Lethal Outcome In Patients Research Articles

Parameters of leukopoiesis and thrombocytopenia in early urosepsis as potential predictors of a lethal outcome in hospitalized patients

Aim. To perform a comparative analysis of leukopoiesis parameters and platelet count in peripheral blood with evaluation of their changes in the first 48 hours from urosepsis (US) verification in hospitalized patients depending on the outcome of the disease.Materials and methods. A retrospective comparative study included 40 patients with US divided into a group of deceased (n = 10) and a group of recovered (n = 30) individuals. Along with a full clinical and paraclinical examination, which is a routine practice in the urology clinic in case of suspected (confirmed) sepsis, we performed a differentiated assessment of leukopoiesis and platelet count in peripheral blood at baseline (at the moment of US verification) and 48 hours after US verification. The assessment included determination of the immature granulocyte count, investigation of neutrophil granularity intensity (NEUT-GI) and neutrophil reactivity intensity (NEUT-RI), and measurement of the mean platelet volume (MPV).Results. The baseline level of organ dysfunction graded by the SOFA (Sequential Organ Failure Assessment) score was significantly higher in deceased patients than in survivors (6 points vs. 3 points, respectively; p = 0.001). The group of the deceased was characterized by lower platelet and monocyte levels. The ROC analysis with the calculation of area under the curve (AUC) identified the following potential predictors of a lethal outcome in US: proportion of monocytes from the total leukocyte count at baseline ≤ 5.5% (AUC 0.732, p = 0.032), proportion of eosinophils from the total leukocyte count at baseline ≤ 0% (AUC 0.756, p = 0.011), absolute eosinophil count at baseline ≤ 0.01 × 109 / l (AUC 0.802, p = 0.009), absolute basophil count at baseline ≤ 0.03 × 109 / l (AUC 0.718, p = 0.028), NEUT-GI at baseline ≤ 153.2 scatter intensity (SI) units (AUC 0.754, p = 0.021), NEUT-RI at baseline ≤ 59.3 SI units (AUC 0.737, p = 0.024) and their increase after 48 hours by > 0.9 SI units (AUC 0.852, p = 0.001) or by > 1.34% (AUC 0.844, p = 0.003), platelet count at baseline ≤ 144 × 109 / l (AUC 0.762, p = 0.007) and after 48 hours ≤ 174 × 109 / l (AUC 0.769, p < 0.007).Conclusion. The assessment of the platelet count and leukopoiesis parameters, including the ones characterizing neutrophil maturation (NEUT-RI, NEUT-GI), in the first 48 hours from US verification, can be effective predictors of a lethal outcome in patients with US.

Prognostic indicators of vector electrocardiography in patients with chronic heart failure with reduced left ventricular ejection fraction

Relevance. Computed vector electrocardiography (VECG) is a method of visualization of the total electrical vector of the heart in 3‑dimensional space based on 12 leads and a known computational procedure. VECG may be an additional method to assess the severity and prognosis of patients with chronic heart failure (CHF).Objective. To determine VECG parameters associated with unfavorable prognosis in patients with CHF with reduced ejection fraction (CHFpEF).Materials and methods. VECGs of 100 patients with CHFpEF were analyzed. All patients underwent baseline clinical examination, echocardiography and natriuretic peptide (NT-proBNP) determination. Patients with both ischemic (55 patients, of whom 10 died) and non-ischemic (45 patients, of whom 6 died) etiologies were included. During follow-up for 24 months, fatal outcomes were recorded. The correlation of ECG and NT-proBNP parameters with patients’ prognosis was evaluated.Results. A total of 16 patients died in the study. According to VECG data the surviving patients had lower spatial QRS-T angle in comparison with the deceased ones (p=0,025). There was a trend towards lower planarity index in the group of deceased patients (p=0.09). ROC-analysis was carried out, according to the results of which with sensitivity 76,5% and specificity 62,7% the cut-off value of 156º of QRS-T spatial angle was obtained, exceeding which the probability of lethal outcome will increase (p=0,002). There was a correlation between lethal outcome in patients with a QRS-T angle value greater than 156º and NT-proBNP level (p=0.017). The threshold value of unfavorable prognosis for NT-proBNP was 927.1 pg/ml.Conclusion. The VECG method is available and promising in the diagnosis and monitoring of patients with CHFpEF. The most informative parameters of ECG for detection of suspicion of CHFpEF are spatial QRS-T angle and planarity index. The results obtained in this study allow us to speak about the prognostic value of the QRS-T angle for patients with CHFpEF.

