Multicenter Evaluation of Risk and Prognostic Factors for COVID-19 Omicron Variant in Meguro Home Medical Care: A Retrospective Cohort Study

Objective: To determine the pattern of coagulation profile and their association with mortality in COVID-19 patients. Study Design: Retrospective descriptive study Place and Duration of Study: Makkah, Saudi Arabia from 2nd March 2020, to 2nd July 2020. Methodology: One thousand, nine hundred and twenty three conceded COVID-19 patients affirmed with polymerase chain response testing were included. Results: Patients' average age was 58.7±2.75 years. Patients drop was observed 6.4% in the survivor group as compared to 0.8% in the non-survivor group with a significant (p=0.000) association with mortality. Prolonged PT/INR was observed in 16% of patients, having a significant association (P=0.003) with mortality. APTT was prolonged in 29.4% of patients, and a comparison of APTT levels between the survivor and non-survivor groups showed a significant difference (p=0.002. A higher fibrinogen level was seen in 23.2% of patients with a significant (p=0.001). Conclusion: Severe COVID-19 infection is related to coagulopathy that is related to the destitute condition of hospitalized patients. Early and consistent evaluation of the coagulation profile along the disease course can help to treat and prevent disease morbidity and mortality in the hospital setting. Keywords: COVID-19, thrombosis, coagulation profile

PurposeVarious parameters have been proposed to predict the outcome of patients with coronavirus disease. The aim of this study was to evaluate the utility of the age-adjusted CCI score and biochemical parameters for predicting outcomes for COVID-19 patients on admission.Patients and methodsA total of 511 patients were included in the study. Only swab or serological tests positive patients were included. The clinical characteristics of the patients were compared between survival and non-survival COVID-19 inpatients. Hemoglobin, platelet, sedimentation, creatinine, AST, ALT, LDH, CK, albumin, ferritin, lymphocyte, neutrophil, CRP (1–5;5–10;10–20 × upper limit), procalcitonin (5–10;10–20; > 20 × upper limit), D Dimer (> 2 × upper limit), age, gender, chronic diseases and CCI scores were compared between the two groups.Results68 patients died and 443 patients survived. Mean age was 74.3±7.3 years in survival group and 76.7±8.0 in nonsurvival group. Age, male sex, ischemic heart disease (CHD), chronic kidney disease and active malignancy was statistically higher in non-survivor group. The biochemical parameters was compared in survival and nonsurvival group. CCI score, AST, LDH, CK, Ferritin, CRP are significantly higher and albumin, lymphocyte levels are significantly lower in nonsurvival group. D-dimer and procalcitonin levels are significantly higher in nonsurvival group. CCI score and neutrophil, creatinine, ALT, AST, d-dimer and procalcitonin elevations were correlated. Low albumin and lymphocyte levels were correlated with the CCI score. There was no significant correlation between ferritin, sedimentation, CRP levels and CCI score. A multivariate logistic regression analysis indicated that anaemia, elevated CRP (> 10–20 × upper limit), procalcitonin (> 5–10 × upper limit), ALT, AST levels and higher CCI score were independent risk factors for mortality in COVID-19 patients.ConclusionAnaemia, elevated CRP, procalcitonin levels, ALT, AST levels and higher CCI score were found independent risk factors for mortality in COVID-19 patients.

