Mortality In Coronavirus Disease 2019 Patients Research Articles

The utility of hemoglobin, albumin, lymphocyte and platelet (HALP) score in predicting mortality among COVID-19 patients: a preliminary study

Several scoring systems are used to predict critical care requirements in coronavirus disease 2019 (COVID-19) patients. This study aims to determine the relationship between the hemoglobin, albumin, lymphocyte, and platelet (HALP) scores and in-hospital mortality for COVID-19 patients who visited the emergency department (ED). This retrospective study included patients over 18 years of age. Data were scanned into a digital information system of the hospital. The area under the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to measure each discriminant cutoff value to predict mortality. A total of 458 patients were included in this study. The mean age of the patients was 72 years, and 216 (47.2%) patients were women. ROC analysis was performed to examine the predictive power of the HALP score in predicting mortality in COVID-19 patients, with an AUC of 0.720 (95%confidence interval: 0.676–0.761), a Youden index of 0.357, and a p value of 0.001. As a result of the statistical analysis, it was determined that the HALP score was statistically significant in the prediction of mortality in COVID-19 patients (p < 0.001). In this study, we found that the HALP score could be a good predictor of in-hospital mortality among COVID-19 patients.

The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients.

Introduction:Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients.Methods:This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality.Results:Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level.Conclusion:pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

Factors affecting mortality in COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) has caused large number of deaths all over the world. Our study was conducted to investigate the factors affecting mortality in patients hospitalized with COVID-19 during second wave of pandemic in India. Material and methods: The data was collected retrospectively from the medical records of P. K. Trauma Care Centre, Mysuru where exclusively COVID-19 patients were admitted during second wave of COVID-19 pandemic in India. This study included total of 98 patients who expired due to COVID-19 during the period of March 2021 to October 2021. Demographic details, clinical presentation, treatment and laboratory data were extracted from medical records. We analysed the significance of the data using chi square test and other statistical tests. Results: A total of 948 cases were admitted during the said period and 98 patients expired. With statistical analysis following factors are found to be significantly associated with high mortality - age above 60 years, unvaccinated, low oxygen saturation at presentation to the hospital, high serum ferritin level, elevated neutrophil –lymphocyte ratio (NLR), elevated D-dimer level, presence of co-morbidities. Duration of symptoms with which the patients presents to the hospital is the least significant factor associated with the mortality. Conclusion: Elderly age group, lack of vaccination, low oxygen saturation at presentation to the hospital, presence of comorbidities like diabetes, hypertension and ischemic heart disease, elevated serum ferritin, D-dimer level and high NL ratio are associated significantly with high mortality in patients with COVID-19 infection. Vaccination, monitoring of oxygen saturation and proper management and control of comorbidities are the easily modifiable factors to reduce the mortality in COVID-19 patients.

Hospital mortality among COVID-19 patients - Experience of a multi-disciplinary tertiary care teaching hospital of Chhattisgarh in Central India.

The mortality from coronavirus disease 2019 (COVID-19) infection and the severity of it vary among populations. There is a dearth of research on epidemiology and clinical outcomes in central Indian populations with COVID-19. Our aim was to provide an analysis of all hospitalized mortality among patients with COVID-19 infection in a tertiary care hospital of Chhattisgarh in central India. This analysis helped us to know the severity predictors for mortality and in future will help the authorities to formulate a plan to decrease the mortality in the epidemic or uncertain ongoing pandemic. This was a retrospective observational study using the hospital-based record of multi-disciplinary teaching hospital in Chhattisgarh, India. All COVID-19 reverse-transcriptase polymerase chain reaction-positive patients who were declared dead or died during the course of treatment from April 1, 2020 to March 31, 2021 were included in the study. In-hospital mortality was the primary outcome of interest. In secondary analysis, age and gender distribution, co-morbidity, length of stay, and the cause of death were also investigated. A total of 7495 patients with a confirmed diagnosis of COVID-19 were enrolled in the study, of whom 762 (10.16%) died in the hospital with COVID-19 as the primary cause of death. The majority of the patients were more than 60 years of age (45.7%). A total of 416 (54.4%) of the deceased patients were having co-morbidity with diabetes (13.4%), hypertension (16.4%), or both (24.4%). The majority of the patients who succumbed had a hospital stay of less than a week (≤7) (68.5%). More than half of the patients (58.3%) who expired had referred and reported to the hospital in the second or third week of illness. The respiratory system involvement was the dominant contributor of death with pneumonia (78.8%) being the most common cause, followed by acute respiratory distress syndrome (62.2%). 13.6% of expired patients had multiple system involvement, and 11.2% had sepsis as well. Mortality in COVID-19 patients was associated with advanced age, co-morbidities such as diabetes and hypertension, and delay in hospitalization. These are high-risk groups and should be vaccinated against COVID-19 on priority.

