Need For Intensive Care Unit Admission Research Articles

Validity of different scoring systems in prediction of intensive care unit admission and mortality in acute organophosphate poisoning.

Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients. A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC=0.983) and mortality (AUC=0.999). The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning.

An explainable machine learning-based model to predict intensive care unit admission among patients with community-acquired pneumonia and connective tissue disease

BackgroundThere is no individualized prediction model for intensive care unit (ICU) admission on patients with community-acquired pneumonia (CAP) and connective tissue disease (CTD) so far. In this study, we aimed to establish a machine learning-based model for predicting the need for ICU admission among those patients.MethodsThis was a retrospective study on patients admitted into a University Hospital in China between November 2008 and November 2021. Patients were included if they were diagnosed with CAP and CTD during admission and hospitalization. Data related to demographics, CTD types, comorbidities, vital signs and laboratory results during the first 24 h of hospitalization were collected. The baseline variables were screened to identify potential predictors via three methods, including univariate analysis, least absolute shrinkage and selection operator (Lasso) regression and Boruta algorithm. Nine supervised machine learning algorithms were used to build prediction models. We evaluated the performances of differentiation, calibration, and clinical utility of all models to determine the optimal model. The Shapley Additive Explanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) techniques were performed to interpret the optimal model.ResultsThe included patients were randomly divided into the training set (1070 patients) and the testing set (459 patients) at a ratio of 70:30. The intersection results of three feature selection approaches yielded 16 predictors. The eXtreme gradient boosting (XGBoost) model achieved the highest area under the receiver operating characteristic curve (AUC) (0.941) and accuracy (0.913) among various models. The calibration curve and decision curve analysis (DCA) both suggested that the XGBoost model outperformed other models. The SHAP summary plots illustrated the top 6 features with the greatest importance, including higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), lower level of CD4 + T cell, lymphocyte and serum sodium, and positive serum (1,3)-β-D-glucan test (G test).ConclusionWe successfully developed, evaluated and explained a machine learning-based model for predicting ICU admission in patients with CAP and CTD. The XGBoost model could be clinical referenced after external validation and improvement.

Calcifediol or Corticosteroids in the Treatment of COVID-19: An Observational Study.

To evaluate how treatment with calcifediol and/or corticosteroids in medical practice modified the need for ICU admission, death, or poor prognosis of patients hospitalized with COVID-19 during the first outbreaks. A retrospective observational cohort study of patients admitted for COVID-19 to the Pneumology Unit of the Hospital Universitario Reina Sofía (Córdoba, Spain). Patients were treated with calcifediol or/and corticosteroids with the best available therapy and standard care, according to clinical practice guidelines. Admission to the intensive care unit (ICU) or death during hospitalization and poor prognosis. Seven hundred and twenty-eight patients were included. According to the treatment received, they were included in four groups: calcifediol (n = 68), glucocorticoids (n = 112), both (n = 510), or neither (n = 38). Of the 578 patients treated with calcifediol, 88 were admitted to the ICU (15%), while of the 150 not treated with calcifediol, 39 required ICU admission (26%) (p < 0.01). Among the patients taking calcifediol without glucocorticoids, only 4 of 68 (5.8%) required ICU admission, compared to 84 of 510 (16.5%) treated with both (p = 0.022). Of the 595 patients who had a good prognosis, 568 (82.01%) had received treatment with calcifediol versus the 133 patients with a poor prognosis, of whom 90 (67.66%) had received calcifediol (p < 0.001). This difference was not found for corticosteroids. The treatment of choice for hospitalized patients with moderate or mild COVID-19 could be calcifediol, not administering corticosteroids, until the natural history of the disease reaches a stage of hyperinflammation.

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study.