BackgroundCOVID-19 is a deadly pandemic caused by an RNA virus that belongs to the family of CORONA virus. To counter the COVID-19 pandemic in resource limited settings, it is essential to identify the risk factors of COVID-19 mortality. This study was conducted to identify the social and clinical determinants of mortality in COVID-19 patients hospitalized in four treatment centers of Tigray, Northern Ethiopia.MethodsWe reviewed data from 6,637 COVID-19 positive cases that were reported from May 7, 2020 to October 28, 2020. Among these, 925 were admitted to the treatment centers because of their severity and retrospectively analyzed. The data were entered into STATA 16 version for analysis. The descriptive analysis such as median, interquartile range, frequency distribution and percentage were used. Binary logistic regression model was fitted to identify the potential risk factors of mortality of COVID-19 patients. The adjusted odds ratio (AOR) with 95% confidence interval was used to determine the magnitude of the association between the outcome and predictor variables.ResultsThe median age of the patients was 30 years (IQR, 25–44) and about 70% were male patients. The patients in the non-survivor group were much older than those in the survivor group (median 57.5 years versus 30 years, p-value < 0.001). The overall case fatality rate was 6.1% (95% CI: 4.5% - 7.6%) and was increased to 40.3% (95% CI: 32.2% - 48.4%) among patients with critical and severe illness. The proportions of severe and critical illness in the non-survivor group were significantly higher than those in the survivor group (19.6% versus 5.1% for severe illness and 80.4% versus 4.5% for critical illness, all p-value < 0.001). One or more pre-existing comorbidities were present in 12.5% of the patients: cardiovascular diseases (42.2%), diabetes mellitus (25.0%) and respiratory diseases (16.4%) being the most common comorbidities. The comorbidity rate in the non-survivor group (44.6%) was higher than in the survivor group (10.5%). The results from the multivariable binary regression showed that the odds of mortality was higher for patients who had cardiovascular diseases (AOR = 2.49, 95% CI: 1.03–6.03), shortness of breath (AOR = 9.71, 95% CI: 4.73–19.93) and body weakness (AOR = 3.04, 95% CI: 1.50–6.18). Moreover, the estimated odds of mortality significantly increased with patient’s age.ConclusionsAge, cardiovascular diseases, shortness of breath and body weakness were the predictors for mortality of COVID-19 patients. Knowledge of these could lead to better identification of high risk COVID-19 patients and thus allow prioritization to prevent mortality.

Severe acute respiratory syndrome called COVID-19, was declared as global health emergency and a pandemic due to its worldwide distribution and frightful spread. Patients are presented with severe respiratory illness along with thrombotic disorders. Elevated d-dimer level (&gt;2000ng/ml) is a potentialpredictive biomarker of the disease outcome and prognosis. The objective of the present study isto find the association ofhigh d-dimer levels and mortality rate in COVID-19 patients to establish the optimal cutoff value for use in clinical setting. Methods: Present study enrolled 318COVID-19 patients admitted to Mayo Hospital, Lahore, Pakistan and confirmed by RT-PCR. On admission d-dimer levelof enrolled patients was measured by fluorescence immuno assay and reported in ng/ml. The enrolled subjects were divided in groupsbased on their age, gender, on admission d-dimer levels (&lt;2000ng/ml and &gt;2000ng/ml), outcome (survivors, non-survivors) and variant (α, β, and γ). Wilcoxon test was used to check the d-dimer level difference in survivor and non-survivor group. Results:81%patients (257/316) died and were categorized as non-survivors while 19% (61/318) were discharged after recovery and were categorized as survivors. Mean d-dimer levelfor survivor group was 2070ng/ml (±3060ng/ml) whereas for non-survivor group was 8010ng/ml (±5404ng/ml) and mean difference was statistically significant (p&lt;0.05).D-dimer level washighest (upto 20,000ng/ml) in second wave(β-variant) as compared to other two wavesand caused highest number of deaths (n=163). Conclusion: Present study reports the d-dimer levels (&gt;2000ng/ml)are strongly associated withhigh mortality rate in COVID-19 patients.

BackgroundPrevious studies have declared that baseline lymphocyte count is associated with COVID-19-related death. However, whether dynamic lymphocyte change over time affects prognosis in COVID-19 patients is unknown. This study aims to investigate the significance of lymphocyte count during the progression of the disease in COVID-19 patients.MethodsThe retrospective cohort study recruited COVID-19 patients at the First People’s Hospital of Jiangxia District in Wuhan from January 7, 2020, to February 28, 2020. The demographics, medical histories, results of the blood routine test, and patients’ outcomes were collected. We utilized a generalized additive mixed model to compare trends in lymphocyte count over time among survivors and non-survivors, with an adjustment for potential confounders. The statistical analysis used R software and EmpowerStats. Significance was determined at a P-value of less than 0.05 (two-sided).ResultsA total of 532 patients were included in the study. Overall, there were 29/532 in-hospital deaths (5.45%). Lymphocytes declined over time in the non-survivor group and increased in the survivor group in the first 10 days of hospitalization. Within 10 days after admission, lymphocyte count increased in the survivor group and decreased in the non-survivor group. The difference in lymphocyte counts between survivors and non-survivors increased by an average of 0.0732 × 109/L daily. After adjusting for several covariables, the increasing value remained at 0.0731 × 109/L per day.ConclusionIn the early stage, lymphocyte count can dynamically reflect the pathophysiological changes in COVID-19 patients. An early decrease in lymphocyte count is associated with mortality in COVID-19 patients.