Physiologic Scoring Systems in Predicting the COVID-19 Patients' one-month Mortality; a Prognostic Accuracy Study.

Introduction : It is critical to quickly and easily identify severe coronavirus disease 2019 (COVID-19) patients and predict their mortality. This study aimed to determine the accuracy of the physiologic scoring systems in predicting the mortality of COVID-19 patients. Methods: This prospective cross-sectional study was performed on COVID-19 patients admitted to the emergency department (ED). The clinical characteristics of the participants were collected by the emergency physicians and the accuracy of the Quick Sequential Failure Assessment (qSOFA), Coronavirus Clinical Characterization Consortium (4C) Mortality, National Early Warning Score-2 (NEWS2), and Pandemic Respiratory Infection Emergency System Triage (PRIEST) scores for mortality prediction was evaluated. Results: Nine hundred and twenty-one subjects were included. Of whom, 745 (80.9%) patients survived after 30 days of admission. The mean age of patients was 59.13 ± 17.52 years, and 550 (61.6%) subjects were male. Non-Survived patients were significantly older (66.02 ± 17.80 vs. 57.45 ± 17.07, P< 0.001) and had more comorbidities (diabetes mellitus, respiratory, cardiovascular, and cerebrovascular disease) in comparison with survived patients. For COVID-19 mortality prediction, the AUROCs of PRIEST, qSOFA, NEWS2, and 4C Mortality score were 0.846 (95% CI [0.821-0.868]), 0.788 (95% CI [0.760-0.814]), 0.843 (95% CI [0.818-0.866]), and 0.804 (95% CI [0.776-0.829]), respectively. All scores were good predictors of COVID-19 mortality. Conclusion: All studied physiologic scores were good predictors of COVID-19 mortality and could be a useful screening tool for identifying high-risk patients. The NEWS2 and PRIEST scores predicted mortality in COVID-19 patients significantly better than qSOFA.

Clinical Characteristics and Risk Factors for Mortality in COVID-19 Patients at a Tertiary Care Centre in Southern Assam, India: A Retrospective Study

Introduction: Coronavirus Disease-2019 (COVID-19) infection can cause a wide range of symptoms, from asymptomatic infection and mild upper respiratory tract disease to severe viral pneumonia with respiratory failure and multiorgan malfunction. Through this study, effort was put forward to know the COVID-19 in terms of clinical characteristics, risk factors and laboratory parameters which in turn may serve as predictors of severe sickness and negative outcomes of COVID-19. Aim: To study the clinical characteristics, risk factors and laboratory parameters of COVID-19 patients in a part of North Eastern India, and also to compare these parameters between survivors and non survivors. Materials and Methods: This retrospective study was conducted in Silchar Medical College and Hospital, Silchar, Assam, India. Study included all patients of COVID-19 diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or Rapid Antigen Test (RAT) admitted from 1st July, 2020 to 31st December, 2020. The data included demographic parameters, presenting symptoms, significant medical, surgical or drug history etc., and laboratory parameters including complete blood count, Random Blood Sugar (RBS), chest x-ray, renal and liver function test, C-reactive protein, Lactate Dehydrogenase (LDH), serum ferritin, troponin I etc. Data were statistically analysed by unpaired t-test for continuous variables and chi-square test was used for comparing proportions. Results: Out of a total 2262 study subjects, 2066 (91.34%) were discharged from the hospital after recovery and 196 (8.66%) had expired. The various parameters contributing significantly to mortality were male gender, age &gt;60 years, various co-morbid conditions like diabetes mellitus, hypertension and cardiac illness. The laboratory parameters observed to be significantly associated with mortality were thrombocytopenia, leucocytosis, hyperglycaemia, raised value of lactate dehydrogenase, creatinine, D-dimer, ferritin, C-reactive protein. Radiological findings including ground glass opacities and pleural effusion also were more common in the non survivor group as compared to the survivor group. Conclusion: More than half of the deceased patients were older than 60 years of age. The prevalence of co-morbidities and mean level of laboratory parameters were significantly high among non survivors as compared to those who recovered.

