Risk Of Intensive Care Unit Admission Research Articles

A comparison of patients with neck abscesses caused by esophageal foreign body impaction vs. inflammatory disease: a retrospective study

ObjectivesDuring clinical practice, we have detected a few cases of neck abscesses in patients diagnosed with esophageal foreign body impaction (EFB) but without the primary inflammatory disease. However, we do not know if neck abscesses caused by an inflammatory source are more like to be associated with a more severe progression or poorer prognosis. In this study, we aimed to identify differences between these two groups of patients by comparing progression and prognosis.Materials and methodsWe retrospectively reviewed all patients who underwent neck abscess incisions between January 2011 and March 2022 and divided these patients into two groups: an EFB group and an inflammation group. Data were described by percentages, means, and standard deviations (SDs). Fisher's precision probability test was used to compare differences between the EFB and inflammation groups. Categorical variables were analyzed by Pearson's Chi-squared test. In addition, three factors including hospital days, intensive care unit (ICU) stay, and drainage-tube removal time were used for multivariate analysis to identify independent correlations separately.ResultsWe enrolled a total of 33 patients with neck abscesses who received surgical incisions; the EFB group included 14 (42%) cases, while the inflammatory group included 19 (58%) cases. No significant differences were identified between the two groups in terms of surgery type (with or without mediastinotomy) and postoperative management (negative pressure drainage or postoperative irrigation). There were no significant differences between the two groups in terms of hospital stay, the timing of drainage-tube removal, the risk of ICU admission, and the probability of receiving intubation and tracheotomy. The incidence rate of esophageal perforation differed significantly between the two groups (p < 0.001). However, there were no significant differences in terms of other preoperative or postoperative comorbidities. The multivariate analysis revealed that the application of mediastinotomy (HR = 0.216 [0.049, 0.963]; p = 0.044) was correlated with a longer stay in the hospital. The time from symptoms to surgery was associated with a longer drainage tube removal time (HR = 0.392 [0.159, 0.967]; P = 0.042) and longer ICU stay (OR = 79.754[1.513, 4203.182]; P = 0.03).ConclusionPatients with neck abscesses associated with EFB and inflammation received the same therapeutic management, and there were no significant differences between these two groups in terms of prognosis. Furthermore, esophageal perforation was found to be irrelevant to the aggravation of neck abscesses, and there was no need for additional surgery to repair a perforated esophagus in patients with neck abscesses.Level of evidence: Retrospective cohort (2b).

Risk factors for intensive care unit admission and death from COVID-19 in fully vaccinated patients hospitalized for severe COVID-19, Brazil, 2021-2022.

To assess factors associated with admission to an intensive care unit (ICU) and death from coronavirus disease 2019 (COVID-19) in fully vaccinated patients with severe COVID-19 in Brazil and the association between ICU admission and death from COVID-19. This was retrospective study of patients hospitalized for COVID-19 from February 12, 2021 to January 10, 2022 across Brazil who were fully vaccinated against COVID-19 before hospitalization. Outcomes were admission in an ICU for COVID-19 and death from COVID-19. Variables evaluated were: sex; age; self-reported skin color; macroregion; comorbidities; time between full vaccination and onset of symptoms; and time between onset of symptoms and hospitalization. A Poisson regression model was used to estimate crude and adjusted risk ratios. Of 74 991 patients hospitalized for severe COVID-19, 67.28% were ≥ 70 years and 68.32% had at least one comorbidity. Men, patients aged 60-69 years, and patients aged 18-39 years with obesity had the greatest risk of ICU admission. Patients aged 18-39 years with obesity, diabetes, or renal diseases had the highest risk of death from COVID-19. When age and time between onset of symptoms and hospitalization were considered effect modifiers, patients admitted to an ICU 9-13 days after symptom onset in each age category had the greatest risk of death from COVID-19. Although older patients were at greatest risk of ICU admission and death from COVID-19, the difference in the risk of dying from COVID-19 between patients admitted to an ICU and those not admitted was greatest for young adults.

Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level.