Left atrial myocardial strain, assessed by the method of speckle-tracking echocardiography, as a marker of fibrosis in patients with ischemic stroke

Introduction. Cardioembolic stroke (CE) is one of the main etiopathogenetic subtypes of ischemic stroke and accounts for approximately 17% of all patients with ischemic stroke. Currently, there is a search for widely accessible radiological diagnostic methods that allow for the accurate diagnosis of left atrial (LA) dysfunction. Among these methods is transthoracic strain echocardiography (EchoCG), which provides additional information about the degree of deformation and change in shape of the LA during the cardiac cycle. To date, the association between strain EchoCG parameters and the severity of fibrotic changes in the LA among patients with CE remains unstudied.Objective. To evaluate the relationship between myocardial deformation parameters of the left atrium and the degree of fibrosis in patients with CE, as well as the impact of LA myocardial deformation changes on the prognosis of patients with CE.Materials and Methods. A prospective cross-sectional study included 132 patients who underwent evaluation and treatment in the Department of Emergency Neurology at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2020 to 2022. Group 1 consisted of 12 patients who died during hospitalization, while Group 2 comprised 120 patients who were discharged from the department after receiving treatment.Results. Deceased patients, compared to survivors, were characterized by the presence of LA myocardial remodeling. Statistically significant differences in LA myocardial deformation parameters were found between the study groups. Correlation analysis revealed statistically significant associations between LA myocardial deformation parameters and the severity of fibrotic changes. In the multifactorial logistic regression model, significant effects on the prognosis of patients were observed for LA strain peak systolic circumferential strain rate (LA-Scs) and LA strain peak systolic longitudinal strain rate (LA-Sls), with each 1% increase in the parameter associated with a 1.128-fold and 1.075-fold increase in the odds of a lethal outcome, respectively (OR: 1.128, 95% CI: 1.021–1.25, p = 0.017, and OR: 1.075, 95% CI: 1.009–1.15, p = 0.025).Conclusions. The conducted study established a strong correlation between LA myocardial deformation and LA fibrosis and the degree of fibrosis in the LA. LA myocardial deformation parameters can be used in risk stratification for the development of a lethal outcome in patients with CE.

Micro–Nanoplastics as Potential Carriers of Dioxins and Toxoplasma gondii in Patients with Carotid Atheromas

A recent major study has shown that there is an increased risk of myocardial infarction, stroke and lethal outcomes in patients affected by carotid atheromas that contain micro-nanoplastics (MNPs) compared to subjects that do not have MNPs in their lesions [...]

Evaluation of systemic immune inflammation index as a predictor of lethal outcome in patients with thoracic empyema

Purpose: No study to date has investigated the prognostic ability of the recently introduced “systemic immune-inflammation index” (SII) in thoracic empyema. Therefore, we aimed to evaluate the association between SII and outcome in such patients. Methods: The single-center retrospective study involved 84 patients with thoracic empyema admitted to the Clinic of Thoracic Surgery at a University Hospital Stara Zagora between January 2021 and October 2023. Clinical and laboratory parameters were recorded at admission. We analyzed the area under receiver operating characteristics (AUROC) curves of SII, qSOFA, and SIRS and compared their prognostic value. Results: The observed in-hospital mortality was 10.7%. As a predictor of death, SII showed the best prognostic ability compared to SIRS (AUROC = 0.782 vs. 0.676) and qSOFA (AUROC = 0.782 vs. 0.747). At the optimal cut-off value of > 3269 x 109/L, we identified a sensitivity of 71.4% and a specificity of 78.7%. Conclusion: In thoracic empyema, SII could be routinely used as a simple, low-cost, and easily assessable indicator for patients at higher risk of poor outcome.

Application of the rectus abdominal muscle in reconstructive and recovery surgery of chest wall defects