COVID-19 is associated with a high prevalence of liver damage: a systematic review and meta-analysis

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak is a serious threat to humans, and the impact of COVID-19 on the liver remains unexplored. At present, no meta-analysis has summarized available findings of COVID-19 patients with liver injury in depth. Thus, we aimed to scrutinize the association of the liver in COVID-19 patients and approximate the prognosis of COVID-19 patients with liver injury thoroughly. Method: We searched different databases for qualified studies between December 2019 to May 2021. Finally, meta-analysis was carried out using fixed-effect or random-effect models based on the heterogeneity. Result: Our Meta-analysis includes 32 studies with a total of 6,933 COVID-19 patients. The pooled prevalence of chronic liver disease (CLD) was 3.5%. Overall, the rates of severity and mortality in COVID-19 patients with underlying CLD were 4.6% and 19.2%, respectively. Additionally, the incidence of acute on chronic failure (ACLF) among COVID-19 patients with CLD was 25.1%. The prevalence of an increase in serum ALT, AST, TBil, and LDH levels was 39.5%, 28.6%, 26.5%, and 55.5%, respectively. Similarly, PT was prolonged in 8.3% of cases, and albumin was decreased in 66.8% of cases. The pooled prevalence of liver injury among COVID-19 patients was 28.2%. Strikingly, the patients with liver injury had significantly more severe disease (42.3%) and a higher incidence of mortality (18.5%) than the patients without liver injury. Conclusion: In conclusion, more than one in five of the COVID-19 patients is at risk of developing a liver injury. Further, patients with liver injury have significantly more severe disease and a higher incidence of mortality than patients without liver injury. Thus, careful monitoring of liver function is advisable while treating COVID-19 patients.

Association Between Myocarditis and Mortality in COVID-19 Patients in a Large Registry

ObjectiveTo present a large registry data assessing the association between myocarditis and mortality in patients with severe acute respiratory syndrome coronavirus 2 infection. Patients and MethodsThe researchers identified adult patients aged 18 to 90 years of age with coronavirus disease 2019 (COVID-19) diagnosis in the TriNetX (COVID-19 research network) database between January 20, 2020, and December 9, 2020. These patients were then divided into groups of those who had a positive myocarditis diagnosis and those who did not. The researchers compared all-cause mortality between propensity-matched pairs of patients in both groups. ResultsA total of 259,352 patients with COVID-19 diagnosis were included in the study. Of those patients, 383 (0.2%) had myocarditis diagnosis, whereas 258,969 (99.8%) did not have myocarditis diagnosis during their hospital stay. Patients were predominantly male in the myocarditis group (59.0% vs 45.0%, P<0.001). As to the propensity-matched cohorts, 383 of 383 were matched, and the all-cause mortality was 13.4 % vs 4.2% (P<0.001) at 30 days. A Kaplan-Meier survival analysis was also statistically significant (P<0.001) at 30 days. ConclusionIn a large multinational database of COVID-19 patients, we observed an association between myocarditis diagnosis and increased mortality. Further prospective studies are recommended to further assess myocarditis outcomes in COVID-19 patients and treatment options.