The treatment of penetrating abdominal injuries has changed in recent years with more focus on "nonoperative management" (NOM) to avoid unnecessary laparotomies while identifying injuries early. Although the NOM approach is widely used for stab wounds, its effectiveness in managing abdominal gunshot wounds is controversial. NOM of penetrating abdominal injuries is becoming more dependent on hemodynamic stability and improved noninvasive radiological interventions. The role of NOM is significantly underreported and underestimated in developing countries, particularly in fragile and conflict-affected states such as Yemen. The present study aims to evaluate the clinical outcomes of NOM in penetrating abdominal trauma injury patients and identify factors associated with NOM failure in a low-resource setting. A retrospective study from January 2021 to December 2022 including patients diagnosed with penetrating abdominal trauma at the General Military Hospital, Sana'a, Yemen, was conducted. Hemodynamically stable patients without peritonitis or clear indications for immediate laparotomy were candidates for NOM and were included in the study. Patients with blunt abdominal injuries, penetrating wounds outside the abdomen, particularly head injury, eviscerated structures, and gastrointestinal hemorrhage, or those pronounced dead on arrival were excluded. The primary outcome was the success and failure rate of NOM necessitating laparotomy. The secondary outcome was the factors associated with NOM failure. During the study, 256 patients with penetrating abdominal injury were admitted, with 222 (86.7%) undergoing immediate laparotomy and 34 (13.3%) treated with NOM. The mean age was 27.6±7.4 years. Bump explosions, mostly sharp objects (secondary blast injuries), were the main causes of injury (n=18, 52.9%). Other causes were low-velocity gunshot wounds, stab wound injuries, and shotgun injuries in 14 (41.2%), one (2.9%), and one (2.9%), respectively. The majority of patients (n=25, 55.9%) were admitted within 6-24 hours of the incident. The abdominal computed tomography (CT) scan revealed various injuries in all patients, including hemoperitoneum in 11 (32.4%), pneumoperitoneum in five (14.7%), liver injury in 15 (44.1%), foreign body attached to the wall colon in 23 (67.6%), kidney injury in two (5.9%), and splenic injury in one (2.9%). NOM was successful in 31 (91.2%) patients. NOM failed in three (8.8%). One patient was treated via the laparoscopic procedure, and two patients were treated with laparotomy procedures. Five (14.7%) cases required intensive care unit (ICU) admission, with no deaths or major complications. In univariate analysis, the presence of free intra-abdominal fluid (pneumoperitoneum) on the initial CT scan and the need for ICU admission were associated with NOM failure and were statistically significant (p<0.05). Our findings support that some penetrating abdominal trauma patientscan benefit from NOM. The goal of preventing unnecessary laparotomies should be aligned with a comprehensive comprehension of the clinical signs and symptoms of NOM failure and the necessity for surgical intervention. Serial abdominal examinations remain the foundation of selected NOM; nevertheless, radiological and laboratory tests can be important tools in decision-making. In this study, free intra-abdominal fluid on the initial CT scan and the need for ICU admission were associated with NOM failure.

Long-Term Particulate Matter Exposure and Mortality in Hospitalized Patients with COVID-19 in South Korea.

Rationale: Particulate matter (PM) exposure exacerbates health outcomes by causing lung damage. Objectives: To investigate whether prior exposure to particulate matter ⩽10 μm and ⩽2.5 μm in aerodynamic diameter (PM10 and PM2.5) was associated with clinical outcomes among patients with coronavirus disease (COVID-19). Methods: Data from the nationwide registration database of the National Health Insurance and Korea Disease Control and Prevention Agency in South Korea were used. The study included adult patients who were admitted to monitoring centers or hospitals between October 8, 2020 and December 31, 2021, after COVID-19 confirmation. AirKOREA database, which compiles air pollutant data from 642 stations in 162 cities and counties across South Korea, was used to extract data on PM levels. Average values of monthly exposure to PM10 and PM2.5 from the year previous to hospital admission because of COVID-19 to the date of confirmation of COVID-19 were calculated and used to define PM exposures of patients with COVID-19. Results: In total, 322,289 patients with COVID-19 were included, and 4,633 (1.4%) died during hospitalization. After adjusting for covariates, a 1-μg/m3 increase in PM10 and PM2.5 exposure was associated with 4% (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.05; P < 0.001) and 6% (OR, 1.06; 95% CI, 1.04-1.07; P < 0.001) increase in the risk of in-hospital mortality, respectively. In addition, a 1-μg/m3 increase in PM10 and PM2.5 was associated with 5% (OR, 1.05; 95% CI, 1.04-1.07; P < 0.001) and 8% (OR, 1.08; 95% CI, 1.06-1.10; P < 0.001) increase in the risks of requiring intensive care unit (ICU) admission and mechanical ventilation, respectively. Conclusions: PM10 and PM2.5 exposure was associated with increased in-hospital mortality and the need for ICU admission and mechanical ventilation among patients with COVID-19 in South Korea.

