = 1.25, p = 0.005), and blood urea nitrogen (OR = 0.96, p = 0.007) as significant positive predictors. Random blood sugar (OR = 0.99, p = 0.014) was inversely associated with ICU admission. Kaplan–Meier and Cox-regression analyses further revealed that obesity, low PaO₂, low BUN, low RBS, pregnancy, and pneumonia significantly shortened the time to ICU admission (all p < 0.05). Conversely, age, gender, comorbidities, and chief complaints were not independently associated with ICU admission.ConclusionThis is the first study in Palestine to comprehensively evaluate ICU admission risk factors among COVID-19 patients. Our findings can inform ICU triage protocols and help shape evidence-based health policies tailored to the Palestinian context and could establish data base for new similar future pandemics and/or resurge of COVID-19 for better emergency preparedness and intervention measures.

Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID-19

BACKGROUND AND OBJECTIVES:Pregnancy and delivery can involve complications that necessitate admission to critical care facilities. The objective of our study was to assess the incidence, indications, and outcomes of obstetric patients requiring admission to an intensive care unit (ICU) in a tertiary care hospital, in Saudi Arabia.DESIGN AND SETTING:Retrospective cohort study of consecutive obstetric admissions to the ICU at the King Abdulaziz Medical City over a 10-year period.PATIENTS AND METHODS:We collected baseline demographic data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome.RESULTS:Over 10 years, 75 obstetric patients were admitted to the ICU, and 59 of these patients (78.6%) were admitted during the antepartum period. The main obstetric indication for ICU admission was pregnancy-induced hypertension (21 patients, 28%) and the leading non-obstetric indication was sepsis (12 patients, 16%). The APACHE II score was 19.59 (15.05). The predicted mortality rate based on the APACHE II score was 21.97%; however, there were only six maternal deaths (8%) among the obstetric patients admitted to the ICU.CONCLUSION:The overall mortality was low. A team approach facilitated the application of optimal care to these patients. Obstetric patients had better outcomes than those predicted by the APACHE II scores. Appropriate antenatal care is important for preventing obstetric complications.

The literature notes that coronavirus disease 2019 (COVID-19) patients with olfactory disturbances tend to have lower disease severity and that olfactory disturbances may act as a protective factor against mortality. So, this study aimed to explore the association of smell and/or taste disturbance with disease severity and all-cause mortality among patients who were hospitalized with COVID-19. A retrospective cohort study (Nutrition and COVID-19 Study [NUTRICOVID19]) was conducted with 1331 patients (men and women, age ≥ 18 years) hospitalized with COVID-19 between June and December 2020. Poisson and Cox regressions were used to investigate the unadjusted and adjusted associations between smell and/or taste disturbance and the following prognostic indicators: length of stay (LOS), intensive care unit admission, need for invasive mechanical ventilation (IMV), and mortality. Patients with altered smell and/or taste had a shorter LOS (9 vs 11 days), were less likely to require IMV (22% vs 35.1%), and experienced lower mortality (17.1% vs 29.2%) compared to those without such symptoms. After multivariable adjustment, patients with smell and/or taste disturbances were 33% less likely to need IMV compared to those without such symptoms (RR = 0.67; 95% CI = 0.50-0.88), but the relationship between these symptoms and mortality lost statistical significance. In this population of patients with COVID-19, the presence of smell and/or taste disturbances was associated to lower rates of IMV.

BackgroundResearch is limited in describing the association between admission source and mortality in critically ill patients. Therefore, this study investigated how intensive care units (ICUs) admission source (emergency department (ED) or ward) correlates with mortality rates.MethodsThis retrospective observational cross-sectional study was conducted in a tertiary pulmonology teaching hospital’s ICU from January 1, 2018, to December 31, 2019. Patients were ICU patients admitted for acute respiratory failure. Demographic, comorbidities, diagnoses, APACHE II score, ICU admission (ED or ward), mechanical breathing support (invasive or noninvasive), length of stay, and mortality were recorded. Comparisons of ICU admission sources and mortality factors were established.ResultsA total of 2,173 ICU patients were studied; 1,011 (46%) were admitted from the ED and 1,162 (54%) from the ward. Their mean age was 70 years, and 66% of them were men. Pneumonia was the leading cause of ICU admission at 60% and Chronic Obstructive Pulmonary Disease (COPD) was the most common comorbidity at 54%. When both groups were evaluated in terms of respiratory support, non-invasive mechanical ventilation use was higher in patients admitted from the emergency room (ED: 50% vs. Ward: 35%), invasive mechanical ventilation was more frequently required in patients admitted from the ward compared to those admitted from the emergency department (ED: 17% vs. Ward: 25%). Length of ICU stay (2 vs. 3 days P < 0.001) and ICU mortality (odds ratio: 1.66, 95% confidence interval 1.297–2.124, P < 0.001) were higher in patients admitted from the ward than in patients admitted from the emergency department. In addition, pneumonia patients and those with malignancies, interstitial lung disease, or noninvasive mechanical ventilation (NIV) failure were associated with higher mortality.ConclusionOur study suggests that ward-to-ICU patients had higher mortality rates compared to ED-to-ICU patients. Triage protocols to better identify potentially critically ill patients in the ED may improve outcomes by avoiding delays in care and better assignment of admission location.

Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Is COVID-19 infection more severe in kidney transplant recipients?

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s...