Cancer and obesity are well-known prognostic factors in COVID-19. Our objective was to study the effect of obesity (and its severity) on the risk of intensive care unit (ICU) admission, severe complications, and in-hospital mortality, in a population of cancer patients hospitalized with or without COVID-19. All patients hospitalized in France for cancer from 1 March 2020 to 28 February 2022 were included from the French national administrative database. The effect of obesity was estimated in COVID-19 and in non-COVID-19 cancer patients using logistic and survival regressions, taking into account age, sex, comorbidities, and different types of cancer. Among the 992,899 cancer patients, we identified 53,090 patients with COVID-19 (5.35%), of which 3260 were obese (6.1%). After adjustment, for patients with or without COVID-19, there is an increased risk of ICU admission or severe complications in obese patients, regardless of the type of obesity. Regarding in-hospital mortality, there is no excess risk associated with overall obesity. However, massive obesity appears to be associated with an increased risk of in-hospital mortality, with a significantly stronger effect in solid cancer patients without COVID-19 and a significantly stronger effect in hematological cancer patients with COVID-19. This study showed that in France, among hospitalized patients with cancer and with or without COVID-19, increased vigilance is needed for obese patients, both in epidemic and non-epidemic periods. This vigilance should be further strengthened in patients with massive obesity for whom the risk of in-hospital mortality is higher, particularly in epidemic periods for patients with hematological cancers.

Hospital admissions with influenza and impact of age and comorbidities on severe clinical outcomes in Brazil and Mexico.

The risk of hospitalization or death after influenza infection is higher at the extremes of age and in individuals with comorbidities. We estimated the number of hospitalizations with influenza and characterized the cumulative risk of comorbidities and age on severe outcomes in Mexico and Brazil. We used national hospital discharge data from Brazil (SIH/SUS) from 2010-2018 and Mexico (SAEH) from 2010-2017 to estimate the number of influenza admissions using ICD-10 discharge codes, stratified by age (0-4, 5-17, 18-49, 50-64, and ≥65 years). Duration of hospital stay, admission to the intensive care unit (ICU), and in-hospital case fatality rates (CFRs) defined the severe outcomes. Rates were compared between patients with or without pre-specified comorbidities and by age. A total of 327,572 admissions with influenza were recorded in Brazil and 20,613 in Mexico, with peaks period most years. In Brazil, the median hospital stay duration was 3.0 days (interquartile range, 2.0-5.0), ICU admission rate was 3.3% (95% CI, 3.2-3.3%), and in-hospital CFR was 4.6% (95% CI, 4.5-4.7). In Mexico, the median duration of stay was 5.0 days (interquartile range, 3.0-7.0), ICU admission rate was 1.8% (95% CI, 1.6-2.0%), and in-hospital CFR was 6.9% (95% CI, 6.5-7.2). In Brazil, ICU admission and in-hospital CFR were higher in adults aged ≥50 years and increased in the presence of comorbidities, especially cardiovascular disease. In Mexico, comorbidities increased the risk of ICU admission by 1.9 (95% CI, 1.0-3.5) and in-hospital CFR by 13.9 (95% CI, 8.4-22.9) in children 0-4 years. The SIH/SUS and SAEH databases can be used to estimate hospital admissions with influenza, and the disease severity. Age and comorbidities, especially cardiovascular disease, are cumulatively associated with more severe outcomes, with differences between countries. This association should be further analyzed in prospective surveillance studies designed to support influenza vaccination strategy decisions.

Development and validation of tools for predicting the risk of death and ICU admission of non-HIV-infected patients with Pneumocystis jirovecii pneumonia.