Introduction. Autologous plastic tissues (muscles and greater omentum) are preferable in the reconstruction of chest wall defects in infectious and inflammatory diseases of the chest wall. Extended and deep defects can be eliminated by flaps of the rectus abdominis muscle.Aid. To study the effectiveness of various options for the use of flaps of the rectus abdominis muscle in plastic surgery of chest wall defects of infectious and inflammatory origin.Object and methods. A retrospective analysis of the results of treatment of 34 patients with osteomyelitis of the sternum and ribs of various etiologies was carried out for the period from January 1, 2012 to May 30, 2023. In 32 patients, the main diagnosis was poststernotomy mediastinitis, 2 patients had post-radiation osteomyelitis of the sternum and ribs after combined cancer treatment. mammary gland. The majority of patients (n = 29) underwent a two-stage approach to treatment using vacuum therapy at the stage of relief of acute inflammation. All patients underwent plasty with a flap of the rectus abdominis muscle. The options for surgical intervention and the outcome of treatment were studied.Results. The area of the defect to be repaired in patients ranged from 50 cm2 to 270 cm2 (mean 143.1 ± 15.3 cm2). There were no intraoperative complications in the patients. The postoperative period was complicated by various wound complications in 9 patients. Marginal necrosis of the skin part of the graft was revealed in 3 patients with full-thickness permanent graft plasty. In 3 patients, despite wound drainage, postoperative seromas were detected. Reoperations were performed in 2 patients: in one case, bleeding from the vein of the fullthickness flap was stopped, in the other case, partial necrosis of the full-thickness flap was detected, which required a second operation and revision of the flap. In 1 patient, the hematoma was emptied 3 days after the operation. The average duration of inpatient treatment of patients was 19.3 ± 2.8 days (range 17 to 38 days). There were no lethal outcomes in patients with muscle plasty with a permanent graft flap. In 1 patient, a postoperative hernia was formed in the region of the anterior abdominal wall. Recurrence of osteomyelitis of the ribs was diagnosed in 1 person 16 months after surgery.Conclusions. The rectus abdominis muscle as an isolated and full-thickness flap is the optimal plastic material for eliminating defects in both the lower part of the sternum and extensive defects in the anterior and lateral surfaces of the chest wall.

Variation of laboratory analyzes according to severity of illness in patients with COVID-19

The Covid-19 disease is a new, unexplored problem for mankind. In a short time, the epidemic of the new coronavirus infection has spread to more than 200 countries. Changes in blood parameters are important for understanding the pathogenesis of this disease and for improving the treatment and diagnosis of COVID-19. The patients with coronavirus infection were evaluated according to the severity of the clinical symptoms and peripheral blood analysis. The general blood analysis showed that in the group of critically ill patients there was an increase in the number of leukocytes at the expense of neutrophils with segmental nuclei and rod nuclei. High reliable values of neutrophils and lymphocytes in peripheral blood were obtained as the most important predictors of severity of illness and risk of lethal outcome in patients.

An artificial intelligence approach for prognosis of COVID-19 course in hospitalized patients

Aim. To create algorithm and risk calculator for predicting the lethal outcome in patients with COVID-19.Materials and methods. Based on machine learning approach mortality risk calculator was developed in Almazov National Medical Research Centre using data of the hospitalised patients with an established diagnosis of COVID-19 (n=4071).Results. This mathematical model, which includes 11 significant features, has been proposed for estimation of fatal outcomes in the Clinical Infectious Hospital named after S.P. Botkin. Some key features were not assessed in most hospitals according to accepted standards of care for COVID-19. So systematic analysis of factors affecting the course of disease in patients (n=2876) were conducted and «urea» and «total protein» were replaced with «sex» and «BMI». Modified algorithm demonstrated high sensitivity and specificity. Conclusion. This calculator is able to predict hospitalisation outcome with high accuracy in patients infected with different strains of SARS-CoV-2. This decision support system may be used for risk stratification and following correct patients routing.

Prognostic and predictive value of a novel 100-point scale in patients with T1–2N0M0 breast cancer

Aim. To increase the efficacy of systemic breast cancer therapy and reduce inappropriate prescriptions using individual immunohistochemical tumor characteristics, as well as to develop prognostic scales to ensure a tailored approach to adjuvant systemic treatment in breast cancer patients. Materials and methods. We conducted a comprehensive study that included collection of literature data on clinical, pathomorphological, prognostic, and predictive factors of breast cancer, as well as a retrospective cohort study using the data from the cancer registry. We also performed histological and immunohistochemical examination of tumor tissue samples from breast cancer patients (for the retrospective cohort study) and statistical data analysis. A total of 1,216 patients with T1–2N0M0 breast cancer were included in this study. Histological and immunohistochemical examinations of tissue samples (paraffin blocks) were conducted in the laboratory of N. N. Petrov National Medical Research Center of Oncology. We stained slides for both routinely used markers (including estrogen receptors, progesterone receptors, HER2, and Ki-67) and other markers (CK14, FOXA1, FOXP3, PD-L1, P53, SMA, androgen receptors, E-cadherin, CD4, CD8, CK5 / 6, EGFR).We analyzed risk factors for lethal outcomes in patients from this group to develop prognostic scales and compared their results. Results. We evaluated the most clinically and statistically significant factors affecting mortality. Using logistic regression, we chose 10 factors that had the greatest impact on the outcomes and then produced several scales, includinga 10-point regression scale (based on 10 most significant factors identified). Survival analysis in high-risk and low-risk patients using the regression scale demonstrated significant differences between these groups (р <0.00001). The assessment of adjuvant chemotherapy efficacy in the combined group of intermediate- and high-risk patients (as estimated by the regression model) showed that intermediate- and high-risk patients receiving adjuvant chemotherapy had significant differences in their survival (р = 0.0057). The regression scale for 10-year prognosis demonstrated sufficient sensitivity (58.05 %), specificity (69.47 %) and ef fectiveness (63.76 %). Conclusion. Our regression prognostic scale includes markers with a high prognostic value. The multifactorial approach used in the developed regression scale for breast cancer 10-year prognosis increases its accuracy and reliability.

