Requirement For Invasive Mechanical Ventilation Research Articles

Clinical decision thresholds for surfactant administration in preterm infants: a systematic review and network meta-analysis

The ideal threshold at which surfactant administration in preterm neonates with respiratory distress syndrome (RDS) is most beneficial is contentious. The aim of this systematic review was to determine the optimal clinical criteria to guide surfactant administration in preterm neonates with RDS. The systematic review was registered in PROSPERO (CRD42022309433). Medline, Embase, CENTRAL and CINAHL were searched from inception till 16th May 2023. Only randomized controlled trials (RCTs) were included. A Bayesian random effects network meta-analysis (NMA) evaluating 33 interventions was performed. The primary outcome was requirement of invasive mechanical ventilation (IMV) within 7 days of life. 58 RCTs were included. In preterm neonates ≤30 weeks after adjusting for the confounding factor of modality of surfactant administration, an arterial alveolar oxygen tension ratio (aAO2)<0.36 (FiO2: 37-55%) was ranked the best threshold for decreasing the risk of IMV, very low certainty. Further, surfactant administration at an FiO2 40-45% possibly decreased mortality compared to rescue treatment when respiratory failure was diagnosed, certainty very low. The reasonable inference that could be drawn from these findings is that surfactant administration may be considered in preterm neonates of ≤30 weeks' with RDS requiring an FiO2 ≥ 40%. There was insufficient evidence for the comparison of FiO2 thresholds: 30% vs. 40%. The evidence was sparse for surfactant administration guided by lung ultrasound. For the sub-group >30 weeks, nebulized surfactant administration at an FiO2 < 30% possibly increased the risk of IMV compared to Intubate-Surfactant-Extubate at FiO2 < 30% and 40%, and less invasive surfactant administration at FiO2 40%, certainty very low. Surfactant administration may be considered in preterm neonates of ≤30 weeks' with RDS if the FiO2 requirement is≥40%. Future trials are required comparing lower FiO2 thresholds of 30% vs. 40% and that guided by lung ultrasound. None.

Clinical and Microbiological Outcomes and Follow-Up of Secondary Bacterial and Fungal Infections among Critically Ill COVID-19 Adult Patients Treated with and without Immunomodulation: A Prospective Cohort Study.

Nearly 10% of COVID-19 cases will require admission to the intensive care unit (ICU). Our aim was to assess the clinical and microbiological outcomes of secondary infections among critically ill COVID-19 adult patients treated with/without immunomodulation. A prospective observational cohort study was performed between 2020 and 2022 at a single ICU. The diagnosis and severity classification were established by the ECDC and WHO criteria, respectively. Eligible patients were included consecutively at admission, and followed for +30 days post-inclusion. Bloodstream-infections (BSIs), ventilator-associated bacterial pneumonia (VAP), and COVID-19-associated invasive pulmonary aspergillosis (CAPA) were defined according to international guidelines. Patient stratification was performed by immunomodulatory therapy administration (dexamethasone, tocilizumab, baricitinib/ruxolitinib). The primary outcome was any microbiologically confirmed major infectious complication, secondary outcomes were invasive mechanical ventilation (IMV) requirement and all-cause mortality. Altogether, 379 adults were included. At baseline, 249/379 (65.7%) required IMV and 196/379 (51.7%) had a cytokine storm. At +30 days post-inclusion, the rate of any microbiologically confirmed major infectious complication was 151/379 (39.8%), IMV requirement and all-cause mortality were 303/379 (79.9%) and 203/379 (53.6%), respectively. There were no statistically significant outcome differences after stratification. BSI, VAP, and CAPA episodes were mostly caused by Enterococcus faecalis (27/124, 22.1%), Pseudomonas aeruginosa (26/91, 28.6%), and Aspergillus fumigatus (20/20, 100%), respectively. Concerning the primary outcome, Kaplan-Meier analysis showed similar probability distributions between the treatment subgroups (118/299, 39.5% vs. 33/80, 41.3%, log-rank p = 0.22), and immunomodulation was not retained as its independent predictor in multivariate logistic regression. Secondary infections among critically ill COVID-19 adult patients represent a relevant burden, probably irrespective of immunomodulatory treatment.

