In-hospital Mortality In COVID-19 Patients Research Articles

Regional differences in triage decisions affect hospital mortality among frail COVID-19 patients in the COvid MEdicaTion study.

The scarcity of intensive care unit (ICU) beds during the COVID-19 pandemic has led to a large number of national and international guidelines for the triage of ICU admission. Regional variation in medical decision making might affect ICU triage decisions. We investigate whether regional differences in ICU admission, as surrogate for triage decisions, affect in-hospital mortality in COVID-19 patients. The COMET study is a multicenter, observational cohort study, including adult patients hospitalized for COVID-19 between March 2020- July 2020. Patients' characteristics, prescribed medication, clinical characteristics, and CFS were collected. Patients from 11 European countries were included and these countries were categorized into two regions: north and south. The effects of region on ICU admission and in-hospital mortality were assessed using logistic regression analyses stratified for frailty. Frail patients had a higher risk for ICU admission in southern compared to northern countries (OR: 1.64; 95%CI: 1.10-2.46), whereas fit patients had a similar risk for ICU admission in southern compared to northern countries (OR: 0.75; 95%CI: 0.55-1.01). There was no difference in in-hospital mortality between northern and southern countries for fit and frail patients (respectively OR: 0.82; 95% CI 0.52-1.29, and OR: 1.11; 95% CI: 0.74-1.66). Our study shows that, despite variation in rates of ICU admission between northern and southern countries for frail patients, no difference in in-hospital mortality was observed. This might help optimize prioritization of resources in a pandemic setting while offering options for palliative care instead of ICU admission.

Outcome Analysis of COVID 19 Patients Using ISARIC/WHO 4C Mortality Score in COVID Unit of Bangladesh Institute of Tropical and Infectious Diseases (BITID)

Background: ISARIC/WHO 4C Mortality Score is a risk stratification tool that helps predict the in-hospital mortality of COVID-19 patients. However, this tool was developed and validated in a British population, and thus, the external validation of this tool in local populations is important. This study aimed to analyze the outcome of COVID 19 patients using 4C Mortality Score in the COVID unit of Bangladesh Institute of Tropical and Infectious Diseases (BITID) Chattogram. Materials and methods: This hospital-based prospective observational study included 115 admitted adult patients with a confirmed diagnosis of COVID-19 by RTPCR method. Patients under age of 18 and those with missing data in any of the components of ISARIC 4C score were excluded from study. Relevant sociodemographic and clinical data were collected, and the 4C mortality score was calculated at admission. Outcome measures were need for oxygen therapy, mode of oxygen therapy, and in-hospital mortality. Results: Mean age of the patients was 50.6±18.4 years in the present study and 47.8% were male. The median ISARIC 4C mortality score was 7.0 (Interquartile range: 3-12) and at the time of admission 31 (27%), 34 (29.6%), 33 (28.7%), and 17 (14.8%) patients were in low, intermediate, high, and very-high risk groups, respectively. The mortality was 10.4%, the area under the curve of the score was 0.921 (95% Confidence Interval [CI]: 0.868-0.974, p < 0.001) and the cutoff value correctly classified 83.5% of the patients. The cutoff value of >11 had sensitivity, 91.67% (95% CI: 61.52-99.79); specificity, 82.52% (95% CI: 73.79-89.30), positive predictive value, 37.93% (95% CI: 20.69-57.74), and negative predictive value, 98.84% (95% CI: 93.69-99.97). There was a significant moderate positive correlation between admission 4C mortality score and length of stay in hospital for the surviving patients (Pearson correlation coefficient=0.514, p<0.001). Conclusion: The ISARIC score was found to have excellent predictive ability for mortality in hospitalized COVID-19 patients in our Bangladeshi cohort. Despite recent advances in the treatment and management of adults hospitalized with COVID-19, 4C mortality score can continue to inform clinical decision making. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 61-67

Prognostic Value of Monocyte-to-High-Density Lipoprotein Cholesterol Ratio in COVID-19 Patients

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.