Evaluation of organ function in patients with severe COVID-19 infections

Evaluation of organ function in patients with severe COVID-19 infections

Impact of covid-19 on patients in radiotherapy oncology departaments in Spain

Endotheliopathy plays an essential role in the pathophysiology of COVID-19. The endothelial activation and stress index (EASIX) indicates endothelial dysfunction. We aimed to investigate the relationship between a high EASIX score and mortality in patients with COVID-19. We retrospectively reviewed COVID-19 patients admitted to the ICU (intensive care unit) of the Ankara Bilkent City Hospital. We recorded hematological and biochemical parameters at the ICU admission and further calculated EASIX with the following equation: EASIX = Lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelet count (109/L). Statistical comparisons were made between the surviving and non-surviving groups in terms of EASIX. The median EASIX score was 1.2 (0.7–2.0) in the survivor group and a median of 2.5 (1.6–4.2) in the non-survivor group (p &lt; 0.001). The mean log2-EASIX was 0.2 ± 0.9 in the survivor group and 1.3 ± 1.2 in the non-survivor group (p &lt; 0.001). Lactate dehydrogenase, creatinine, Troponin I, D-dimer, procalcitonin, ferritin, and IL-6 were statistically significantly higher in the non-survivor group compared to the survivor group. The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of the EASIX score was 2.05 (The area under the curve [AUC] = 0.764, p = 0.001, 95% CI: 0.662–0.847). Our study showed an association between high EASIX scores and poor prognosis in COVID-19 patients. Lactate dehydrogenase, creatinine, Troponin I, D-dimer, procalcitonin, ferritin, IL-6, EASIX, and log2-EASIX were statistically significantly higher in the non-survivor group compared to the survivor group. Being old and having chronic kidney disease increases the risk of death. Eventually, EASIX can be used to predict mortality in COVID-19 patients.

This study aimed to identify the cost analysis between survivor and non-survivor of mechanically ventilated COVID-19 patients. We conducted a cohort retrospective study analysing the cost comparison among mechanically ventilated COVID-19 patients in our hospital, DR.Soetomo Hospital, which is a tertiary referral hospital in our country, from from June to September 2020. COVID-19 patients who was mechanically ventilated was included in our study, but for those who were passed away <24 hours upon ICU admission, or patients who were discharge against medical advice, were excluded from this study. A total of 72 mechanically ventilated COVID-19 patients were analysed. These patients were divided into 2 groups: survivor and non-survivor groups. Survivor group consisted of 21 patients and 51 patients in non-survivor group. Baseline characteristics were significantly different for the variables of: body mass index, presenting blood pressure, acute kidney injury complication, prothrombin time, albumin, P/F ratio and SOFA scores. The average total cost spent in survivor group was $3711,7 while in non-survivor group was $5417,7. This result showed a significant finding (p=0.047). Cost distribution pattern was similar in both groups, that cost medical items was the highest cost that spent during ICU stays among mechanically-ventilated COVID-19 patients; but significant difference of medical item cost was documented between survivor and non-survivor group. An average of cost medical items was spent of $1145,5 in survivor group, compared to $2353,8 in non-survivor group (p=0.003). We conclude that non-survivor group of mechanically ventilated patients tend to spend more cost during ICU stays, especially for the medical items cost.