Impacts of pregnancy and menopause on COVID-19 severity: A systematic review and meta-analysis of 4.6 million women.

COVID-19 pandemic is still a public health emergency of international concern. However, whether pregnancy and menopause impact the severity of COVID-19 remain unclear. This study is performed to investigate the truth. Study appraisal and Synthesis follows PRISMA guideline. Meta-analysis is performed in random-effects model. PubMed, Embase, Cochrane database, Central, CINAHL, ClinicalTrials.gov, WHO COVID-19 database, and WHO-ICTRP are searched until March 28 2023. In total, 57 studies (4,640,275 COVID-19 women) were analyzed. Pregnant women were at a lower risk of severe COVID-19, intensive care unit (ICU) admission and disease mortality compared to those nonpregnant women with comparable comorbidities. In contrast, pregnant women with more prepregnancy comorbidities were at a higher risk of severe COVID-19, ICU admission and invasive mechanical ventilation (IMV). In addition, pregnant women with pregnancy complications had a significantly increased risk of severe COVID-19 and ICU admission. Menopause increased COVID-19 severity, IMV requirement and disease mortality. Hormone replacement therapy (HRT) inhibited COVID-19 severity in postmenopausal women. Premenopausal and postmenopausal women had a lower chance of severe illness than age-matched men. The impact of pregnancy on COVID-19 severity was significant in Americans and Caucasians, while the effect of menopause on COVID-19 severity was only significant in Chinese. Pregnancy and menopause are protective and risk factors for severe COVID-19, respectively. The protective role of pregnancy on COVID-19 is minimal and could be counteracted or masked by prepregnancy or pregnancy comorbidities. The administration of estrogen and progesterone may prevent severe COVID-19.

Effectiveness of tocilizumab in non-intubated cases with COVID-19: a systematic review and meta-analysis.

Tocilizumab, a monoclonal IL-6 receptor blocker, is an effective agent for severe-to-critical cases of COVID-19; however, its target patients for the optimum use need to be detailed. We performed a systematic review and meta-analysis to define its effect among severely ill but non-intubated cases with COVID-19. We searched PubMed, Scopus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Medrxiv, and Biorxiv until February 13, 2022, for non-intubated cases, and included randomized-controlled trials (RCT) based on bias assessment. The primary outcomes were the requirement of invasive mechanical ventilation and mortality. Random effect and fixed-effect models were used. The heterogeneity was measured using the χ2 and I2 statistics, with χ2 p ≤ 0.05 and I2 ≥ 50% indicating the presence of significant heterogeneity. We registered the study to the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021232575. Among 261 articles, 11 RCTs were included. The pooled analysis of the 11 RCTs demonstrated that the rate of mortality was significantly lower in the tocilizumab group than in the control group (20.0% and 24.2%, OR: 0.84, 95% CI 0.73-0.96, and heterogeneity I2 = 0%. p = 0.82.). The mechanical ventilation rate was lower in the tocilizumab group than the control group (27% vs 35.2%, OR: 0.76, 95% CI 0.67-0.86, and heterogeneity I2 = 6%. p = 0.39). Among non-intubated severe COVID-19 cases, tocilizumab reduces the risk of invasive mechanical ventilation and mortality compared to standard-of-care treatment.

Utility of the Brixia CXR score, C-Reactive Protein and Absolute Neutrophil Count in Predicting the Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Mortality in Moderate to Severe COVID-19 Patients

Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderatesevere COVID-19 patients. Materials and Methods: This was a single-centre, retrospective, study on 122 COVID -19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) ≥ 14 days, and mortality. Results: 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39 -151) mg/L and 11.0 (4-30) mg/L (p &lt; 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p &lt;0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP ≥ 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC &gt;8500/μL predicted IMV requirement with an AUC of 0.657. The fifth day CRP ≥ 32 mg/L, ANC ≥ 11,000/ μL and Brixia CXR score ≥ 7 predicted a higher mortality in hospitalized patients. Conclusion: Baseline CRP (&gt; 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (&gt; 8500/μL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP ≥ 32 mg/L, ANC ≥ 11,000/ μL and Brixia CXR score ≥ 7 predicted a higher mortality.