Predictors of Carbohydrate Metabolism Disorders and Lethal Outcome in Patients after Myocardial Infarction: A Place of Glucose Level.

The aim of this study was to reveal statistical patterns in patients with acute myocardial infarction (AMI) that cause the development of carbohydrate metabolism disorders (CMD) (type 2 diabetes mellitus and prediabetes) and death within 5 years after AMI. 1079 patients who were treated with AMI in the Almazov National Medical Research Center were retrospectively selected for the study. For each patient, all data from electronic medical records were downloaded. Statistical patterns that determine the development of CMDs and death within 5 years after AMI were identified. To create and train the models used in this study, the classic methods of Data Mining, Data Exploratory Analysis, and Machine Learning were used. The main predictors of mortality within 5 years after AMI were advanced age, low relative level of lymphocytes, circumflex artery lesion, and glucose level. Main predictors of CMDs were low basophils, high neutrophils, high platelet distribution width, and high blood glucose level. High values of age and glucose together were relatively independent predictors. With glucose level >11 mmol/L and age >70 years, the 5-year risk of death is about 40% and it rises with increasing glucose levels. The obtained results make it possible to predict the development of CMDs and death based on simple parameters that are easily available in clinical practice. Glucose level measured on the 1st day of AMI was among the most important predictors of CMDs and death.

Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit

BackgroundUnpredictable vegetative deteriorations made the treatment of patients with acute COVID-19 on intensive care unit particularly challenging during the first waves of the pandemic. Clinical correlates of dysautonomia and their impact on the disease course in critically ill COVID-19 patients are unknown.MethodsWe retrospectively analyzed data collected during a single-center observational study (March 2020–November 2021) which was performed at the University Medical Center Hamburg-Eppendorf, a large tertiary medical center in Germany. All patients admitted to ICU due to acute COVID-19 disease during the study period were included (n = 361). Heart rate variability (HRV) and blood pressure variability (BPV) per day were used as clinical surrogates of dysautonomia and compared between survivors and non-survivors at different time points after admission. Intraindividual correlation of vital signs with laboratory parameters were calculated and corrected for age, sex and disease severity.ResultsPatients who deceased in ICU had a longer stay (median days ± IQR, survivors 11.0 ± 27.3, non-survivors 14.1 ± 18.7, P = 0.85), in contrast time spent under invasive ventilation was not significantly different (median hours ± IQR, survivors 322 ± 782, non-survivors 286 ± 434, P = 0.29). Reduced HRV and BPV predicted lethal outcome in patients staying on ICU longer than 10 days after adjustment for age, sex, and disease severity. Accordingly, HRV was significantly less correlated with inflammatory markers (e.g. CRP and Procalcitonin) and blood carbon dioxide in non-survivors in comparison to survivors indicating uncoupling between autonomic function and inflammation in non-survivors.ConclusionsOur study suggests autonomic dysfunction as a contributor to mortality in critically ill COVID-19 patients during the first waves of the pandemic. Serving as a surrogate for disease progression, these findings could contribute to the clinical management of COVID-19 patients admitted to the ICU. Furthermore, the suggested measure of dysautonomia and correlation with other laboratory parameters is non-invasive, simple, and cost-effective and should be evaluated as an additional outcome parameter in septic patients treated in the ICU in the future.

ПРОГНОЗ НАСТУПЛЕНИЯ ЗНАЧИМЫХ ИШЕМИЧЕСКИХ СОБЫТИЙ И ЛЕТАЛЬНОГО ИСХОДА У БОЛЬНЫХ ИНФАРКТОМ МИОКАРДА НА ФОНЕ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ

Introduction. Myocardial infarction remains significant due to its high prevalence and disability. Of particular importance is the prediction of the risk of adverse events in myocardial infarction patients with cardiorespiratory comorbidity, in particular with chronic obstructive pulmonary disease. It can be assumed that endogenous intoxication syndrome can be considered as a predictor of life-threatening events (repeated myocardial infarction, stroke) and lethal outcome in patients with myocardial infarction against chronic obstructive pulmonary disease. Aim. The aim is to determine the probability of combined endpoint development (repeated myocardial infarction, stroke, lethal outcome) in patients with myocardial infarction against chronic obstructive pulmonary disease during 12-month follow-up depending on gender-anamnestic and clinical-functional characteristics. Material and methods. We examined 325 patients with myocardial infarction - 195 patients with myocardial infarction against chronic obstructive pulmonary disease and 130 patients with myocardial infarction without chronic obstructive pulmonary disease (comparison group). As markers of endogenous intoxication syndrome, we studied middle weight molecules, hematological intoxication indices, blood gas indices, apoptosis, protein and lipid peroxidation and antioxidant protection, inflammation and renal function. Statistical data processing was performed using SPSS 26.0 software package. Results and discussion. Two-stage cluster analysis resulted in four clusters characterizing the type of endogenous intoxication syndrome: «polymarker-retentive», «necrotic- inflammatory», «hypoxic-inflammatory» and a cluster with no endogenous intoxication syndrome. The polymarker- retentive type of endogenous intoxication syndrome prevailed among patients with myocardial infarction against chronic obstructive pulmonary disease. Recurrent myocardial infarction, stroke and mortality constituted the combined endpoint. A decision tree was constructed to determine the probability of developing the combined endpoint in patients with myocardial infarction against the background of chronic obstructive pulmonary disease during the 12-month follow-up. It was found that the most significant predictors of combined endpoint occurrence are polymarker-retentive type of endogenous intoxication syndrome, the presence of acute infarction period complications and pronounced bronchoobstruction (degree 3-4). Conclusion. The constructed decision tree allows to stratify patients with high risk of repeated infarction, stroke and lethal outcome during the first year of follow-up after myocardial infarction against chronic obstructive pulmonary disease without increasing economic costs, which promotes optimization of treatment and secondary prevention in this category of patients.

ASSOCIATION OF SERUM C-REACTIVE PROTEIN AND D-DIMER CONCENTRATION WITH CLINICAL SEVERITY CAUSED BY CORONAVIRUS IN HOSPITALIZED PATIENTS WITH DIABETES

BACKGROUND: The aim of this research was to compare the levels of inammatory markers (D-dimers and Creactive protein) in diabetic and non-diabetic patients depending on severity of clinical manifestation, therefore based on such, dene them as potential predictors of lethal outcome and clinical severity. A total of 422 subjects were included in this METHODS: research by retrospective review of the documentation at the Clinic for Infectious Diseases of University Clinical Hospital Mostar. While reviewing the medical records, the following data were lled in: demographic (age, sex, diabetes mellitus), oxygen saturation and paO2/O2 ratio, inammatory markers (C-reactive protein and D-dimers), used therapy (non-invasive ventilation, oxygen therapy, invasive mechanical ventilation) and nal outcome of disease. Based on the presence of diabetes mellitus the patients were divided into two groups: diabetic and nondiabetic patients. Data entry into tables was followed by statistical data processing using IBM SPSS Statistics v.26 and Microsoft Excel 2016. RESULTS: Out of total number of subjects, 161 had diabetes and 261 did not. Surprisingly, women statistically had a higher average value of Ddimers in comparison to men and they had a higher percetage of lethal outcome compared to men. Deceased patients had a higher average value of CRP (126,25) and D-dimers (2,20) in comparison to survivors. Also, the deceased had a lower average of oxygen saturation (83,07), lowered paO2/O2 ratio (131,5) and more liters of oxygen used in oxygen therapy (11,59). Statistically signicant higher lethality was noted in patients with diabetes compared to non-diabetic patients. Levels of C-reactive protei CONCLUSION: n and D-dimers were higher in patients with a more severe clinical manifestation. Since lethal outcome was more statistically prevalent in those subjects, CRP and D-dimers are stated as prognostic factors of clinical severity and lethal outcome in patients with COVID-19. Lastly, there was no notably increased difference in CRP and D-dimer levels between diabetic and non-diabetic patients.

Formulation of the final clinical, pathological, forensic diagnosis, selection and coding according to ICD-10 of the original cause of death in lethal outcomes associated with pathology of transplanted organs

Introduction. When compiling the final clinical, pathoanatomical and forensic diagnoses, as well as choosing and coding according to ICD-10 the initial cause of death in patients after organ transplantation, difficulties often arise due to the lack of unified recommendations.Materials and methods. We analyzed 60 protocols of post-mortem autopsies of lethal outcomes in patients after organ transplantation at the Sklifosovsky Research Institute of Emergency Medicine, Moscow for 7 years (from 2016 to 2022).Results. Based on the results of the analysis, taking into account the literature data, recommendations were formulated on the formulation of the final clinical, pathoanatomical and forensic diagnoses, selection and coding according to ICD-10 of the initial cause of death in patients after solid organ transplantation.Findings. The developed recommendations on the formulation of the final clinical, pathoanatomical and forensic diagnoses in cases of death of patients after solid organ transplantation can be used in the daily practice of clinical doctors, pathologists and forensic experts.