Artificial intelligence (AI)-assisted chest computer tomography (CT) insights: a study on intensive care unit (ICU) admittance trends in 78 coronavirus disease 2019 (COVID-19) patients.

The global coronavirus disease 2019 (COVID-19) pandemic has posed substantial challenges for healthcare systems, notably the increased demand for chest computed tomography (CT) scans, which lack automated analysis. Our study addresses this by utilizing artificial intelligence-supported automated computer analysis to investigate lung involvement distribution and extent in COVID-19 patients. Additionally, we explore the association between lung involvement and intensive care unit (ICU) admission, while also comparing computer analysis performance with expert radiologists' assessments. A total of 81 patients from an open-source COVID database with confirmed COVID-19 infection were included in the study. Three patients were excluded. Lung involvement was assessed in 78 patients using CT scans, and the extent of infiltration and collapse was quantified across various lung lobes and regions. The associations between lung involvement and ICU admission were analysed. Additionally, the computer analysis of COVID-19 involvement was compared against a human rating provided by radiological experts. The results showed a higher degree of infiltration and collapse in the lower lobes compared to the upper lobes (P<0.05). No significant difference was detected in the COVID-19-related involvement of the left and right lower lobes. The right middle lobe demonstrated lower involvement compared to the right lower lobes (P<0.05). When examining the regions, significantly more COVID-19 involvement was found when comparing the posterior vs. the anterior halves and the lower vs. the upper half of the lungs. Patients, who required ICU admission during their treatment exhibited significantly higher COVID-19 involvement in their lung parenchyma according to computer analysis, compared to patients who remained in general wards. Patients with more than 40% COVID-19 involvement were almost exclusively treated in intensive care. A high correlation was observed between computer detection of COVID-19 affections and the rating by radiological experts. The findings suggest that the extent of lung involvement, particularly in the lower lobes, dorsal lungs, and lower half of the lungs, may be associated with the need for ICU admission in patients with COVID-19. Computer analysis showed a high correlation with expert rating, highlighting its potential utility in clinical settings for assessing lung involvement. This information may help guide clinical decision-making and resource allocation during ongoing or future pandemics. Further studies with larger sample sizes are warranted to validate these findings.

Atorvastatin Effect on COVID-19 Outcomes: A Propensity Score Matched Study on Hospitalized Patients.

This study investigated the association of atorvastatin use on survival, need for intensive care unit (ICU) admission, and length of hospital stay (LOS) among COVID-19 inpatients. A retrospective study was conducted between March 20th, 2020, and March 18th, 2021, on patients with confirmed COVID-19 admitted to three hospitals in Tehran, Iran. The unadjusted and adjusted effects of atorvastatin on COVID-19 prognosis were investigated. Propensity score matching (PSM) was used to achieve a 1:1 balanced dataset with a caliper distance less than 0.1 and the nearest neighbor method without replacement. Of 4322 COVID-19 patients, 2136 (49.42%) were treated with atorvastatin. After PSM, 1245 atorvastatin inpatients and 1245 controls were included with a median age of 62.0 (interquartile range [IQR]: 51.0, 76.0) and 63.0 (IQR: 51.0, 75.0) years, respectively. The standardized mean differences were less than 0.1 for all confounders, suggesting a good covariate balance. The use of atorvastatin was associated with decreased COVID-19 mortality (HR: 0.80; 95% CI: 0.68-0.95), whereas no relationship was found between atorvastatin and the need for ICU admission (HR: 1.21; 95% CI: 0.99-1.47). LOS was significantly higher in the atorvastatin cohort than controls (Atorvastatin vs. others: 7 [5, 11] vs. 6 [4, 10] days; p = 0.003). The survival rate was higher in combination therapy of atorvastatin plus enoxaparin than in those who received atorvastatin alone (p-value=0.001). Atorvastatin may reduce the risk of COVID-19 in-hospital mortality and could be a beneficial option for an add-on therapy. Randomized trials are warranted to confirm the results of the current observational studies.