Body mass index and its association with COVID-19 clinico-neurological outcomes: Findings from the Philippine CORONA study (P5-10.005)

<h3>Objective:</h3> To explore the association between body mass index (BMI) and clinico-neurological outcomes in a large cohort of patients with coronavirus disease 2019 (COVID-19). <h3>Background:</h3> We hypothesize that either abnormally low or high BMI significantly affects clinical and neurologic outcome measures in this subset of patients. <h3>Design/Methods:</h3> This is a secondary analysis of a 37-site, nationwide, multicenter, retrospective cohort study that investigated the clinical and neurological outcomes of adult patients with confirmed COVID-19 admitted from February to December 15, 2020. <h3>Results:</h3> We analyzed 4,463 patients with BMI and outcome data. A total of 790 (17.7%) and 710 (15.9%) had the primary outcome of in-hospital mortality and need for invasive mechanical ventilation (IMV), respectively. There was no significant association between WHO BMI groups and these outcomes. Using Asia-Pacific cutoffs showed a significant association between obesity and in-hospital mortality risk (P = 0.012). Being underweight was an independent predictor of prolonged IMV requirement regardless of BMI criteria used (P &lt; 0.01). Obesity correlated with the need for intensive care unit admission using Asia-Pacific cutoffs (P = 0.029). There was a significant association between any BMI abnormality and odds of severe/critical COVID-19 (P &lt; 0.05). Obese patients with concomitant acute neurological presentation/diagnosis during their COVID-19 admission were shown to have lower odds of neurologic recovery (P &lt; 0.05). <h3>Conclusions:</h3> We found BMI abnormalities to be associated with several adverse clinical and neurologic outcomes, although such associations may be more evident with the use of race-specific BMI criteria. <b>Disclosure:</b> Dr. Espiritu has nothing to disclose. Dr. Reyes has nothing to disclose. Carl Froilan Leochico has nothing to disclose. Marie Charmaine Sy has nothing to disclose. Emilio Villanueva III has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LabX Corporation. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving as a Consultant for Torrent Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Medichem Philippines. Michelle Anlacan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Hi Eisai Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Natrapharm Philippines. Michelle Anlacan has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Alzheimer’s disease association of the philippines. Michelle Anlacan has received research support from Philippine Council for Health Research and Development. Michelle Anlacan has received research support from Philippine Neurological Association. Roland Dominic Jamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for torrent. Roland Dominic Jamora has received research support from CCXDP.

The ACE rs1799752 Variant Is Associated with COVID-19 Severity but Is Independent of Serum ACE Activity in Hospitalized and Recovered Patients.

This paper assesses the association of the insertion/deletion ACE (angiotensin-converting enzyme) variant (rs1799752 I/D) and the serum ACE activity with the severity of COVID-19 as well as its impact on post-COVID-19, and we compare these associations with those for patients with non-COVID-19 respiratory disorders. We studied 1252 patients with COVID-19, 104 subjects recovered from COVID-19, and 74 patients hospitalized with a respiratory disease different from COVID-19. The rs1799752 ACE variant was assessed using TaqMan® Assays. The serum ACE activity was determined using a colorimetric assay. The DD genotype was related to risk for invasive mechanical ventilation (IMV) requirement as an indicator of COVID-19 severity when compared to the frequencies of II + ID genotypes (p = 0.025, OR = 1.428, 95% CI = 1.046-1.949). In addition, this genotype was significantly higher in COVID-19 and post-COVID-19 groups than in the non-COVID-19 subjects. The serum ACE activity levels were lower in the COVID-19 group (22.30 U/L (13.84-32.23 U/L)), which was followed by the non-COVID-19 (27.94 U/L (20.32-53.36 U/L)) and post-COVID-19 subjects (50.00 U/L (42.16-62.25 U/L)). The DD genotype of the rs1799752 ACE variant was associated with the IMV requirement in patients with COVID-19, and low serum ACE activity levels could be related to patients with severe disease.

Severe COVID-19: Drugs and Clinical Trials.