The mortality rate of non-HIV-infected Pneumocystis jirovecii pneumonia (PCP) is high. This research aimed to develop and validate two clinical tools for predicting the risk of death and intensive care unit (ICU) admission in non-HIV-infected patients with PCP to reduce mortality. A retrospective study was conducted at Peking Union Medical College Hospital between 2012 and 2021. All proven and probable non-HIV-infected patients with PCP were included. The least absolute shrinkage and selection operator method and multivariable logistic regression analysis were used to select the high-risk prognostic parameters. In the validation, the receiver operating characteristic curve and concordance index were used to quantify the discrimination performance. Calibration curves were constructed to assess the predictive consistency compared with the actual observations. A likelihood ratio test was used to compare the tool and CURB-65 score. In total, 508 patients were enrolled in the study. The tool for predicting death included eight factors: age, chronic lung disease, respiratory rate, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), cytomegalovirus infection, shock, and invasive mechanical ventilation. The tool for predicting ICU admission composed of the following factors: respiratory rate, dyspnea, lung moist rales, LDH, BUN, C-reactive protein/albumin ratio, and pleural effusion. In external validation, the two clinical models performed well, showing good AUCs (0.915 and 0.880) and fit calibration plots. Compared with the CURB-65 score, our tool was more informative and had a higher predictive ability (AUC: 0.880 vs. 0.557) for predicting the risk of ICU admission. In conclusion, we developed and validated tools to predict death and ICU admission risks of non-HIV patients with PCP. Based on the information from the tools, clinicians can tailor appropriate therapy plans and use appropriate monitoring levels for high-risk patients, eventually reducing the mortality of those with PCP.

PSUN197 Rate of admission to the Intensive Care Unit in patients with Diabetic Ketoacidosis and its associated risk factors, a single centre experience.

Abstract Background Diabetic ketoacidosis (DKA) is one of the most common admission diagnoses to the intensive care unit (ICU). This study aims primarily to identify the rate of DKA-related ICU admission, and to assess the possible leading risk factors. Secondarily, to assess the rate of ICU readmission and mortality. Methods This retrospective observational study took place in King Abdulaziz University Hospital and collected data from January 2018 till December 2020. Patients aged 15 years and older with DKA Related-ICU admissions were included. Association between variables such as, demographics, precipitating factor, biochemical data, ICU stay details. History of readmission, arising complications within the study period were collected. Mortality cases were identified and the direct cause of death was investigated. Statistical analysiswas performed using the SPSS program version 25. Qualitative data were expressed as numbers and percentages, and quantitative data were expressed as mean and standard deviation. Linear regression analysis was used to adjust for the predictors and their association with the admission to the ICU. Result: ICU admissions were 28.4% of all DKA-related admissions (50 out of 176 patients), with a female predominance of 52%. Median length of ICU stay was 3 days. Medications nonadherence was the leading precipitating factor for ICU admission in 50% of the patients. Factors significantly associated with risk of ICU admission were on bivariate analysis: pH level of &amp;lt;7.0 (p =0.001), and Patients of &amp;gt;60 years as they had 4 times more risk of ICU admission compared to 15-20 years age group (P=0.04). Nine patients died, but none of them died primarily from DKA as the main cause of death was the DKA precipitating factor. Six patients were readmitted to the ICU (12%) during the study period, the mean duration between the two admissions was 19.74± 26.57 weeks. Conclusion Our findings highlight that nonadherence to medications is the most common precipitating factor to ICU-related DKA admission. Thus, educating patients and early dentification of patients at risk are crucial. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Association of COVID-19 Vaccinations With Intensive Care Unit Admissions and Outcome of Critically Ill Patients With COVID-19 Pneumonia in Lombardy, Italy