Prognostic Value of Serum Interleukin-6 Level in Hypertensive Patients with COVID-19-Associated Pneumonia

Background. An interleukin-6 (IL-6) is a proinflammatory cytokine which plays an important role in COVID-19-associated hyperinflammation.
 Aim. This study aimed to assess the predictive ability of serum IL-6 levels for the development of severe/critical clinical conditions, a hypoxemic state requiring supplemental oxygen, and lethal outcomes in patients with COVID-19-associated pneumonia and arterial hypertension (AH).
 Materials and Methods. One hundred and thirty-five unvaccinated patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. AH was diagnosed in 78.5% of cases. Pneumonia was confirmed radiologically. SARS-COV-2 as an etiological factor was confirmed by either PCR or ELISA. In addition to conventional laboratory tests, IL-6, ferritin, and soluble interleukin-2 levels were measured.
 Results. Among AH patients, the median levels of IL-6 were higher in non-survivors (95.1 [37.8 - 158.8] pg/mL) as compared to survivors (39.5 [13.6 - 81.1] pg/mL) (p=0.04). Among AH patients, the median serum level of IL-6 was 98.3 [37.8 - 158.8] pg/mL in critically ill patients, 41.7 [11.8 - 83.4] pg/mL in severely ill patients, 37.8 [13.6 - 74.4] pg/mL in moderately ill patients (p=0.051). The median serum level of IL-6 was lower at the time of discharge (6.5 [2.0 - 21.5] pg/mL) as compared to that on admission (43.2 [16.1 - 92.0] pg/mL) (p< 0.001). IL-6 level failed to predict severe/critical condition (AUC=0.59, p=0.13) and the need for supplemental oxygen (AUC=0.61, p=0.06); however, it might be used for the prediction of the lethal outcome (AUC=0.69, p=0.03). The cut-off value of IL-6 level for lethal outcome prediction of 91.0 pg/mL showed a sensitivity of 58.3% and a specificity of 78.7%. Patients with IL-6 levels > 91.0 pg/mL on admission had higher odds of lethal outcomes (OR = 4.87 [1.40 - 16.92], p=0.01).
 Conclusions. Serum IL-6 level on admission did not show significant predictive ability for severe/critical conditions and hypoxemic states requiring supplemental oxygen in AH patients. However, serum IL-6 levels on admission were higher in non-survivors and might be used for the prediction of lethal outcomes with a cut-off value of 91.0 pg/mL in AH patients.

Determining the time of maximum risk of death and associated factors in patients with COVID-19 in the hospital and after discharge

Due to the rather specific course of COVID-19, the question of what day after the start of hospitalization should be expected to be the maximum risk of death in patients both during hospitalization and after discharge is relevant.Aim. The aim of the study was to determine the time of maximum risk of death during hospitalization of patients with COVID-19 as well as after their discharge from the hospital.Methodology and Research Methods. A total of 2,410 patients hospitalized with a diagnosis of COVID-19 were retrospectively studied. Inhospital 28-day mortality rate was 131 patients, and 28-day mortality rate after discharge from the hospital was 9. The accelerated failure time model (AFT) was used to determine the time of maximum risk of death in patients with COVID-19 after hospitalization as well as after discharge from the hospital during the period up to 28 days.Results. Without taking into account the influence of pathological values of other risk factors, lethal outcomes in patients occurred on days 9-11 after admission to hospital. Age over 60 years and the elevated levels of D-dimer, glucose, urea, creatinine, AST, and C-reactive protein were the risk factors (p < 0.01) that shortened the time to death, except for total protein, which lengthened this period. The maximum risk of death in patients after discharge from the hospital occurred on days 13-25, and an increase in creatinine and a decrease in INR were associated with a shorter time to death.Conclusion. The periods of maximum risk of death as well as the factors affecting these periods in patients with COVID-19 were determined for both hospital stay (days 9-11) and time after discharge from hospital (days 13-25).

Determining the time of maximum risk of death and associated factors in patients with COVID-19 in the hospital and after discharge