Left Bundle Branch Block and Mortality in COVID-19 Patients

Letter to the Editor: Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients

Background : In the severe community-acquired pneumonia, it has been known that the immune status is occasionally suppressed. This study was performed to identify the immunologic markers related with the prognostic factors in severe community-acquired pneumonia. Methods : 23 patients with severe community-acquired pneumonia were involved in this study, and divided into survivor (16) and nonsurvivor (7) groups. In this study, the medical history, laboratory tests(complete blood counts, routine chemistry profile, immunoglobulins, complements, lymphocyte subsets, cytokines, sputum and blood culture, urine analysis), and chest radiographs were scrutinized. Results : 1) Both groups had lymphopenia(total lymphocyte count in the survivor and in the nonsurvivor group). 2) The T-lymphocyte count of the nonsurvivor group() was lower than the survivor group() (p in the survivor and in the nonsurvivor group. The BUN of the nonsurvivor group() was higher than that of the survivor group()(p) than that in the survivor group()(p) than in the nonsurvivor group() (p level was in the survivor group and in the nonsurvivor group. 6) A cytokine study showed an insignificant difference in both groups. 7) Chronic liver disease, DM, and COPD were major underlying diseases in both groups. Conclusion : These results suggest that decreased a T-lymphocyte count and immunoglobulin G level, and an increased BUN and creatinine level may be associated with the poor prognosis of severe community-acquired pneumonia.

To date, the COVID-19 pandemic has caused millions of deaths across the world. Prognostic scores can improve the clinical management of COVID-19 diagnosis and treatment. The objective of this study was to assess the predictive role of 4C Mortality, CURB-65, and NEWS in COVID-19 mortality among the Romanian population. A single-center, retrospective, observational study was conducted on patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-proven COVID-19 admitted to the Municipal Emergency Clinical Hospital of Timisoara, Romania, between 1 October 2020 and 15 March 2021. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were performed to determine the discrimination accuracy of the three scores. The mean values of the risk scores were higher in the non-survivors group (survivors group vs. non-survivors group: 8 vs. 15 (4C Mortality Score); 3 vs. 8.5 (NEWS); 1 vs. 3 (CURB-65)). In terms of mortality risk prediction, the NEWS performed best, with an AUC of 0.86, and the CURB-65 score performed poorly, with an AUC of 0.80. CURB-65, NEWS, and 4C Mortality scores were significant mortality predictors in the analysis, with acceptable calibration. Among the scores assessed in our study, NEWS had the highest performance in predicting in-hospital mortality in COVID-19 patients. Thus, the findings from this study suggest that the use of NEWS may be beneficial to the early identification of high-risk COVID-19 patients and the provision of more aggressive care to reduce mortality associated with COVID-19.

Aims: A significant portion of individuals infected with COVID-19 experience severe illness and require intensive care. Especially in these cases, the disease may ultimately be fatal. Monocyte to high-density lipoprotein cholesterol ratio (MHR) has been reported to be a novel marker for major adverse outcomes in many diseases. In this study, we aimed to reveal the relationship of MHR with the prognostic markers of COVID-19 and its role in predicting the severity of disease and in-hospital mortality in COVID-19. Materials and Methods: This single-center, retrospective, and cross-sectional study included 195 hospitalized patients diagnosed with COVID-19. The patients who were discharged from the hospital formed the survivor group, whereas those who were deceased were categorized as the non-survivor group. Clinical and biochemical data of patients were retrospectively collected from medical records. Results: The age of the patients ranged from 19 to 92 years and the mean age was 57.0±16.3 years. Ninety-eight (50.3%) of the patients were female. Forty-one of the patients died during hospitalization due to COVID-19 and related complications. Median MHR was significantly higher in the non-survivor group than in the survivor group. MHR was significantly correlated with age, ferritin, uric acid, urea, and creatinine levels. Univariate logistic regression analysis demonstrated no significant association between MHR and in-hospital mortality (p=0.132). Conclusion: MHR is increased in COVID-19 survivors compared to non-survivors and correlates with age, ferritin, uric acid, urea, and creatinine levels. However, MHR cannot be used as a prognostic marker to predict the severity of the disease and in-hospital mortality in COVID-19 patients.