By January of 2023, the COVID-19 pandemic had led to a reported total of 6,700,883 deaths and 662,631,114 cases worldwide. To date, there have been no effective therapies or standardized treatment schemes for this disease; therefore, the search for effective prophylactic and therapeutic strategies is a primary goal that must be addressed. This review aims to provide an analysis of the most efficient and promising therapies and drugs for the prevention and treatment of severe COVID-19, comparing their degree of success, scope, and limitations, with the aim of providing support to health professionals in choosing the best pharmacological approach. An investigation of the most promising and effective treatments against COVID-19 that are currently available was carried out by employing search terms including "Convalescent plasma therapy in COVID-19" or "Viral polymerase inhibitors" and "COVID-19" in the Clinicaltrials.gov and PubMed databases. From the current perspective and with the information available from the various clinical trials assessing the efficacy of different therapeutic options, we conclude that it is necessary to standardize certain variables-such as the viral clearance time, biomarkers associated with severity, hospital stay, requirement of invasive mechanical ventilation, and mortality rate-in order to facilitate verification of the efficacy of such treatments and to better assess the repeatability of the most effective and promising results.

Interleukin-28 as a Promising Marker for Predicting Invasive Mechanical Ventilation Requirement and Mortality in COVID-19 Patients.

The study aimed to evaluate serum interleukin-28 levels in COVID-19 patients and correlate the results with disease severity. This study included 90 patients who presented to the COVID-19 outpatient clinics, hospital wards, and intensive care units. Serum interleukin-28, C-reactive protein, lactate dehydrogenase, fibrinogen, d-dimer, and ferritin levels were measured. Patients were divided into 3 groups based on clinical severity to mild, moderate, and severe groups (each group consisted of 30 patients). There were significant differences in serum C-reactive protein, lactate dehydrogenase, fibrinogen, d-dimer, ferritin, and interleukin- 28 levels between all groups. The mean serum interleukin-28 levels of all patients were 383.74 ± 63.58 ng/L. The mean serum interleukin-28 levels were 335.52 ± 42.12 ng/L in the mild group, 366.88 ± 41.27 ng/L in the moderate group, and 453.46 ± 36.78 ng/L in the severe group. There were significant differences in comparisons of all pairs (P < .05). Interleukin-28 may be a promising biomarker for detecting disease severity in COVID-19 patients.

Echocardiographic detection of transpulmonary bubble transit during coronavirus-2019 disease (COVID-19)

BackgroundTranspulmonary bubble transit (TPBT) detected with contrast echocardiography is reported as a sign of intrapulmonary arteriovenous shunt. However, its pathological meaning is not clear during coronavirus-2019 disease (COVID-19) related acute respiratory distress syndrome (ARDS). Our aim was to determine the prevalence and clinical significance of TPBT detection during COVID-19 related ARDS. MethodsWe carried out a prospective observational study performed in a high complexity intensive care unit from Argentina. Patients with COVID-19 related ARDS underwent transthoracic echocardiography with saline contrast. Moderate-to-large TPBT was defined as right-to-left passage of at least twelve bubbles to left chambers after at least three cardiac cycles and complete opacification of the right atrium. ResultsWe analyzed the results of 28 patients (24 men and 4 women). Seventy-five percent of the patients received invasive mechanical ventilation. Moderate-to-large TPBT was detected in 1 patient (3.5%). Among the 27 patients without significant TPBT, 23 had no TPBT and 4 had a minor TPBT. TPBT was not associated with invasive mechanical ventilation requirement (p=0.5737) nor in-hospital mortality (p=1). ConclusionsTPBT was not associated with severe hypoxemia or invasive mechanical ventilation requirement, although more studies are needed to further clarify its contributing role in COVID-19 hypoxemia.

Comparison of Parkinson’s patients with and without COVID-19 in terms of prognosis