Data on the association of COVID-19 vaccination with intensive care unit (ICU) admission and outcomes of patients with SARS-CoV-2-related pneumonia are scarce. To evaluate whether COVID-19 vaccination is associated with preventing ICU admission for COVID-19 pneumonia and to compare baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU. This retrospective cohort study on regional data sets reports: (1) daily number of administered vaccines and (2) data of all consecutive patients admitted to an ICU in Lombardy, Italy, from August 1 to December 15, 2021 (Delta variant predominant). Vaccinated patients received either mRNA vaccines (BNT162b2 or mRNA-1273) or adenoviral vector vaccines (ChAdOx1-S or Ad26.COV2). Incident rate ratios (IRRs) were computed from August 1, 2021, to January 31, 2022; ICU and baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU were analyzed from August 1 to December 15, 2021. COVID-19 vaccination status (no vaccination, mRNA vaccine, adenoviral vector vaccine). The incidence IRR of ICU admission was evaluated, comparing vaccinated people with unvaccinated, adjusted for age and sex. The baseline characteristics at ICU admission of vaccinated and unvaccinated patients were investigated. The association between vaccination status at ICU admission and mortality at ICU and hospital discharge were also studied, adjusting for possible confounders. Among the 10 107 674 inhabitants of Lombardy, Italy, at the time of this study, the median [IQR] age was 48 [28-64] years and 5 154 914 (51.0%) were female. Of the 7 863 417 individuals who were vaccinated (median [IQR] age: 53 [33-68] years; 4 010 343 [51.4%] female), 6 251 417 (79.5%) received an mRNA vaccine, 550 439 (7.0%) received an adenoviral vector vaccine, and 1 061 561 (13.5%) received a mix of vaccines and 4 497 875 (57.2%) were boosted. Compared with unvaccinated people, IRR of individuals who received an mRNA vaccine within 120 days from the last dose was 0.03 (95% CI, 0.03-0.04; P < .001), whereas IRR of individuals who received an adenoviral vector vaccine after 120 days was 0.21 (95% CI, 0.19-0.24; P < .001). There were 553 patients admitted to an ICU for COVID-19 pneumonia during the study period: 139 patients (25.1%) were vaccinated and 414 (74.9%) were unvaccinated. Compared with unvaccinated patients, vaccinated patients were older (median [IQR]: 72 [66-76] vs 60 [51-69] years; P < .001), primarily male individuals (110 patients [79.1%] vs 252 patients [60.9%]; P < .001), with more comorbidities (median [IQR]: 2 [1-3] vs 0 [0-1] comorbidities; P < .001) and had higher ratio of arterial partial pressure of oxygen (Pao2) and fraction of inspiratory oxygen (FiO2) at ICU admission (median [IQR]: 138 [100-180] vs 120 [90-158] mm Hg; P = .007). Factors associated with ICU and hospital mortality were higher age, premorbid heart disease, lower Pao2/FiO2 at ICU admission, and female sex (this factor only for ICU mortality). ICU and hospital mortality were similar between vaccinated and unvaccinated patients. In this cohort study, mRNA and adenoviral vector vaccines were associated with significantly lower risk of ICU admission for COVID-19 pneumonia. ICU and hospital mortality were not associated with vaccinated status. These findings suggest a substantial reduction of the risk of developing COVID-19-related severe acute respiratory failure requiring ICU admission among vaccinated people.

Association between Barthel Index, Grip Strength, and Physical Activity Level at Admission and Prognosis in Community-Acquired Pneumonia: A Prospective Cohort Study.

Impaired functional status is a risk factor for hospitalization in patients with community-acquired pneumonia (CAP). The aim was to determine the influence of functional status and physical activity level on severe outcomes, including length of stay, admission to the intensive care unit (ICU), readmission, and mortality in patients with CAP. A prospective cohort study among patients hospitalized with CAP. Functional status was assessed with the Barthel index and grip strength, and physical activity level was assessed using the international physical activity questionnaire. Linear regression was used to assess the association with length of stay, and logistic regression was used to assess the risk of severe outcomes. Among 355 patients admitted with CAP, 18% had a low Barthel index (&lt;80), 45% had a low grip strength, and 75% had a low physical activity level. Low Barthel index was associated with increased risk of ICU admission (OR 3.6, 95% CI 1.2-10.9), longer length of stay (27.9%, 95% CI 2.3-59.7%), readmission within 30, 90, and 180 days (OR 2.1-2.4, p &lt; 0.05), and mortality within 90 and 180 days (OR 4.2-5.0, p &lt; 0.05). Low grip strength was associated with increased risk of 90 days readmission (OR 1.6, 95% CI 1.0-2.6, p &lt; 0.05) and mortality within 30, 90, and 180 days (OR 2.6-3.2, p &lt; 0.05). Low physical activity level was associated with increased risk of readmission within 90 and 180 days (OR 1.8-2.1, p &lt; 0.05) and mortality within 30, 90, and 180 days (OR 3.3-5.5, p &lt; 0.05). Impaired functional status and low physical activity level were associated with a longer length of stay and increased risk of ICU admission, readmission, and mortality in patients hospitalized with CAP. Routine assessment of functional status and physical activity level in clinical care could enable early identification of individuals with excess risk for a poor prognosis. ClinicalTrials.gov, NCT03795662.