Prevalence of vitamin D deficiency in patients with COVID-19 admitted to a tertiary hospital in Rio Grande do Sul

Background: Increasing data suggests a connection between vitamin D (vitD) and COVID-19. VitD may impact COVID-19 by affecting innate cellular immunity and exacerbating cytokine storms linked to severe respiratory syndrome from the virus. Objective: To assess the prevalence of vitD deficiency in COVID-19 patients hospitalized at Hospital Ernesto Dornelles and examine its links to in-hospital mortality, the need for Intensive Care Unit (ICU), patient demographics, and hospital stay duration. Methods: A cross-sectional study was performed, in which 3518 hospitalized patients with a confirmed diagnosis of COVID-19 were evaluated to obtain the prevalence of vitD deficiency, from March 2020 to August 2022. Data collection was performed using electronic medical records, excluding patients without serum levels of vitD measured during hospitalization, and including those with the exam in their medical records, which were later placed for statistical analysis. Results: 486 patients had their serum level of vitD measured, with a mean age of 68.3 years, 57.2% female, and 42.8% male. The prevalence of vitD deficiency was 60.1% (292 patients). There was no difference between the groups with and without vitD deficiency when comparing age, gender, and comorbidities. The median length of hospital stay, the need for ICU admission, and the outcome of death were significantly higher in the group with vitD deficiency (p&lt;0.001; p=0.005; p=0.03). After adjusting for confounding factors, only the risk of ICU admission remained 1.38x higher in the group with vitD deficiency than in the group without (p=0.015), as well as age and CRF were factors with a higher risk for ICU admission. Conclusions: The prevalence of vitD deficiency in patients with COVID-19 was 60%, being associated with a higher risk of ICU admission, possibly presenting or not an association with higher mortality rates and length of stay. Therefore, further studies are needed to establish a cause-and-effect association.

Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study

Rationale and objectivesThe prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of pericardial effusion in patients with Covid 19 in a large multicentre setting. Materials and methodsThis retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. ResultsOverall, 46.4% of the patients were admitted to intensive care unit (ICU), mechanical lung ventilation was performed in 26.6%, and 30-day mortality was 24%.PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR = 1.54, CI95% (1.05; 2.23), p=0.02 (univariable analysis), and HR = 1.60, CI95% (1.03; 2.48), p=0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR = 1.02, CI95% (1.003; 1.05), p=0.03) and the need for ICU admission (OR = 1.03, CI95% (1.005; 1.05), p=0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR=1.56, CI95%(1.01-2.43), p=0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. ConclusionThe prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.

The effects of combination-therapy of tocilizumab and baricitinib on the management of severe COVID-19 cases: a randomized open-label clinical trial.

Background: Tocilizumab and baricitinib are considered standard treatments for hospitalized COVID-19 patients with an inflammatory status. However, the effects of co-administering these medications aiming for more rapid patient recovery are controversial among practitioners. The potential benefits include the rapid improvement of patients and regulation of the immune system, and the potential risks include the increased chance of serious adverse events, including infections. This study aimed to investigate the effects of co-administering these two medications on the 28-day mortality rate, other efficacy parameters, and safety issues. Methods: In this randomized open-label trial, 68 patients were recruited. The study was conducted at Dr. Masih Daneshvari Hospital during 6months (from 21 March 2022 to 23 August 2022). Severely ill patients aged between 18 and 100years old with confirmed COVID-19 were enrolled. The primary outcomes included the need for invasive mechanical ventilation and a 28-day mortality rate. Secondary outcomes included the need for non-invasive mechanical ventilation, the need for admission to the intensive care unit (ICU), the length of hospital stay, and the need for a second dose of tocilizumab. Safety assessments were also performed for 28days. The data were collected from the patients' medical records, which included age, gender, and comorbidities. Results: The 28-day mortality rate or the need for mechanical ventilation was not statistically different among the two groups (p-value = 0.49 for both outcomes). The need for non-invasive mechanical ventilation, the need for admission to the ICU, or the need for a second dose of tocilizumab and the length of hospital stay was not affected either (p-value = 1; 0.1; 0.49 and 0.9, respectively). One patient developed thrombosis in the combination group. No adverse events related to infectious complications were recorded in any groups. Conclusion: This study showed no beneficial effects of combining tocilizumab and baricitinib in managing severe COVID-19 cases. However, the need for ICU admission was meaningfully lower in the combination group. Studies with larger sample sizes are needed to confirm these results. Clinical Trial Registration: Identifier: RCT20151227025726N30M.