Due to the rather specific course of COVID-19, the question of what day after the start of hospitalization should be expected to be the maximum risk of death in patients both during hospitalization and after discharge is relevant.Aim. The aim of the study was to determine the time of maximum risk of death during hospitalization of patients with COVID-19 as well as after their discharge from the hospital.Methodology and Research Methods. A total of 2,410 patients hospitalized with a diagnosis of COVID-19 were retrospectively studied. Inhospital 28-day mortality rate was 131 patients, and 28-day mortality rate after discharge from the hospital was 9. The accelerated failure time model (AFT) was used to determine the time of maximum risk of death in patients with COVID-19 after hospitalization as well as after discharge from the hospital during the period up to 28 days.Results. Without taking into account the influence of pathological values of other risk factors, lethal outcomes in patients occurred on days 9-11 after admission to hospital. Age over 60 years and the elevated levels of D-dimer, glucose, urea, creatinine, AST, and C-reactive protein were the risk factors (p < 0.01) that shortened the time to death, except for total protein, which lengthened this period. The maximum risk of death in patients after discharge from the hospital occurred on days 13-25, and an increase in creatinine and a decrease in INR were associated with a shorter time to death.Conclusion. The periods of maximum risk of death as well as the factors affecting these periods in patients with COVID-19 were determined for both hospital stay (days 9-11) and time after discharge from hospital (days 13-25).

Prediction of fatal outcome in patients with confirm COVID-19

SARS-CoV-2, the new coronavirus underlying the development of the COVID-19 pandemic, has led to a sharp increase in the burden on healthcare systems, high mortality and significant difficulties in organizing medical care. The aim of the study was to conduct a systematic analysis of factors affecting the course of infectious disease in patients with diagnosed COVID-19 hospitalized. In order to predict the course of the disease and determine the indications for more aggressive treatment, many different clinical and biological markers have been proposed, however, clinical and laboratory assessment of the condition is not always simple and can clearly predict the development of a severe course. Technologies based on artificial intelligence (AI) have played a significant role in predicting the development of the disease. One of the main requirements during a pandemic is an accurate prediction of the required resources and likely outcomes. In the present study, a machine learning (ML) approach is proposed to predict the fatal outcome in patients with an established diagnosis of COVID-19 based on the patient’s medical history and clinical, laboratory and instrumental data obtained in the first 72 hours of the patient’s stay in the hospital. A machine learning algorithm for predicting the lethal outcome in patients with COVID-19 during 72 hours of hospitalization demonstrated high sensitivity (0.816) and specificity (0.865). Given the serious concerns about limited resources, including ventilators, during the COVID-19 pandemic, accurately predicting patients who are likely to require artificial ventilation can help provide important recommendations regarding patient triage and resource allocation among hospitalized patients. In addition, early detection of such persons may allow for routine ventilation procedures, reducing some of the known risks associated with emergency intubation. Thus, this algorithm can help improve patient care, reduce patient mortality and minimize the burden on doctors during the COVID-19 pandemic.

Myasthenia gravis treated in the neurology intensive care unit: a 14-year single-centre experience.

Severe myasthenia gravis (MG) exacerbation with respiratory failure and/or dysphagia usually requires monitoring and treatment in the neurology intensive care unit (NICU). The aim of our study was to identify all patients with severe MG exacerbation treated in the NICU in order to assessed potential factors affecting patients' need for mechanical ventilation, occurrence of complications and the final outcome. We retrospectively included all patients with severe exacerbation of MG who required management in the NICU during a 14-year period. Baseline sociodemographic and clinical features, data on medication, comorbidities and outcome were obtained by reviewing medical records and institutional databases. Our study comprised 130 severe MG exacerbations detected in 118 patients. Median age of patients was 61.5years, and women accounted for 58.5% of the patients. Half of the patients required mechanical ventilation during hospitalization. Lethal outcome was observed in 12.3% of severe MG exacerbations. Only elder age was an independent negative predictor of survival (OR 0.89, 95% CI 0.82-0.97, p < 0.01). Complications during hospitalization were detected in 50% of patients. A higher number of comorbidities (OR 1.09, 95% CI 1.60-2.35, p = 0.01) and mechanical ventilation (OR 28.48, 95% CI 8.56-94.81, p < 0.01) were independent predictors of complications during hospitalization. Patients with a severe MG exacerbation who do not require mechanical ventilation have a good outcome after treatment in the NICU. Elder age is an independent predictor of lethal outcome in patients with severe MG exacerbation. Mechanical ventilation and a higher number of comorbidities lead to more frequent complications.

КЛІНІКО-ЛАБОРАТОРНІ ОСОБЛИВОСТІ КОРОНАВІРУСНОЇ ХВОРОБИ ТА ФАКТОРИ РИЗИКУ СМЕРТІ У ПАЦІЄНТІВ, ЩО ПОТРЕБУВАЛИ ГОСПІТАЛІЗАЦІЇ У ТРЕТЮ ХВИЛЮ COVID-19 В УКРАЇНІ: ОДНОЦЕНТРОВЕ РЕТРОСПЕКТИВНЕ ДОСЛІДЖЕННЯ