Impacts on the short-term outcome of patients with Tako-Tsubo syndrome

Abstract Background Tako-Tsubo syndrome (TTS) is a form of acute heart failure which mostly affects postmenopausal women, often following an emotional or physical trigger factor. There are many hypotheses for the development of TTS but the complete pathophysiology still remains unclear. Although most patients recover after a few days, some have to be treated at the intensive care unit (ICU) and may even die from the condition. Purpose The aim of this study was to find out if pre-existing diseases, cardiovascular risk factors (CVRF), comorbidities and trigger factors have any impact on the short-term outcome of TTS patients. Methods Data of all patients who presented to our centre with TTS from 2009–2017 were gathered retrospectively. Baseline characteristics, including somatic and psychiatric pre-existing diseases, CVRF (smoking, hypertension, diabetes, dyslipidaemia) as well as physical and emotional trigger factors were collected. Somatic diseases were additionally categorised into cardiac, autoimmune, malignant and other diseases. Admission to intensive care unit post TTS and/or in-hospital death were defined as poor short-term outcome. Outcome predictors were analysed with binary logistic regression model using the combined variable admission to an ICU and/or death. Results Out of 102 patients, 84 (82.4%) were females and 18 (17.6%) males with a median age of 65±15 years. 30 (29.4%) patients had an emotional and 23 (22.5%) a physical trigger factor. 27 (26.5%) had a psychiatric and 88 (86.3%) a somatic pre-existing disease. 33 (32.4%) patients were smokers, 58 (56.3%) had hypertension and 18 (17.5%) were diabetics. 19 patients (18.6%) had to be admitted to ICU and 8 patients (7.8%) died. No pre-existing diseases, baseline characteristics, CVRF or comorbidities behaved as significant independent predictor for bad outcome in TTS patients. Physical trigger was the only significant predictor for ICU admission and/or death (p=0.012). Conclusion Our study showed that patients with physical trigger factors have a higher risk of ICU admission and/or death than patients with emotional or no stressful trigger factors before TTS and should therefore be monitored closely. Interestingly, contrary to many other acute cardiac diseases, pre-existing diseases, cardiovascular risk factors and comorbidities do not seem to have any impact on the short-term outcome of patients with TTS. Funding Acknowledgement Type of funding sources: None.

Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from academic hospital in Saudi Arabia.

The coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, of which 5% required intensive care, especially mechanical ventilation. The prognosis depends on several factors including comorbidities. This study was conducted to identify the comorbidities associated with the intensive care unit (ICU) admission in elderly with COVID-19 admitted to a tertiary academic hospital. A retrospective cross-sectional study was conducted at KSUMC including all hospitalized patients (age ≥ 65 years) with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted between March 2020 and August 2021. Data collection included sociodemographic characteristics, underlying comorbidities, and the Charlson comorbidity index. Comorbidities were compared between the elderly patients with COVID-19 admitted to the ICU and those not admitted to the ICU. The odds ratios were calculated and a P value of < .05 and 95% confidence intervals were used to report the statistical significance A total of 444 patients (ICU = 147, non-ICU = 297) were included in the study. The study revealed that elderly patients with COVID-19 admitted to ICU had a higher rate of mortality (n = 64, 67.4%; P < .0001) and a higher proportion of them had shortness of breath (n = 97, 38.3%; P = .007) compared to the elderly patients not admitted to ICU. The mean length of stay (P < .0001), and weight (P = .02) among ICU patients were higher than the values for the non-ICU group, while the mean oxygen saturation (SpO2; P = .006) was lower among the ICU group. The comorbidities that demonstrated a statistically significant association with ICU admission were heart failure (P = .004, odd ratio (OR) = 2.02, 95% confidence intervals (CI) [1.263, 3540]), chronic obstructive pulmonary disease (COPD; P = .027, OR = 3.361, 95% CI [1.080, 10.464]), and chronic kidney disease (P = .021, OR = 1.807, 95% CI [1.087, 3.006]). The current study identified that the comorbidities such as COPD, heart failure, and factors like SpO2 and length of stay are associated with an increased risk of ICU admission in elderly patients with COVID-19. These findings highlight the clinical implications of comorbidity among geriatric population.