Oral Health of COVID-19 Patients Using Extracorporeal Membrane Oxygenation: A Clinical Study of 19 Cases.

The oral health of coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is an important issue in treatment of respiratory failure. We retrospectively investigated the oral health history of severe COVID-19 patients who received extracorporeal membrane oxygenation (ECMO) from April 2020 to December 2020 using the oral assessment guide from Fukuoka University (OAG-F). Nineteen consecutive patients (median age: 62 years) were divided into two groups according to survival (survivors, n = 12; non-survivors, n = 7). A univariate analysis revealed no significant differences between the groups in sex, age, body mass index (BMI), or the number of remaining teeth, whereas the ECMO assistance of non-survivors (median: 34 days) was prolonged in comparison to survivors (median: 8 days; p < 0.05). Among the factors of OAG-F, significant differences were observed between the groups in the conditions of the saliva, mucous membrane, and gingiva. The total scores in non-survivors (median: 19) were significantly higher in comparison to survivors (Median: 15.5), suggesting that the frequency of oral health deterioration was higher in non-survivors (p < 0.05). Taken together, these findings suggest that poor oral health is associated with mortality in COVID-19 patients receiving ECMO in the ICU.

The value of urinalysis in predicting acute kidney injury and mortality in COVID-19 patients

Abstract. Kidney involvement is frequent among patients with coronavirus disease 2019 (COVID-19). However, kidney involvement is varied and mild kidney injury can easily go unnoticed. We aimed to investigate the urinalysis data of COVID-19 patients on admission and to explore the value of urinalysis in the prediction of acute kidney injury (AKI) and in-hospital mortality in patients with COVID-19.&#x0D; Methods. The demographic, clinical and laboratory data of patients with confirmed COVID-19 were retrospectively collected from the electronic health records of the hospital. The outcomes were the development of AKI and in-hospital mortality.&#x0D; Results. 244 patients were included in the analysis. The mean age was 59.6 ± 13.7 and 65.2% of patients were male. Serum creatinine on admission was 0.86 (0.72-1.05) mg/dL. Glucosuria, proteinuria and hematuria were found in 36.1%, 22.9% and 22.1% of patients, respectively. AKI was detected in 63 patients (25.8%) at any time of hospitalization. According to multivariate analysis, AKI development was associated with higher WBC and decreased eGFR as well as with proteinuria on admission. During median 8 (IQR, 5-12) days of follow-up, 33 patients (13.5%) died. Older age, higher C-reactive protein levels and proteinuria on admission were also independent predictors of in-hospital mortality.&#x0D; Conclusion. Proteinuria on admission was associated with the development of AKI and in-hospital mortality in patients with COVID-19. Urinalysis can be useful for early diagnosis of kidney damage before serum creatinine rise and mortality prediction in COVID-19 patients.

319. Presepsin as a Prognostic Biomarker for Mortality in COVID-19 Patients vs Community-Adquired Pneumonia (CAP) Patients

Abstract Background Lower respiratory tract infections such as community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) are the main current causes of mortality worldwide. Several scores and biomarkers have been proposed to identify patients at risk of dying, with unclear results. Presepsin is a glycoprotein expressed on the surface of the membrane of monocytes and macrophages and its utility has been proven in sepsis as a predictor of severity and treatment response. However, it is unknown the utility of this biomarker as a mortality predictor among COVID-19 and CAP patients. Thus, the aim of this study was to determine the utility of serum presepsin to identify patients at risk of dying due to COVID-19 and CAP. Methods A prospective observational study was conducted at Clinica Universidad de La Sabana, Colombia. We included 240 patients who required hospital admission due to CAP or COVID-19. Plasma samples were collected within 24 hours of admission. The presepsin concentration was quantified using the PATHFAST system. Afterwards, a two-tailed test was used to compare mortality rates among patients and their presepsin plasma concentration. Lastly, the ROC was calculated to determine presepsin’s sensibility as a mortality predictor. Results A total of 88 patients with CAP and 152 patients with COVID-19 were included in the study. The median [with IQR] in Presepsin plasma concentration was higher in all patients who died (920 [573 - 2340] vs 573 [307,5 - 1052,5], p-value&amp;lt; 0.0001). Furthermore, comparing to the study group, the median concentration of presepsin was higher in patients deceased by COVID-19 than those who survived. (1358 [642,8 - 2976,8] vs 570 [333,2 - 1007,5], p-value&amp;lt; 0.0001). In addition, the area under the curve (AUC) ROC of presepsin to predict risk of mortality was 0.769. DeLong’s test comparing ROC curves in COVID-19 and CAP patients had a p-value=0.073. Serum presepsin results Conclusion Plasma concentrations of presepsin plasma were higher among COVID-19 patients who died. Moreover, serum concentration of presepsin were not useful to identify CAP patients at risk of dying. However, practical use of Presepsin as a prognostic biomarker of severity is yet to be assessed as further studies are needed. Disclosures All Authors: No reported disclosures