Clinical characteristics and risk factors for in-hospital mortality of COVID-19 patients in Hubei Province: A multicenter retrospective study

BackgroundCoronavirus disease (COVID-19) remains one of the most significant factors threatening public health security worldwide. The COVID-19 pandemic has been ongoing for more than 3 years; however, there are few studies on the clinical characteristics and mortality risk factors in patients with COVID-19 based on comprehensive data from multiple centers. MethodsA total of 53,030 patients with confirmed COVID-19 from 138 hospitals in Hubei Province were included in this study. We compared the clinical characteristics between survivors and non-survivors and analyzed the risk factors for in-hospital mortality. ResultsAmong the 53,030 patients with COVID-19, 49,320 (93.0 %) were discharged, and 3,710 (7.0 %) died during hospitalization. Cardiovascular disease was the most common comorbidity, followed by endocrine and digestive diseases. Male sex, >65-year-old, and high diastolic blood pressure, a series of abnormal laboratory test indicators and hyponatremia, hypokalemia, acute respiratory distress syndrome, shock, solid tumor, hematological tumor, and insulin use were independent risk factors for in-hospital mortality of patients with COVID-19. In addition, male sex, older age, and higher disease severity were associated with increased mortality in patients with COVID-19. ConclusionPatients with early COVID-19 in Hubei Province had high mortality and a high proportion of severe cases and initial comorbidities. Cardiovascular disease was the most common comorbidity in patients with COVID-19. Male sex, older age, comorbidities, and abnormal laboratory data have been identified as independent risk factors for in-hospital mortality in patients with COVID-19. Therefore, there should be an increased focus on patients with COVID-19 with these risk factors.

Risk Factors associated with In-Hospital Death in Adult COVID-19 Patients in Karachi, Pakistan: A Retrospective Chart Review

Objective: To identify the risk factors associated with in-hospital mortality of COVID-19 patients in the largest Navy hospitals in Pakistan. Study Design: Retrospective chart review. Place and Duration of Study: Department of Medicine, Pakistan Navy Station Shifa Hospital, Karachi Pakistan, from Apr to May 2020. Methodology: All patients who died in the Intensive care unit of Pakistan Navy Station Shifa Hospital, Karachi during study period, having polymerase chain reaction positive COVID-19 infection were included. The data recorded included basic demographics (age, gender and length of stay in hospital), documentation of co-morbidities (e.g. diabetes mellitus, ischemic heart disease and other medical and surgical problems), need for mechanical ventilation and most probably cause or contributory factor to the death of the patient. Descriptive statistics were used for calculating mean and frequencies. Chi-square test was used to determine the association between variables of the study, Results: A total of 22 cases were included. There were 21 males. The mean age was 65.7 years. Most 12(56.5%) of the patients were more than 65 years of age. Diabetes Mellitus was the most common risk factor in 15(69%) patients followed by hyperten-sion 13(59%) and ischemic heart disease in 10(45%). The hospital admission ranged from 1 to 19 days with a mean of 7.13 days. Conclusion: We identified length of stay, mechanical ventilation, age >65 years, pneumonia and DIC are the potential risk factors for in-hospital mortality in severely ill COVID-19 patients. This audit can guide the clinicians working in resource constrained areas, ....

Association between Clinical Frailty Scale and mortality 24 months after hospitalisation in adult patients with COVID-19

BackgroundThe clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. MethodsThe COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020–July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (<65 and ≥65 years), and adjusted for covariates (age, sex, number of drugs, and types of drug class as a proxy for comorbidities) were used to study the association between the CFS and 24-month mortality after hospitalisation. ResultsIn this study, 1238 fit (CFS 1–3), 478 mildly frail (CFS 4–5), and 235 frail (CFS 6–9) patients were included for baseline analysis (median age 68 years (IQR 58–78); 58.5 % male). Frailty was associated with an increased risk of 24-month mortality after hospitalisation in older patients (HR 1.91, 95 % CI [1.17–3.12]), in younger adults a trend was seen (HR 3.13, 95 % CI [0.86–11.36]). ConclusionThe results suggest that the CFS is an indicator for mortality 24 months after hospitalisation in COVID-19 patients.

Insights into the baseline blood pH homeostasis at admission and the risk of in-hospital mortality in COVID-19 patients.