Background &amp; Objectives: This study aimed to compare PD patients with and without COVID-19 and to evaluate the associated factors about prognosis. Methods: The data of 37 hospitalized PD patients associated with COVID-19 pneumonia were evaluated. It was compared with the data of 40 PD patients who did not have COVID-19 in the same period. Clinical findings, prognosis, mortality and other related factors were compared in PD patients with and without COVID-19. Results: Hypertension was higher comorbid disease in PD patients with COVID-19 (p = 0.005). The duration of PD was longer in patients without COVID-19 disease (6.02 ± 2.80 vs 5.08 ± 4.59) (p = 0.028). In PD patients with COVID-19, the most common symptoms were myalgia-arthralgia (73.0%) and fatigue (48.6%). Intensive care was required in 17 (45.9%) patients, and invasive mechanical ventilation (IMV) was required in 9 (24.3%) patients. The in-hospital mortality rate was 29.7% (n = 11). Mortality and IMV requirement were higher in patients whose initial symptom was diarrhea (p = 0.004, p = 0.008, respectively). No correlation was detected between PD stage, treatment options and prognosis (p &lt; 0.05). Conclusion: Mortality rate and IMV requirement are higher in PD patients with COVID-19 pneumonia, particularly in patients with initial symptoms of diarrhea. These patients should be followed more carefully in terms of probable poor prognosis.

Disparities between Latinx migrants and Spanish natives in COVID-19 outcome in Madrid

ABSTRACT Previous studies have suggested an increased susceptibility of COVID-19 among certain populations. We analyzed whether COVID-19 presentation and mortality differ between Latinx migrants and Spanish natives. Methods and Materials. COVID-19 patients between 35–64 years old admitted between January 26th-May-5th 2020 were reviewed. Demographics, major comorbidities, symptoms, signs and analytical parameters on admission were recorded. Respiratory failure was defined as PaO2/FiO2 ≤ 200 mmHg, noninvasive or invasive mechanical ventilation requirement at any time during hospitalization. A propensity score (PS) adjustment was created between Latinx and Spanish. A multivariable logistic regression model adjusted by the PS was performed to evaluate the effects of different variables on mortality. Results. 894 patients: 425 (47.5%) Latinx and 469 (52.5%) Spanish natives were included. Latinx were younger (50 vs 55 years p < 0.001) and had less comorbidities (29.4% vs 55.0% p < 0.001) than Spanish natives. More often they exhibited fever (22.1% vs 9.8% p = 0.018) and had higher inflammatory markers (PCR) (11.3 mg/dl vs 7.7 mg/dl p < 0.001). Mortality seemed lower among Latinx (4.7% vs 8.7%, p = 0.017). No association was found between ethnicity and mortality. Respiratory failure [OR = 23.978 (CI 95% 9.4–60.1) p < 0.001], LDH [OR (per unitary increment) = 1.002; CI95% (1.000–1.004;p = 0.036] and PCR [OR (per unitary increment) = 1.044 (CI95% 1.06–1.08); p = 0.02] were independently associated to mortality. Conclusions: We were unable to identify significant ethnic disparities between Latinx and Spanish natives in terms of COVID-19 mortality. Universal access to the health care system in Spain may have contributed to a better outcome of Latinx patients. Differences previously described might be a consequence of socioeconomic disparities.

Outcomes and Prognostic Factors in Critical Patients with Hematologic Malignancies.

Patients with hematologic malignancies (HMs) have a significantly elevated risk of mortality compared to other cancer patients treated in the intensive care unit (ICU). The prognostic impact of numerous poor outcome indicators has changed, and research has yielded conflicting results. This study aims to determine the ICU and hospital outcomes and risk factors that predict the prognosis of critically ill patients with HMs. In this retrospective study, conducted at a referral hospital in Taiwan, 213 adult patients with HMs who were admitted to the medical ICU were evaluated. We collected clinical data upon hospital and ICU admission. Using a multivariate regression analysis, the predictors of ICU and hospital mortality were assessed. Then, a scoring system (Hospital outcome of critically ill patients with Hematological Malignancies (HHM)) was built to predict hospital outcomes. Most HMs (76.1%) were classified as high grade, and more than one-third of patients experienced a relapsed or refractory disease. The ICU and hospital mortality rates were 55.9% and 71.8%, respectively. Moreover, the disease severity was high (median Sequential Organ Failure Assessment (SOFA) score: 11 and Acute Physiology and Chronic Health Evaluation (APACHE II) score: 28). The multivariate analysis revealed that high-grade HMs, invasive mechanical ventilation requirement, renal replacement therapy initiation in the ICU, and a high SOFA score correlated with ICU mortality. Furthermore, a higher HHM score predicted hospital mortality. This study demonstrates that ICU mortality primarily correlates with the severity of organ dysfunction, whereas the disease status markedly influences hospital outcomes. Furthermore, the HHM score significantly predicts hospital mortality.