Blood lactate concentration in COVID-19: a systematic literature review.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory condition sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which manifests prevalently as mild to moderate respiratory tract infection. Nevertheless, in a number of cases the clinical course may deteriorate, with onset of end organ injury, systemic dysfunction, thrombosis and ischemia. Given the clinical picture, baseline assessment and serial monitoring of blood lactate concentration may be conceivably useful inCOVID-19. We hence performed a systematic literature review to explore the possible association between increased blood lactate levels, disease severity and mortality in COVID-19 patients, including comparison of lactate values between COVID-19 and non-COVID-19 patients. We carried out an electronic search in Medline and Scopus, using the keywords "COVID-19" OR "SARS-CoV-2" AND "lactate" OR "lactic acid" OR "hyperlactatemia", between 2019 and present time (i.e. October 10, 2021), which allowed to identify 19studies, totalling 6,459 patients. Overall, we found that COVID-19 patients with worse outcome tend to display higher lactate values than those with better outcome, although most COVID-19 patients in the studies included in our analysis did not have sustained baseline hyperlactatemia. Substantially elevated lactate values were neither consistently present in all COVID-19 patients who developed unfavourable clinical outcomes. These findings suggest that blood lactate monitoring upon admission and throughout hospitalization may be useful for early identification of higher risk of unfavourable COVID-19 illness progression, though therapeutic decisions based on using conventional hyperlactatemia cut-off values (i.e.,2.0mmol/L) upon first evaluation may be inappropriate in patients with SARS-CoV-2 infection.

Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study.

BackgroundAs the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran. MethodsPatients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model.ResultsThe median (interquartile range) age of patients was 60 years (44–74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019).Conclusions: Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.

Inflammatory Markers upon Admission as Predictors of Outcome in COVID-19 Patients

Background: Coronavirus disease 2019 (COVID-19) may cause dysregulation of the immune system, leading to hyperinflammation. Inflammatory markers can be used to predict in-hospital mortality in COVID-19 patients. This research was aimed to investigate the association between the levels of various inflammatory markers and mortality in COVID-19 patients.Methods: This study was conducted at Persahabatan National Respiratory Referral Hospital, Indonesia. Blood tests were performed upon admission, measuring the C-reactive protein, PCT, leukocyte, differential counts, and platelet count. The outcome measured was the mortality of hospitalized COVID-19 patients. Statistical analysis methods included the Mann–Whitney U test, receiver operating characteristic (ROC) analysis, and area under the curve (AUC) test.Results: Total 110 patients were included, and the laboratory values were analyzed to compare survivors and non-survivors. The non-survivor group had significantly higher leukocyte count, lower lymphocyte count, higher CRP and PCT levels, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), and lower lymphocyte-to-CRP ratio. As predictors of mortality, AUC analysis revealed that PCT, CRP, NLR, and PLR had AUCs of 0.867, 0.82, 0.791, and 0.746, respectively.Conclusions: Routine and affordable inflammatory markers tested on admission may be useful as predictors of in-hospital mortality in COVID-19 patients requiring hospitalization.