Aim: A laboratory finding in critically ill COVID-19 patients is blood academia (pH <7.35). We investigated its cause in connection with the admission baseline blood pH homeostasis.Patients & methods: We retrospectively monitored the baseline blood pH homeostasis of 1215 COVID-19 patients who were admitted with pneumonia using data-driven knowledge. Two categories of patients were identified: non-survivors (107) and survivors (1108).Results: Non-survivors showed greater levels of lactate and lower blood pH, saturation, and partial pressure of oxygen than survivors. A bivariate Spearman's correlation matrix showed that the [HCO3-]/pCO2 and pCO2 of non-survivors exhibited an unmatched connection, but not in the survivor group. When comparing non-survivors to survivors, the dendrograms derived from the bivariate comparison matrix showed differences in gasometry parameters like blood pH, [HCO3-]/pCO2 ratio, anion gap and pO2.Conclusion: The little variations in the gasometry readings between survivors and non-survivors upon admission suggested abnormal changes in the complementary renal and respiratory systems that bring blood pH back to normal. In advanced COVID-19, modest blood acid-base imbalances could become blood acidemia if these compensatory strategies were overused. Data-driven monitoring of acid-base parameters may help predict abnormal blood pH and the advancement of metabolic acidemia before it is too late.

External validation of two clinical prediction models for mortality in COVID-19 patients (4C and NEWS2), in three centers in Medellín, Colombia: Assessing the impact of vaccination over time

ObjectivesExternal validation of the 4C and NEWS2 scores for the prediction of in-hospital mortality in COVID-19 patients, and evaluation of its operational performance in two time periods: before and after the start of the vaccination program in Colombia. MethodsRetrospective cohort in three high complexity hospitals in the city of Medellín, Colombia, between June 2020 and April 2022. ResultsThe areas under the ROC curve (AUC) for the 4C mortality risk score and the NEWS2 were 0.75 (95% CI 0.73–0.78) and 0.68 (95% CI 0.66–0.71), respectively. For the 4C score, the AUC for the first and second periods was 0.77 (95% CI 0.74–0.80) and 0.75 (95% CI 0.71–0.78); whilst for the NEWS2 score, it was 0.68 (95% CI 0.65–0.71) and 0.69 (95% CI 0.64–0.73). The calibration for both scores was adequate, albeit with reduced performance during the second period. ConclusionsThe 4C mortality risk score proved to be the more adequate predictor of in-hospital mortality in COVID-19 patients in this Latin American population. The operational performance during both time periods remained similar, which shows its utility notwithstanding major changes, including vaccination, as the pandemic evolved.

AB2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units

PurposeTo develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. Materials and methodsThis retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. ResultsFrom 558 patients, median age was 69 years (IQR 58–78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. ConclusionsThe AB2CO score is a fast and easy tool to be used upon ICU admission.

Manifestations of kidney involvement in COVID-19 patients and progression to chronic kidney disease

Introduction. COVID-19 was initially considered a predominantly respiratory infection, with mortality associated with progression of respiratory failure, but currently is recognized as a multisystem disease with a wide range of manifestations. One of the most common complications of COVID-19 is acute kidney injury (AKI), which predominantly evolved to chronic kidney disease (CKD). The objective of the study was to investigate the types of acute kidney injury and their prognostic value in hospitalized patients with COVID-19 with evolution to chronic kidney disease. Material and methods. The study utilized a comprehensive database of patients admitted to general department of COVID-19 at Timofei Moșneaga Republican Clinical Hospital from 2020 to 2022 years (in total 1000 patients). The first part of the study was a retrospective study, focusing on patients with confirmed COVID-19 and lung injury was diagnosed by computer tomography. The second part was a prospective study assessing the prognostic value of inflammatory markers, renal functional status and kidney injury. Results. AKI occurs in 29.6% of patients with COVID-19. The risk of AKI and CKD is higher in patients with more comorbidities, a more severe course of disease, elevated levels of ASAT/ALAT &gt; 1.6 and hematuria at admission, which significantly increases the risk of progression to CKD. Patients with a history of CKD, and who had ASAT &gt; 40 U/L, ASAT/ALAT &gt; 1.6 and hematuria, experience the onset of AKI before hospitalization. Independent negative predictors of hospital-developed AKI include hypertension, Charlson Comorbidity Index &gt; 4 points, respiratory failure, ASAT/ALAT &gt; 1.6, D-dimers &gt; 250 ng/ml, and hematuria. Hospital mortality in patients with COVID-19 was 20.8%, compared to 8.5% in patients without AKI, and this rate increased to 50% when AKI developed (p &lt; 0.001). Conclusions. Patients who developed AKI during admission had a higher incidence of negative outcomes compared to those with AKI prior to admission. Independent predictors of in-hospital mortality in COVID-19 patients were increased serum CRP. Death in hospitalized patients with COVID-19 and AKI was independently associated with factors such as age &gt; 75 years, history of CKD, admission to Intensive Care Unit, leukocytosis, and ASAT/ALAT &gt; 1.6.