Evaluation of the association between inflammatory markers and the prognosis of Covid-19

ABSTRACT Introduction: Coronavirus disease 2019 (COVID-19) triggers the immune system and causes changes in the serum level of inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein, ferritin, interleukin-6, LDH, D-dimer, and procalcitonin (PCT); in this study, we investigate the association between the serum level of inflammatory markers and the prognosis of COVID-19, which included mortality and intensive care unit (ICU) admission of patients Methods: This cross-sectional study was conducted on 200 COVID-19 patients hospitalized at Ayatollah Rouhani Hospital, Babol, from March 2020 to March 2021. Demographic indicators and inflammatory markers were recorded in the questionnaire and were investigated based on disease outcome, length of hospitalization, need for non-invasive ventilation (NIV), and need for hospitalization in the ICU and ventilator. Patients who died or were discharged within the first 24 hours of hospitalization (before the test) were excluded from the study. Finally, the data were recorded in SPSS Statistics 26.0 and then analyzed. Results: The average age of patients with COVID-19 hospitalized in the hospital was 57.92 ± 16.18. The prevalence of death due to coronavirus disease in hospitalized patients was 8.5%. Besides, 23.5% of patients were hospitalized in the ICU and 28.5% required NIV. Based on the disease’s outcome, a significant difference was found in the neutrophil-to-lymphocyte ratio (NLR), so the NLR was significantly higher in patients who died due to coronavirus. Moreover, the levels of erythrocyte sedimentation rate (ESR), D-dimer, LDH, and PCT in deceased individuals were considerably higher compared to those who recovered. Conclusion: NLR, ESR, D-dimer level, LDH, and PCT are among the markers that affect COVID-19 patient outcomes. The increment of any of these markers will lead to an increase in the risk of death and also the need for ICU admission.

A nomogram proposal for early prediction of intensive care unit admission in patients with acute antipsychotic poisoning.

Early identification of antipsychotic poisoned patients who may have a potential risk for intensive care unit (ICU) admission is crucial especially when resources are limited. Nomograms were previously used as a practical tool to predict prognosis and planning the treatment of some diseases including some poisoning conditions. However, they were not previously investigated in antipsychotic poisoning. The current study aimed to construct a nomogram to predict the need for ICU admission in acute antipsychotic poisoning. Patients and methods: This 2-year study included 140 patients acutely intoxicated with antipsychotics and admitted at Tanta University Poison Control Centre throughout July 2019 to June 2021. Personal and toxicological data, findings of clinical examination and electrocardiography, as well as, results of laboratory investigations at time of admission were recorded. According to the outcome, patients were divided into ICU-admitted and ICU-not admitted groups. The results of this study provided a proposed nomogram that included five significant independent predictors for ICU admission in acute antipsychotic intoxications; the presence of seizures (OR: 31132.26[108.97-Inf]), corrected QT interval (OR: 1.04[1.01-1.09]), mean arterial blood pressure (OR: 0.83[0.70-0.92]), oxygen saturation (OR: 0.62[0.40 to 0.83)], and Glasgow Coma Scale (OR: 0.25 [0.06-0.56]). It could be concluded that the developed nomogram is a promising tool for easy and rapid decision making to predict the need for ICU admission in acute antipsychotic poisoning.

Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria.

Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. We examined our institutional Trauma Registry over a 2 year period. A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

Appropriate Management of Splenic Trauma

Introduction: Inappropriate management of splenictrauma is related to high rates of morbidity and mortality, and an effective understanding of its mechanisms is vital. Closed abdominal or thoracoabdominal trauma, such as localized contusions from various incidents, is typically the cause of splenic injuries. Splenic trauma must be promptly evaluated in the context of urgency, and a surgical approach must be performed according to the degree of injury. Methods: This is a retrospective, quantitative, and cross-sectional analysis of the medical records of operated-on patients. Results: The medical records of 50 patients were analyzed, scored, and selected based on the following variables: mechanism of trauma, clinical signs of splenic injury, splenectomy as an emergency approach, degree of injury, postoperative period, complications, sequelae, and length of stay after surgery, as well as the need for intensive care unitadmission and mortality. Data from 50 medical records of patients undergoing urgent splenectomy allowed researchers to draw the conclusion that 48% of patients had experienced splenic trauma as a result of auto accidents, and 38% of patients had Kehr's sign. Additionally, it was determined that grade III–V injuries were the most common in 70% of the cases submitted for urgent splenectomy after an anatomopathological investigation. Further, localized abscesses, the most common type of complications, were present in 50% of the patients. The average length of stay was 8 days, and 38% of the patients needed an intensive care unit. Finally, it was possible to conclude that 10% died. In terms of care, a profile has been established in which a direct and effective approach is required because, when compared with current literature, the number of patients with complications is very low when compared to patients approached conservatively, who present a degree of sequelae of 70% depending on the degree of injury. Conclusion: As a result, the demand for more effective policies that aim to reduce morbidity and mortality is reinforced. This is critical given the high frequency of instances.

Characterization of upper airway microbiome across severity of COVID-19 during hospitalization and treatment.

Longitudinal studies on upper respiratory tract microbiome in coronavirus disease 2019 (COVID-19) without potential confounders such as antimicrobial therapy are limited. The objective of this study is to assess for longitudinal changes in the upper respiratory microbiome, its association with disease severity, and potential confounders in adult hospitalized patients with COVID-19. Serial nasopharyngeal and throat swabs (NPSTSs) were taken for 16S rRNA gene amplicon sequencing from adults hospitalized for COVID-19. Alpha and beta diversity was assessed between different groups. Principal coordinate analysis was used to assess beta diversity between groups. Linear discriminant analysis was used to identify discriminative bacterial taxa in NPSTS taken early during hospitalization on need for intensive care unit (ICU) admission. A total of 314 NPSTS samples from 197 subjects (asymptomatic = 14, mild/moderate = 106, and severe/critical = 51 patients with COVID-19; non-COVID-19 mechanically ventilated ICU patients = 11; and healthy volunteers = 15) were sequenced. Among all covariates, antibiotic treatment had the largest effect on upper airway microbiota. When samples taken after antibiotics were excluded, alpha diversity (Shannon, Simpson, richness, and evenness) was similar across severity of COVID-19, whereas beta diversity (weighted GUniFrac and Bray-Curtis distance) remained different. Thirteen bacterial genera from NPSTS taken within the first week of hospitalization were associated with a need for ICU admission (area under the receiver operating characteristic curve, 0.96; 95% CI, 0.91-0.99). Longitudinal analysis showed that the upper respiratory microbiota alpha and beta diversity was unchanged during hospitalization in the absence of antimicrobial therapy.

Development and validation of a risk prediction nomogram for disposition of acute clozapine intoxicated patients to intensive care unit.