M10. Investigating prognostic value of cardiac biomarkers for predicting mortality in novel coronavirus disease-2019 patients: A meta-analysis of diagnostic test accuracy

AimsCardiac injury is common in novel coronavirus disease-2019 (COVID-19) patients and is associated with an increased risk of mortality. However, the prognostic accuracy of cardiac biomarkers in predicting mortality in COVID-19 patients remains unclear. A meta-analysis of diagnostic test accuracy was conducted to find cost-effective biomarkers, particularly those frequently evaluated to enable risk stratification and sensible resource allocation.MethodsWe systematically searched PubMed, Europe PMC, and SCOPUS for studies published up to June 2021. Studies were enrolled, if they included assessment of the accuracy of predetermined cardiac biomarkers (troponin, lactate dehydrogenase (LDH), creatine kinase, and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in predicting mortality of COVID-19 patients and provided sufficient data to construct a 2 x 2 contingency table.ResultsThis meta-analysis showed cardiac troponin was the most reliable biomarker in prognosticating mortality in COVID-19 patients (area under curve (AUC) = 0.79 (0.76–0.83), sensitivity = 0.63 (0.52–0.73), specificity = 0.80 (0.74–0.84)), followed by LDH (AUC = 0.75 (0.71–0.78), sensitivity = 0.72 (0.63–0.80), specificity = 0.65 (0.54–0.75)), NT-proBNP (AUC = 0.73 (0.69–0.77), sensitivity = 0.55 (0.41–0.68), specificity = 0.79 (0.68–0.87)), and creatine kinase (AUC = 0.35 (0.31–0.39), sensitivity = 0.27 (0.19–0.36), specificity = 0.76 (0.49–0.92)).ConclusionIncreased cardiac injury biomarkers may aid in the identification of individuals who are most at risk, especially cardiac troponin with AUC 0.79, 63% sensitivity and 80% specificity.

Predictors of Mortality in COVID-19-Positive Patients On and Off CPAP: A Review From a Tertiary Care Setting in the NHS.

IntroductionSince the first description of a coronavirus-related pneumonia outbreak in December 2019, the virus SARS-CoV-2 that causes the infection/disease coronavirus disease 2019 (COVID-19) has evolved into a pandemic, and as of today, millions have been affected.ObjectivesOur aim was to identify the predictors of mortality in COVID-19-positive patients on or off continuous positive airway pressure (CPAP).MethodologyThis was an observational study. Data were collected from February 2020 to April 2020 with patients admitted to the COVID-19 ward at The James Cook University Hospital, Middlesbrough, England. The inclusion criteria were COVID-19-positive patients confirmed through PCR tests on or off CPAP. Patients who had negative RT-PCR for COVID-19 and those who were intubated were excluded.ResultsA total of 56 patients diagnosed with COVID-19 (through RT-PCR) were included in the final analysis, among which 27 were on CPAP, while 29 did not require CPAP (NCPAP). The overall mean age of the patients was 66 ± 14 (range: 26-94) years. The mean age of CPAP and NCPAP patients was 63 ± 15 (range: 26-85) years and 68 ± 13 (range: 40-94) years, respectively. The ethnicity of 54 (96.4%) patients was White-Caucasian, while 2 (3.6%) were British-Asian. In the study sample, 16 (28.6%) patients expired, of which 11 (40.7%) were on CPAP, while 5 (16.7%) did not require CPAP during the disease course. Correlation analysis showed that overall higher age, Medical Research Council Dyspnoea (MRCD) score, performance status (PS), and consolidation affecting more than one quadrant of the lungs were significantly correlated with increased mortality. Among patients receiving CPAP, higher age, MRCD score, and PS were significant predictors of mortality. Among the NCPAP group, advancing age, respiratory rate, MRCD score, PS, increased creatinine levels, and consolidation affecting more than one quadrant of the lungs were the predictors of mortality.ConclusionEven with a small sample size, we can see that there are definitive predictors that are directly proportional to increased mortality in COVID-19 patients on CPAP, such as higher age, performance status, MRCD score, and increased lung involvement of consolidation in more than one quadrant, which can help us rationalize management.