The Association between Coagulation Parameters, C-Reactive Protein, D-Dimer and In-Hospital Mortality of Covid-19 Patients with Suspected Pulmonary Embolism

COVID-19 is a respiratory disease with severe cardiovascular complications, one of them is pulmonary embolism (PE). Studies have shown many contributing factors related to mortality of hospitalized COVID-19 patients that developed pulmonary embolism. This study aimed to find the association between coagulation parameters (PT and APTT), C-reactive protein (CRP), and D-dimer with in-hospital mortality of COVID-19 patients with suspected PE. COVID-19 patients in Ulin General Hospital Banjarmasin who met the clinical criteria of suspected PE, assessed with clinical scorings (Well’s score for PE and Padua prediction score for venous thromboembolism), and receiving anticoagulant therapy recorded in medical records were included in this study. A total of 91 patients were included, with most patients were female (59.3%), average age of 53.36 years, average BMI of 25.82 kg/m2, having normal electrocardiogram (79.1%), with history of hypertension (56%), and no histories of smoking (94.5%), diabetes mellitus (70.3%), heart failure (93.4%), coronary artery disease (96.7%), and chronic lung disease (95.6%). As much as 39.57% patients with suspected PE was deceased during the course of hospitalization. Unadjusted analysis showed significant increased levels of PT, APTT, and CRP, in deceased patients compared to those discharged alive (mean 14.62 vs 11.91 seconds, 42.94 vs 28.57 seconds, and 98.19 vs 47.01 mg/dL, respectively; p value &lt; 0.01), and a non-significant increased level of D-dimer (mean 10.89 mg/L; p = 0.09). Multivariate logistic regression showed non-significant associations between PT, APTT, D-dimer, and CRP with in-hospital mortality (p values of 0.06, 0.14, 0.52, and 0.23, respectively). In conclusion, there is no association between coagulation parameters, CRP, and D-dimer levels with in-hospital mortality in COVID-19 patients with suspected PE. A further study with a larger sample size is needed to see the role of laboratory findings in predicting in-hospital mortality in COVID-19 patients with suspected PE.

Association Between Head Computed Tomography Findings and In-Hospital Mortality in COVID-19 Patients.

The present study investigated the association between head computed tomography (CT) findings and mortality in patients with COVID-19. Specifically, we focused on low-density lesions identified on head CT screenings. We performed a single-center, retrospective cohort study based on data obtained from the medical charts of inpatients admitted to the Tokyo Metropolitan Hiroo Hospital between January 1 and December 31, 2021. We focused on the basal ganglia--a representative anatomical region for assessing routine head CT in patients with COVID-19. Patients were divided into two groups based on the presence or absence of low-density lesions in the basal ganglia. The primary outcome was all-cause in-hospital mortality, and the secondary outcome was the length of hospital stay. We performed multivariable regression analyses for outcomes to adjust for patients' background and disease severity. During the study period, 1,906 COVID-19 patients were admitted to our facility. Among them, 1,203 patients underwent head CT evaluations and were included in this study. The median age was 56 years (interquartile range: 43-76 years) and 725 patients (60.3%) were male. A total of 235 (19.5%) patients required oxygen therapy on admission and 1,051 (87.4%) patients had pneumonia. Crude in-hospital mortality was 6.1% and the median length of hospital stay was 10 days (interquartile range: 8-14 days). The multivariate regression analyses showed that low-density lesions in the basal ganglia were significantly associated with increased in-hospital mortality and prolonged hospital stay. The presence of ischemic changes in the basal ganglia denoted by low-density findings may be a promising prognostic factor in patients with COVID-19.

Thrombocytopenia Secondary to COVID-19: Outcomes Analysis in Terms of Thrombotic Microangiopathy, Acute Kidney Injury, and Mortality.

Background: COVID-19 usually complicates respiratory failure; microvascular, macrovascular, and renal complications are common. Both micro and macrovascular complications are associated with multi-organ dysfunction and in-hospital mortality. Thrombotic microangiopathy (TMA) causes microvascular thromboses associated with organ failure, including acute kidney injury (AKI). Materials and Methods: This Retrospective Cohort study included 100 COVID-19 patients with thrombocytopenia, followed up in a university hospital's intensive care unit (ICU). The primary endpoints were in-hospital mortality or discharge from the hospital and assessing the occurrence of TMA and AKI during the hospitalization. The effect of thrombotic microangiopathy and acute kidney injury on mortality was investigated using logistic regression models in Stata software version 12.1. Results: The TMA and AKI were associated with in-hospital mortality in COVID-19 patients presenting with thrombocytopenia in multivariate regression analysis, adjusted for other variables. The effect of AKI on mortality was obtained (adjusted OR 4.09, 95% CI: 1.33-12.53, p = 0.01). Moreover, the odds of mortality due to TMA were ten-fold higher in the patients who had TMA than those who did not (adjusted OR 10.26, 95% CI: 1.26-83.76, p = 0.03). Conclusion: We outlined TMA in COVID-19 patients, which could be responsible for kidney injury and mortality in critically COVID-19 patients.

Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients.

Background The COVID-19 pandemic has brought about unprecedented global health challenges, with its impact extending beyond respiratory manifestations to encompass cardiovascular complications, including arrhythmias. Dysrhythmias in COVID-19 are multifactorial, ranging from direct myocardial insult due to the cytokine storm to metabolic derangements. Objective In this study, we aim to examine the incidence of new-onset atrial fibrillation and to study its association with all-cause mortality of COVID-19. Methods A cross-sectional study was conducted at Cabell Huntington Hospital, West Virginia, utilizing electronic medical records of COVID-19 patients from 2020 to 2021. Inclusion criteria comprised patients aged >18 years with COVID-19 diagnosis and cardiac arrhythmias during hospitalization. Logistic regression analysis was employed to examine the relationship between demographic and clinical variables and in-hospital mortality. Results Of the 264 eligible patients, those aged >66 years had lower odds of in-hospital mortality (p < 0.001), while gender, ejection fraction, and diabetes mellitus did not significantly predict mortality. Atrial fibrillation (p = 0.011) and heart failure (p = 0.030) were associated with increased odds of mortality, while hypertension showed no significant predictive power (p = 0.791). Conclusion This study highlights the significance of atrial fibrillation and heart failure as predictors of in-hospital mortality in COVID-19 patients. Our findings underscore the importance of recognizing and managing arrhythmias in COVID-19 and call for further research on the mechanisms and long-term effects of these cardiac complications in the context of the pandemic. These insights can guide clinical practice and interventions to optimize patient outcomes.

Azvudine reduces the in-hospital mortality of COVID-19 patients: A retrospective cohort study

Azvudine reduces the in-hospital mortality of COVID-19 patients: A retrospective cohort study

Sex differences in ischemic stroke during COVID-19 first outbreak in northern Italy

IntroductionCOVID-19 pandemic had a great impact on outcome in SARS-CoV-2 positive patients with ischemic stroke during the first wave in Italy. Few data are available on outcome stratified by sex. MethodsThe Italian Society of Hospital Neuroscience conducted a multi-center, retrospective, observational study on neurological complications in COVID-19 patients with ischemic stroke. All the patients admitted from March 1st to April 30th, 2020 in 20 Neurology Units in Northern Italy were recruited. Demographical and clinical features, treatment and outcome data were compared focusing on sex differences. Results812 patients with ischemic stroke were enrolled, of whom 129 with COVID-19; males were 53.8%. In-hospital mortality in COVID-19 patients was 35.3% in males and 27.9% in females while 8.5% in male and 5.8% in female patients without COVID-19. SARS-CoV-2 positive patients had a higher frequency of stroke of undetermined etiology, than negative ones (32.8% vs 22.5%; p = 0.02), especially in females compared to males (36.1% vs 27.9%), albeit without statistical significance. Male patients with SARS-CoV-2 were more likely to require cPAP (30.9% vs 14.8%; p = 0.03), endotracheal tube (14.9% vs 3.3%; p = 0.02) and reperfusion strategies (29.4% vs 11.5%; p = 0.01) than females, as well as to have a higher CRP and D-dimer. These elements together with older age, a total anterior circulation stroke and lymphopenia were predictors of a worse outcome. DiscussionOur study detected some differences due to sex in ischemic stroke with and without COVID-19, supporting the possibility to perform sex analyses for SARS-CoV-2 positive patients for a better clinical management.

AF and in-hospital mortality in COVID-19 patients

There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF. The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection. This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF. The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732). New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients.

Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients

BackgroundAcute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality.MethodsThis study is part of the “Brazilian COVID-19 Registry”, a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score.ResultsA total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48–70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909–0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914–0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69–0.73]).ConclusionThe MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.

Correlation between Chest Computed Tomography Score and Laboratory Biomarkers in the Risk Stratification of COVID-19 Patients Admitted to the Emergency Department.