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study.

Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality.

In-hospital outcomes of SARS-CoV-2-infected health care workers in the COVID-19 pandemic first wave, Quebec, Canada

BackgroundHealth care workers (HCW), particularly immigrants and ethnic minorities are at increased risk for SARS-CoV-2 infection. Outcomes during a COVID-19 associated hospitalization are not well described among HCW. We aimed to describe the characteristics of HCW admitted with COVID-19 including immigrant status and ethnicity and the associated risk factors for Intensive Care unit (ICU) admission and death.MethodsAdults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Canada were included. Demographics, comorbidities, occupation, immigration status, country of birth, ethnicity, workplace exposures, and hospital outcomes (ICU admission and death) were obtained through a chart review and phone survey. A Fine and Gray competing risk proportional hazards model was used to estimate the risk of ICU admission among HCW stratified by immigrant status and region of birth.ResultsAmong 1104 included persons, 150 (14%) were HCW, with a phone survey participation rate of 68%. HCWs were younger (50 vs 64 years; p<0.001), more likely to be female (61% vs 41%; p<0.001), migrants (68% vs 55%; p<0.01), non-White (65% vs 41%; p<0.001) and healthier (mean Charlson Comorbidity Index of 0.3 vs 1.2; p<0.001) compared to non-HCW. They were as likely to be admitted to the ICU (28% vs 31%; p = 0.40) but were less likely to die (4% vs. 17%; p<0.001). Immigrant HCW accounted for 68% of all HCW cases and, compared to Canadian HCW, were more likely to be personal support workers (PSW) (54% vs. 33%, p<0.01), to be Black (58% vs 4%) and to work in a Residential Care Facility (RCF) (59% vs 33%; p = 0.05). Most HCW believed that they were exposed at work, 55% did not always have access to personal protective equipment (PPE) and 40% did not receive COVID-19-specific Infection Control (IPAC) training.ConclusionImmigrant HCW were particularly exposed to COVID-19 infection in the first wave of the pandemic in Quebec. Despite being young and healthy, one third of all HCW required ICU admission, highlighting the importance of preventing workplace transmission through strong infection prevention and control measures, including high COVID-19 vaccination coverage.

The Association of Metabolic-Associated Fatty Liver Disease with Clinical Outcomes of COVID-19: A Systematic Review and Meta-Analysis.

IntroductionMetabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD also is associated with worse clinical outcomes of COVID-19, such as disease severity, intensive care unit (ICU) admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aimed to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group.MethodsA comprehensive search was conducted in the Cumulative Index of Nursing and Allied Health (CINAHL), PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. The pooled prevalence of MAFLD among COVID-19 patients and the pooled odds ratios (OR) with 95% confidence intervals (CI) for clinical outcomes of COVID-19 were calculated.ResultsSixteen observational studies met inclusion criteria involving a total of 11,484 overall study participants, including 1,746 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.29 (95% CI: 0.19–0.40). MAFLD was associated with the COVID-19 disease severity OR 3.07 (95% CI: 2.30–4.09). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR 1.46 (95% CI: 1.12–1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR 1.45 (95% CI: 0.74–2.84).ConclusionsIn this study, a high percentage of COVID-19 patients had MAFLD. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.

The Impact of Asthma as an Underlying Disease for COVID-19 in ICU Admitted Patients

Background: Asthma is one of the most common chronic diseases triggered by viral respiratory infections leading to severe exacerbations. This study was performed to compare asthma with other underlying systemic disorders in coronavirus patients of 2019 (COVID-19) to evaluate any significant difference between these two groups in terms of ICU admission.&#x0D; Method: The study was a retrospective study using hospital records of patients’ from Intensive Care Units of Azad University hospitals in Tehran. Adult patients admitted to intensive care unit (ICU) due to COVID19 infection for a period of one year from March 2020 to February 2021, were enrolled in this cross-sectional study and their anonymized information was collected from an electronic system.&#x0D; Results: This study evaluated a total of 160 COVID-19 patients, aged 29 to 92 years old (mean age: 63.03±15.67 years). 90 (56.3%) patients were males and 70 (43.7%) were females. Comparing the mortality rate of COVID-19 patients with underlying systemic disorders to those with asthma showed that there was no significant difference between them. However, the rate of ICU admission in COVID-19 patients with diabetes and hypertension were significant compared with asthma (P =0.03).&#x0D; Conclusion: Asthma does not increase the risk of ICU admission in case of COVID-19 infection. Among the ICU admitted patients due to COVID-19 infection, the presence of asthma is not necessarily associated with a significant increase in poor outcomes.