CLINICAL AND LABORATORY FEATURES OF CORONAVIRUS DISEASE AND RISK FACTORS OF LETHAL OUTCOME IN PATIENTS WHO REQUIRED HOSPITALIZATION DURING THE THIRD WAVE OF COVID-19 IN UKRAINE: A SINGLE-CENTER RETROSPECTIVE STUDY Т. О. Pertseva, K. Y. Gashynova, V. V. Rudakova, V. V. Rodionova, V. V. Dmytrychenko, O. Y. Kovalenko, O. V. Kravets, N. O. But, N. V. Laksha, L. A. Hlyniana, O. F. Mykhailenko, S. P. Novikov Abstract August 2021 in Ukraine marked the beginning of the third wave of COVID-19, catastrophic in terms of hospitalization and mortality, when, according to the Ministry of Health, the Delta strain was the dominant variant of the virus. By that time, it had already been established that clinical characteristics of patients and levels of inflammatory markers differed between Delta and non-Delta variants. The aim of the study was to analyze the anthropometric, clinical, anamnestic and laboratory characteristics of patients with COVID-19 who required hospitalization during the third wave of the epidemic in Ukraine, in order to determine the risk predictors of fatal outcome. Materials and methods. The study was a single-center retrospective analysis conducted on an original cohort of 632 patients who were admitted with confirmed COVID-19 to Public Non-profit Organization “City Clinical Hospital № 4” Dnipro City Council during August-October 2021. The following data were obtained and analyzed from the medical records of the studied patients: degree of severity at the time of admission according to the COVID-19 Severity Index, demographic characteristics, comorbidity, presentation, vital signs and laboratory parameters at admission, results of chest computed tomography, treatment options and the outcomes. Results. The patients’ median age was 63 years, 38,8 % were male. Hospital mortality rate was 23,58%. The median of bed count days — 9 [6, 12]. Fever (76,3 %), dyspnea (85,4 %), cough (53,3 %) and fatigue (49,5 %) were the most common clinical manifestations on admission. The percentage of patients with comorbidities was significantly higher among deceased (96,0 % vs. 56,1 %). The most prevalent were cardio- and neurometabolic comorbidities. The median SpO2 on admission was significantly lower among deceased — 86 [75, 90]. There were 25,44 % and 57,23 % of all hospitalized patients who received ICU care and oxygen therapy, respectively. The regression analysis revealed the age older than 57 years (HR 3,198, 95 % CI 1,992–5,134), neuromuscular symptoms (HR 2,033, 95 % CI 1,358–3,045) and chest pain (HR 1,867, 95 % CI 1,055–3,306), the presence of co-morbidity (HR 26,678, 95% CI 8,498–83,750), primarily arterial hypertension (HR 3,945, 95 % CI 2,725–5,712), coronary heart disease (HR 7,619, 95% CI 5,155–11,259), heart failure (HR 2,823, 95% CI 2,020–3,944), diabetes (HR 2,966, 95 % CI 2,095–4,200), arrhythmia (HR 2,247, 95 % CI 1,524–3,312), cerebrovascular diseases (HR 2,746, 95% CI 1,725–4,372) were reliable predictors of fatal outcome in COVID-19. At the same time, after conducting the regression analysis of initial laboratory parameters, the additional prognostic risk factors were revealed: lymphocyte level ≤ 0,66 (HR 1,81, 95 % CI 1,19–2,76), AST &gt; 50,2 (HR 1,86, 95 % CI 1,15–3,02), total protein ≤ 66,1 (HR 1,55, 95% CI 1,02-2,36), creatinine &gt; 102,7 (HR 2,57, 95 % CI 1,51–4,34), urea &gt; 7,54 (HR 2,30, 95 % CI 1,41–3,75), CRP &gt; 46,8 (HR 4,37, 95 % CI 2,48–7,68). Conclusion. The third wave of the coronavirus disease pandemic in Ukraine is characterized by a larger number of patients with a severe course and a lower level of blood oxygenation upon admission; accordingly, a more significant number of patients requiring oxygen support (57,23 %), treatment in the intensive care unit (25,44 %) and a higher mortality rate (23,58 %). For the timely identification of a high-risk group of patients with COVID-19 with the purpose of targeted monitoring and early change or intensification of treatment tactics, the following potential risk factors were determined: age &gt; 57 years, presence of chest pain, and neuromuscular symptoms on admission to the hospital, more than 2 comorbidities, primarily, arterial hypertension, diabetes, cerebrovascular diseases, coronary heart disease, heart failure, and arrhythmia, as well as some laboratory indicators: lymphocyte level ≤ 0,66; AST &gt; 50,2; total protein ≤ 66,1; creatinine &gt; 102,7; urea &gt; 7,54; CRP &gt; 46,8. Key words: COVID-19, hospitalized patients, risk factors for lethal outcome Ukr. Pulmonol. J. 2022;30(4):6–18.