It has been reported that mid-regional proadrenomedullin (MR-proADM) could be considered a useful tool to stratify the mortality risk in COVID-19 patients upon admission to the emergency department (ED). During the COVID-19 outbreak, computed tomography (CT) scans were widely used for their excellent sensitivity in diagnosing pneumonia associated with SARS-CoV-2 infection. However, the possible role of CT score in the risk stratification of COVID-19 patients upon admission to the ED is still unclear. The main objective of this study was to assess if the association of the CT findings alone or together with MR-proADM results could ameliorate the prediction of in-hospital mortality of COVID-19 patients at the triage. Moreover, the hypothesis that CT score and MR-proADM levels together could play a key role in predicting the correct clinical setting for these patients was also evaluated. Epidemiological, demographic, clinical, laboratory, and outcome data were assessed and analyzed from 265 consecutive patients admitted to the triage of the ED with a SARS-CoV-2 infection. The accuracy results by AUROC analysis and statistical analysis demonstrated that CT score is particularly effective, when utilized together with the MR-proADM level, in the risk stratification of COVID-19 patients admitted to the ED, thus helping the decision-making process of emergency physicians and optimizing the hospital resources.

High Prevalence of Diabetes Among Hospitalized COVID-19 Minority Patients: Data from a Single Tertiary Hospital.

Type 2 diabetes mellitus (DM) is a common comorbidity in the minority population and is associated with poor outcomes in COVID-19 patients. We hypothesized that COVID-19 patients with pre-existing diabetes mellitus are prone to fatal outcomes compared to non-diabetic patients. We aimed to illustrate the characteristics and outcomes and identify the risk factors for in-hospital mortality of COVID-19 patients with DM. In this single-center retrospective study, electronic medical records of hospitalized patients with confirmed COVID-19 diagnosis at Howard University Hospital (HUH) from March 2020 to Dec 2021 were analyzed. Clinical, demographic, and serological information, as well as outcomes, were recorded and analyzed. Among 463 COVID-19 patients, 66.3% (n = 307) were African Americans (AA) and 35.9% (n = 166) had diabetes, with a mean age of 64years. The majority of the diabetic patients were AA (n = 123, 74.1%) and had a higher mortality rate (n = 26, 74.3%) compared to others. Length of stay in the hospital is significantly more for the diabetic than for the non-diabetic patients (11.3 vs. 8.3days, p = 0.03). A higher proportion of ICU admission (32.3% vs. 17.9%, p = < 0.001), intubation (17% vs. 11.7%, p = 0.04), and increased mortality (21.1% vs. 12.2%, p = 0.01) were identified in COVID-19 patients with DM than in those with no DM. Among DM patients, non-survivors were older (69.9 vs. 62.9years). DM patients were more likely to have underlying hypertension (72.3% vs. 43.3%, p = < 0.001), obesity (44.8% vs. 32.1%, p = 0.007), chronic kidney disease (23.6 vs. 11.8%, p = 0.001), and cardiovascular disease (29.5% vs. 14.3%, p = 0.001) than the non-DM patients. HbA1C above 9%, indicating poorly controlled hyperglycemia, was associated with poor outcome among the DM subjects. AST (23.5% vs. 31.3%) and creatinine (61.4% vs. 37.9%) were significantly more elevated in DM COVID-19 patients (all p-values < 0.05). The levels of serum troponin (42.5% vs. 30.9%, p = 0.03), interleukin-6 (67.2 vs. 50%, p = 0.04), ferritin (65.6% vs. 44.6%, p = 0.03), procalcitonin (58.1% vs. 46.1, p = 0.03), and D-dimers (92.8% vs. 86.5%, p = 0.04) were significantly higher in DM patients as compared to those in non-DM COVID-19 patients, indicating more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm. The prevalence of DM is high among hospitalized COVID-19 patients in our cohort. While DM patients have a higher mortality rate and ICU admission than non-DM patients, other factors such as underlying comorbidities, old age, elevated creatinine, AST, serum inflammatory markers, and D-dimer are more significant predictors of fatal outcomes. DM patients had higher metabolic derangements, hypercoagulability, and severe inflammatory response. No significant difference of outcome was noted between DM patients of different races in our cohort. In the diabetic group, it appears that race may not significantly contribute to the observed mortality disparity. This could be attributed to the significant influence of diabetes, which acts as a major effector, potentially overshadowing the significance of race in this context.