Relative Virulence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Among Vaccinated and Unvaccinated Individuals Hospitalized With SARS-CoV-2.

BackgroundThe rapid development of safe and effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a singular scientific achievement. Confounding due to health-seeking behaviors, circulating variants, and differential testing by vaccination status may bias analyses toward an apparent increase in infection severity following vaccination.MethodsWe used data from the Ontario, Canada, Case and Contact Management Database and a provincial vaccination dataset (COVaxON) to create a time-matched cohort of individuals who were hospitalized with SARS-CoV-2 infection. Vaccinated individuals were matched to up to 5 unvaccinated individuals based on test date. Risk of intensive care unit (ICU) admission and death were evaluated using conditional logistic regression.ResultsIn 20 064 individuals (3353 vaccinated and 16 711 unvaccinated) hospitalized with infection due to SARS-CoV-2 between 1 January 2021 and 5 January 2022, vaccination with 1, 2, or 3 doses significantly reduced the risk of ICU admission and death. An inverse dose–response relationship was observed between vaccine doses received and both outcomes (adjusted odds ratio [aOR] per additional dose for ICU admission, 0.66; 95% confidence interval [CI], .62 to .71; aOR for death, 0.78; 95% CI, .72 to .84).ConclusionsWe identified decreased virulence of SARS-CoV-2 infections in vaccinated individuals, even when vaccines failed to prevent infection sufficiently severe to cause hospitalization. Even with diminished efficacy of vaccines against infection with novel variants of concern, vaccines remain an important tool for reduction of ICU admission and mortality.

Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya

Limited data is available on the coronavirus disease 2019 (COVID-19), critical illness rate, and in-hospital mortality in the African setting. This study investigates determinants of critical illness and in-hospital mortality among COVID-19 patients in Kenya. We conducted a retrospective cohort study at Kenyatta National Hospital (KNH) in Kenya. Multivariate logistic regression and Cox proportional hazard regression were employed to determine predictor factors for intensive care unit (ICU) admission and in-hospital mortality, respectively. In addition, the Kaplan-Meier model was used to compare the survival times using log-rank tests. As a result, 346 (19.3%) COVID-19 patients were admitted to ICU, and 271 (15.1%) died. The majority of those admitted to the hospital were male, 1,137 (63.4%) and asymptomatic, 1,357 (75.7%). The most prevalent clinical features were shortness of breath, fever, and dry cough. In addition, older age, male, health status, patient on oxygen (O2), oxygen saturation levels (SPO2), headache, dry cough, comorbidities, obesity, cardiovascular diseases (CVDs), diabetes, chronic lung disease (CLD), and malignancy/cancer can predicate the risk of ICU admission, with an area under the receiver operating characteristic curve (AUC-ROC) of 0.90 (95% confidence interval [CI]: 0.88–0.92). Survival analysis indicated 271 (15.1%) patients died and identified older age, male, headache, shortness of breath, health status, patient on oxygen, SPO2, headache, comorbidity, CVDs, diabetes, CLD, malignancy/cancer, and smoking as risk factors for mortality (AUC-ROC: 0.90, 95% CI: 0.89–0.91). This is the first attempt to explore predictors for ICU admission and hospital mortality among COVID-19 patients in Kenya.

Describing characteristics of adults with and without congenital heart defects hospitalized with COVID-19.