Outcome of severe leptospirosis presenting with ARDS in respiratory ICU

Introduction: Acute Respiratory Distress Syndrome (ARDS) is a rare presentation and a major complication of leptospirosis associated with high mortality despite advances in management. Methods: We conducted a retrospective observational study, in 48 patients presenting with ARDS due to leptospirosis. Clinical presentation, risk factors, management and outcome of patients were noted. Factors associated with survival and mortality were studied. Results: Our study showed a male preponderance (87%) with a mean age of presentation of 31.5 years. All patients presented with multiorgan failure. PaO2/FiO2 ratio less than 100 on 3rd day was associated with 90% mortality. The requirement for invasive mechanical ventilation carried a mortality risk of 70.4%. Overall mortality was 39.6%. Conclusion: Leptospirosis can cause serious ARDS with a high case fatality. Prompt treatment with non-invasive mechanical ventilation to maintain haemodynamic stability and intravenous steroids can improve the outcome.

EFFECTS OF DIABETES AND FIRST-WEEK HYPERGLYCEMIC EPISODE FREQUENCY ON THE MORTALITY AND INFLAMMATION IN CRITICALLY ILL COVID-19 PATIENTS: A CASE-CONTROL STUDY.

We know that mortality had increased in diabetic patients with COVID-19 pneumonia. The aim of this study was to compare the mortality and inflammation parameters difference in critically ill COVID-19 patients according to their admission HbA1c levels and diabetes mellitus status. Secondary aim was to evaluate the effect of the first week hyperglycemic episode frequency on mortality. Critically ill COVID-19 patients who were tested for HbA1c levels on ICU admission were analyzed retrospectively. Of 218 COVID PCR(+) patients, 139 met the inclusion criteria in study period. The median age was 67 [57-76] years and 55(40%) of them were female. Seventy-six (55%) of the patients required invasive mechanical ventilation (IMV). The IMV requirement was higher in diabetic patients (p=0.01). When the groups were compared in terms of inflammatory parameters no significant difference was found except for admission and first week's highest fibrinogen levels (p=0.02 and p=0.03, respectively). In multivariate analysis, fibrinogen levels were not determined as a risk factor for mortality. Overall ICU mortality was 43% (60/139). In group-1 23 (37%), in group-2 27 (57%), and in group-3 10 (34%) patients had died. There was no statistically significant difference between groups in terms of mortality (p=0.05). Records of 96 (69%) patients revealed there were more than five glucose readings over 180mg/dL during the first week. Mortality was higher in patients with more frequently hyperglycemic recordings (p=0.03). There was no significant mortality and inflammatory parameters difference in patients with and without diabetes. However, more than five glucose readings over 180mg/dL during the first week were found with increased mortality.

COVID-19 outcomes in people living with HIV: Peering through the waves

ObjectiveTo evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. MethodsThis is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. ResultsThroughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). ConclusionsOur results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Impact of vaccination against COVID-19 on patients with cancer in ACHOC-C19 study: Real world evidence from one Latin American country.

Introduction: During the pandemic, it has been recommended that vaccination against COVID-19 be a priority for patients with cancer; however, these patients were not included in the initial studies evaluating the available vaccines. Objective: To define the impact of vaccination against COVID-19 in preventing the risk of complications associated with the infection in a cohort of patients with cancer in Colombia. Methods: An analytical observational cohort study, based on national registry of patients with cancer and COVID 19 infection ACHOC-C19, was done. The data was collected from June 2021, until October 2021. Inclusion criteria were: Patients older than 18 years with cancer diagnosis and confirmed COVID-19 infection. Data from the unvaccinated and vaccinated cohorts were compared. Outcomes evaluated included all-cause mortality within 30 days of COVID-19 diagnosis, hospitalization, and need for mechanical ventilation. The estimation of the effect was made through the relative risk (RR), the absolute risk reduction (ARR) and the number needed to treat (NNT). Multivariate analysis was performed using generalized linear models. Results: 896 patients were included, of whom 470 were older than 60 years (52.4%) and 59% were women (n=530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of clinical outcomes among the unvaccinated vs vaccinated patients were: for hospitalization 42% (95% CI: 38.7%-46.1%) vs 29%; (95% CI: 22.4%-36.5%); for invasive mechanical ventilation requirement 8.4% (n=61) vs 4.6% (n=8) and for mortality from all causes 17% (n=123) vs 4.65% (n=8). Conclusion: In our population, unvaccinated patients with cancer have an increased risk of complications for COVID -19 infection, as hospitalization, mechanical ventilation, and mortality. It is highly recommended to actively promote the vaccination among this population.

Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score

ObjectiveTo develop and validate an updated lung injury prediction score for coronavirus disease 2019 (COVID-19) (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in COVID-19. Patients and MethodsThis was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were performed on remaining patients enrolled from more than 120 hospitals in 15 countries. The original lung injury prediction score (LIPS) was calculated and enhanced using reported COVID-19–specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, and progression in WHO ordinal scale. ResultsThe derivation cohort consisted of 3710 patients, of whom 1041 (28.1%) developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an area under the curve (AUC) of 0.79 compared with original LIPS (AUC, 0.74; P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS’s performance was comparable in the validation cohort of 5426 patients (15.9% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC, 0.68; P<.001). The c-LIPS’s performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively. ConclusionIn this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.

Mortality and Associated Factors in Patients with COVID-19: Cross-Sectional Study.

The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly virulent and causes coronavirus disease 2019 (COVID-19), resulting in high morbidity and mortality mainly associated with pulmonary complications. Because this virus is highly transmissible, it was quickly spread globally, resulting in COVID-19 being declared as a pandemic. This study aimed to analyze the prevalence of mortality and the factors related to mortality due to COVID-19 in patients with severe acute respiratory syndrome (SARS) at a university hospital in the Central—West region of Brazil. This retrospective cross-sectional study was based on an analysis of the medical records of patients with SARS aged >18 years and admitted to an intensive care unit due to COVID-19 with the requirement of invasive mechanical ventilation. Hospital death was considered as an outcome variable in this study. Moreover, demographic and lifestyle-related variables as well as the therapeutic measures used during the hospital stay were recorded and correlated with the death outcome. After excluding 188 medical records, 397 were analyzed. Most of the participants were men (59.7%), and the mortality rate in patients with SARS due to COVID-19 was 46.1%. Multiple regression analysis indicated that the independent factors associated with mortality in patients with SARS due to COVID-19 were the age of >60 years (p < 0.001) and the use of azithromycin (p = 0.012). Protective factors for mortality were considered as not having the following diseases: hyperthyroidism, asthma, hepatic inheritance, and not being a smoker. The mortality rate in patients with SARS due to COVID-19 was associated with older age and the use of azithromycin.

Impact of accumulative smoking exposure and chronic obstructive pulmonary disease on COVID-19 outcomes: report based on findings from the Japan COVID-19 task force

ObjectivesSmoking and chronic obstructive pulmonary disease (COPD) are risk factors for severe COVID-19. However, limited literature exists on the effect of COPD and smoking on COVID-19 outcomes. This study examined the impact of smoking exposure in pack-years (PY) and COPD on COVID-19 outcomes among smokers in Japan. MethodsThe study included 1266 smokers enrolled by the Japan COVID-19 task force between February 2020 and December 2021. PY and COPD status was self-reported by patients. Patients were classified into the non-COPD (n = 1151) and COPD (n = 115) groups; the non-COPD group was further classified into <10 PY (n = 293), 10-30 PY (n = 497), and >30 PY (n = 361). The study outcome was the need for invasive mechanical ventilation (IMV). ResultsThe incidence of IMV increased with increasing PY and was highest in the COPD group (<10 PY = 7.8%, 10-30 PY = 12.3%, >30 PY = 15.2%, COPD = 26.1%; P <0.001). A significant association was found for IMV requirement in the >30 PY and COPD groups through univariate (odds ratio [OR]: >30 PY = 2.11, COPD = 4.14) and multivariate (OR: >30 PY = 2.38; COPD = 7.94) analyses. Increasing PY number was also associated with increased IMV requirement in patients aged <65 years. ConclusionCumulative smoking exposure was positively associated with COVID-19 outcomes in smokers.