Demographic and Clinical Features Association With Mortality in Patients With COVID-19: A Cross-Sectional Study in the West of Iran

The coronavirus disease 2019 (COVID-19) pandemic as an emergency public health concern has caused hundreds of thousands of deaths in the world. Identifying predictors of death in COVID-19 patients is a key to improving survival and helping patients triage, better management, and assist physicians and health care. The present study was conducted on 512 positive COVID-19 patients confirmed by real-time PCR hospitalized in Sina Hospital, Hamadan, in 2020. The data of demographic characteristics, clinical manifestations, laboratory findings, chest examination, and disease outcome were collected. The logistic regression model was performed to explore the predictors of in-hospital mortality. Among 512 patients, 57 (11.1%) deaths have occurred. The adjusted odds ratios (OR) estimate of death in COVID-19 for patients with age more than 60 years versus those lower than 60 years was 3.15 (95% CI: 1.06, 9.37). The adjusted OR estimate of death in patients with hypertension comorbidity versus those with no comorbidity was 3.84 (95% CI: 1.27, 11.59). In addition, the adjusted OR estimate (95% CI) of death in patients with respiratory rate above 30 per minute, BUN &gt;20 mg/dL, LDH &gt;942 U/L and SGOT &gt;45 U/L against lower than those values was respectively 10.72 (1.99, 57.68), 5.85 (2.19, 15.63), 13.42 (2.17, 83.22) and 2.86 (1.02, 8.05). The risk of death was higher among the patients with multiple comorbidity diseases, systolic BP lower than 90 mmHg, SPO2 lower than 88 and more than ten days hospitalization in comparison with COVID-19 patients with no comorbidity disease (P=0.002), systolic BP higher than 90 mmHg (P=0.002), SPO2 higher than 88 (P&lt;0.001) and hospitalization for lower than ten days (P=0.012). Our findings suggest that older age, pre-existing hypertension and/or multiple co-morbidities, high respiratory rate, elevated BUN, LDH and SGOT, low systolic BP, and hypoxemia were independently associated with in-hospital mortality in COVID-19 patients. These results can be helpful for physicians and health care workers to improve clinical management and appropriate medical care of COVID-19 patients.

D-dimer Levels as Novel Biomarker Predictor for All-cause In-hospital Mortality Risk in COVID-19 Patients

Background : Coronavirus disease 2019 (COVID-19) has affected people all around the world in varying degrees of severity, causing death. The global case fatality rate (CFR) due to COVID-19 was 2.2 % as of January 1st, 2021. The CFR in the Kediri district is 7.7%, which is higher than the Nasional CFR of 3%. In COVID-19, we looked at high D-dimer as one of the predictors of in-hospital mortality. Objectives : The goal of this study was to find a link between D-dimer levels and all-cause in-hospital mortality in COVID-19 patients, as well as to define the best cut-off point. Methods : A single-center cross-sectional study was conducted. From March to December 2020, 185 COVID-19 patients treated at Kediri General Hospital who were confirmed positive by RT-PCR matched the eligibility criteria. The levels of D-dimer were divided into two groups: those above and those below the cutoff point. We 􏰏􏰚􏰏􏰦􏰗􏰱􏰋􏰕 􏰲 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊􏰌􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰢􏰣􏰤 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰧 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰸 􏰶􏰟􏰷􏰔􏰦􏰳 􏰏􏰚􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣 The primary endpoint was all-cause in-hospital mortality. Data were collected retrospectively and processed using SPSS version 25.0. Results : 􏰴􏰞􏰑􏰝􏰚􏰟 􏰜􏰓􏰌􏰐􏰝􏰊􏰏􏰦􏰝􏰱􏰏􏰊􏰝􏰓􏰚􏰳 􏰲􏰤 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰪􏰧􏰲􏰣􏰸􏰹􏰮 􏰎􏰋􏰑􏰋 􏰕􏰝􏰋􏰕􏰣 􏰺􏰦􏰋􏰻􏰏􏰊􏰋􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦 􏰎􏰏􏰌 􏰌􏰊􏰏􏰊􏰝􏰌􏰊􏰝􏰩􏰏􏰦􏰦􏰗 significant associated with all-cause inhospital mortality (adjusted odds ratio [OR] 3.46; 95% confidence interval [CI] = 1.41 – 8.49, p = 0.007), with a sensitivity of 82.1% and a specificity of 42.2% ( area under curve [AUC] = 0.628; 95% CI = 0.527 – 0.728; p = 0.012). Conclusion : Elevated D-dimer levels were associated with all-cause in-hospital mortality. In our study, the 􏰓􏰐􏰊􏰝􏰔􏰏􏰦 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰻􏰏􏰦􏰞􏰋 􏰎􏰏􏰌 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣

Preadmission usage of metformin and mortality in COVID-19 patients including the post-discharge period.

BackgroundThe effect of preadmission metformin usage (PMU) on the mortality of coronavirus disease-2019 (COVID-19) patients with diabetes is conflicting. Most studies have focused on in-hospital mortality; however, mortality after discharge also increases in COVID-19 patients.AimsExamining the effect of PMU on all-cause mortality, including the post-discharge period.MethodsPatients with diabetes who were hospitalised in 2020 due to COVID-19 were included in the study. They were divided into two groups: those with a history of metformin use (MF( +)) and those without such history (MF( −)). Propensity score matching (PSM) was performed at a ratio of 1:1 for age and sex. COX regression analyses were used to demonstrate risk factors for mortality.ResultsWe investigated 4103 patients hospitalised for COVID-19. After excluding those without diabetes or with chronic liver/kidney disease, we included the remaining 586 patients, constituting 293 women (50%) with an overall mean age of 66 ± 11.9 years. After PSM analysis, the in-hospital and post-discharge mortality rates were higher in the MF( −) group though not significantly different. However, overall mortality was higher in the MF( −) group (51 (42.5%) vs. 35 (29.2%), p = 0.031). For overall mortality, the adjusted HR was 0.585 (95% CI: 0.371 − 0.920, p = 0.020) in the MF( +) group.ConclusionPMU is associated with reducing all-cause mortality. This effect starts from the in-hospital period and becomes more significant with the post-discharge period. The main limitations were the inability to evaluate the compliance with metformin and the effects of other medications due to retrospective nature.

Dexamethasone therapy and rates of secondary pulmonary and bloodstream infections in critically ill COVID-19 patients.

BackgroundCoronavirus disease 2019 (COVID-19) has become a pandemic. Bacterial superinfections seem to be associated with higher mortality in COVID-19 patients in intensive care units (ICUs). However, details on the prevalence and species distribution of secondary infections are limited. Moreover, the increasing use of dexamethasone may pose an additional risk of superinfections.MethodsWe performed a single-center retrospective study of the clinical and microbiological characteristics of 154 COVID-19 patients admitted to the ICU between March 2020 and January 2021, focusing on bacterial infections, use of antimicrobial agents and dexamethasone therapy.ResultsThe median age was 68 years; 67.5% of the patients were men. Critically ill COVID-19 patients were treated with dexamethasone since July 2020 (second wave), which was not common during the first wave of the pandemic. In the dexamethasone group (n=90, 58.4%), respiratory pathogens were detected more frequently, as were multidrugresistant pathogens. The number of patients with polymicrobial detection of respiratory pathogens was significantly increased (p=0.013). The most frequently detected species were Enterobacterales, Staphylococcus aureus, and Aspergillus fumigatus. The rates of bloodstream infections did not differ between the groups. The use of dexamethasone in ICU COVID-19 patients was associated with higher rates of respiratory infectious complications.ConclusionsSecondary infections are present in a substantial fraction of critically ill COVID-19 patients. Respiratory pathogens were detectable in the majority of COVID-19 ICU patients. The use of dexamethasone poses a potential risk of secondary pulmonary infections. Infectious complications in patients with dexamethasone therapy could be associated with worse outcomes.