BackgroundWe sought to describe patient characteristics in adults with and without congenital heart defects (CHDs) during hospitalization for COVID‐19.MethodsWe analyzed data collected by Optum®, a nationally representative database of electronic medical records, for 369 adults with CHDs and 41,578 without CHDs hospitalized for COVID‐19 between January 1, 2020, and December 10, 2020. We used Poisson regression to describe and compare epidemiologic characteristics, heart‐related conditions, and severe outcomes between these two groups.ResultsThe distributions of many epidemiologic characteristics were similar between the two groups, but patients with CHDs were significantly more likely to be current or former smokers compared to patients without CHDs (risk ratio [RR]: 1.5, 95% confidence interval [CI]: 1.2, 1.8). Patients with CHDs were also significantly more likely to have heart failure, stroke, acute arrhythmia, myocardial injury, acute pulmonary hypertension, venous thromboembolism, and obesity documented at the time of the COVID‐19 hospitalization (RR range: 1.5–4.7) but not respiratory failure. Patients with CHDs (7 days) had a significantly longer median length of stay than those without CHDs (5 days; p < .001) and were significantly more likely to have an intensive care unit (ICU) admission (RR: 1.6, 95 CI: 1.2–1.9).ConclusionsOur description of patients among a large population improves our understanding of the clinical course of COVID‐19 among adults with CHDs. Adults with CHD appear to be at greater risk for more severe CHD, including greater risk of ICU admission and longer length of hospital stays.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

BackgroundFew data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice.MethodsWe conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models.ResultsOur analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42–4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13).ConclusionsAmong hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

Effect of Preexisting Asthma on the Risk of ICU Admission, Intubation, and Death from COVID-19: A Systematic Review and Meta-Analysis.

Background The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidity in COVID-19 that increases the risk of severity and death. However, research has shown that asthma is not associated with increased severity and death, thus making the consequences of asthma in COVID-19 unclear. Methods We searched the electronic databases PubMed, WHO COVID-19 database, and Taylor and Francis Online for studies that compared the medical outcomes of COVID-19 between patients with and without asthma, from the emergence of SARS-CoV-2 in December 2019 to the 3rd of September 2021, excluded duplicates, reviews, editorials, and case reports, and screened the titles, abstracts, and full texts. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS) for nonrandomized studies. Rates of intensive care unit (ICU) admission, intubation, and death among patients with and without asthma were compiled and meta-analysis was conducted using a random-effects model. Results Nineteen studies with a total of 289,449 participants met the inclusion criteria. COVID-19 patients with asthma had no significant association with increased risk of ICU admission, intubation, and death as compared with those without asthma ((odds ratio (OR) = 1.25, confidence interval (CI) = 0.90–1.74, I2 = 82%, X2 = 55.13, p < 0.01), (OR = 0.89, CI = 0.59–1.34, I2 = 91%, X2 = 110.82, p < 0.01), and (OR = 0.90, 95% CI = 0.63–1.27, I2 = 88%, X2 = 146.96, p < 0.01)), respectively. Conclusion Preexisting asthma did not significantly increase the risk of poorer prognosis and death from COVID-19.

Prognostic accuracy of inflammatory markers in predicting risk of ICU admission for COVID-19: application of time-dependent receiver operating characteristic curves.

ObjectiveIntensive care unit (ICU) admission occurs at different times during hospitalization among patients with COVID-19. We aimed to evaluate the time-dependent receive operating characteristic (ROC) curve and area under the ROC curve, AUC(t), and accuracy of baseline levels of inflammatory markers C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting time to an ICU admission event in patients with severe COVID-19 infection.MethodsIn this observational study, we evaluated 724 patients with confirmed severe COVID-19 referred to Ayatollah Rohani Hospital, affiliated with Babol University of Medical Sciences, Iran.ResultsThe AUC(t) of CRP and NLR reached 0.741 (95% confidence interval [CI]: 0.661–0.820) and 0.690 (95% CI: 0.607–0.772), respectively, in the first 3 days after hospital admission. The optimal cutoff values of CRP and NLR for stratification of ICU admission outcomes in patients with severe COVID-19 were 78 mg/L and 5.13, respectively. The risk of ICU admission was significantly greater for patients with these cutoff values (CRP hazard ratio = 2.98; 95% CI: 1.58–5.62; NLR hazard ratio = 2.90; 95% CI: 1.45–5.77).ConclusionsUsing time-dependent ROC curves, CRP and NLR values at hospital admission were important predictors of ICU admission. This approach is more efficient than using standard ROC curves.