Clozapine is an atypical antipsychotic drug used for the treatment of refractory schizophrenia. It is reported as the most toxic in its class. Using serum clozapine level as a severity indicator is doubtful and unfeasible, particularly in low resourced countries. This is an extended two-phase retrospective study that utilized medical records of patients diagnosed with acute clozapine intoxication and admitted to Tanta University Poison Control Center, Egypt during the past 6years. Two hundred and eight medical records were used to establish and validate a nomogram for predicting the need for intensive care unit (ICU) admission in acute clozapine intoxicated patients. A reliable simple bedside nomogram was developed and proved its significant ability to predict the need for ICU admission, with an area under the curve (AUC) of 83.9% and 80.8% accuracy. It encompassed the age of admitted patients (AUC = 64.8%, p = .003), respiratory rate (AUC = 74.7%, p < .001), O2 saturation (AUC = 71.7%, p < .001), and random blood glucose level upon admission (AUC = 70.5%, p < .001). External validation of the proposed nomogram showed a high AUC (99.2%) with an overall accuracy of 96.2%. There is a need to develop a reliable objective tool predicting the severity and need for ICU admission in acute clozapine intoxication. The proposed nomogram is a substantially valuable tool to estimate ICU admission probabilities among patients with acute clozapine intoxication and will help clinical toxicologists make rapid decisions for ICU admission, especially in countries with low resources.

Effect of COVID-19 Vaccination on the In-Hospital Prognosis of Patients Admitted during Delta and Omicron Waves in Italy.

All-cause mortality related to the SARS-CoV-2 infection has declined from the first wave to subsequent waves, probably through vaccination programs and the availability of effective antiviral therapies. Our study aimed to evaluate the impact of the SARS-CoV-2 vaccination on the prognosis of infected patients. Overall, we enrolled 545 subjects during the Delta variant wave and 276 ones during the Omicron variant wave. Data were collected concerning vaccination status, clinical parameters, comorbidities, lung involvement, laboratory parameters, and pharmacological treatment. Outcomes were admission to the intensive care unit (ICU) and 30-day all-cause mortality. Overall, the final sample included 821 patients with a mean age of 62 ± 18 years [range 18-100], and 59% were men. Vaccinated patients during the Delta wave were 37% (over ¾ with two doses), while during the Omicron wave they were 57%. Vaccinated patients were older (68 vs. 57 years), and 62% had at least one comorbidity Admission to the ICU was 20%, and the mortality rate at 30 days was 14%. ICU admissions were significantly higher during the Delta wave than during Omicron (OR 1.9, 95% CI 1.2-3.1), while all-cause mortality did not differ. Unvaccinated patients had a higher risk of ICU admission (OR 2.0, 95% CI 1.3-3.1) and 30-day all-cause mortality (OR 1.7, 95% CI 1.3-2.7). Results were consistent for both Delta and Omicron variants. Overall, vaccination with at least two doses was associated with a reduced need for ICU admission. Even one shot of the vaccine was associated with a significantly reduced 30-day mortality.

Admission neutrophil-to-lymphocyte ratio predicts length of hospitalization and need for ICU admission in adults with Status Epilepticus

Background and objectivesStatus epilepticus (SE) is a time-dependent neurological emergency. The current study evaluated the prognostic value of admission neutrophil-to-lymphocyte ratio (NLR) in patients with status epilepticus. MethodsIn this retrospective observational cohort study we included all consecutive patients discharged from our neurology unit with the clinical or EEG diagnosis of SE from 2012 to 2022. Stepwise multivariate analysis was conducted to test the association of NLR with length of hospitalization, need for Intensive Care Unit (ICU) admission and 30 days mortality. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to identify patients who will need ICU admission. ResultsA total of 116 patients were enrolled in our study. NLR was correlated with length of hospitalization (p = 0.020) and need for ICU admission ( p = 0.046). In addition, the risk of ICU admission increased in patients with intracranial hemorrhage and length of hospitalization was correlated with C-reactive protein-to-albumin ratio (CRP/ALB). ROC analysis identified a NLR of 3.6 as best cutoff value to discriminate need of ICU admission (area under the curve [AUC]=0.678; p = 0.011; Youden's index=0.358; sensitivity, 90.5%, specificity, 45.3%). DiscussionIn patients with SE admission NLR could be a predictor of length of hospitalization and need for ICU admission.

Doxycycline for the prevention of progression of COVID-19 to severe disease requiring intensive care unit (ICU) admission: A randomized, controlled, open-label, parallel group trial (DOXPREVENT.ICU).

After admission to hospital, COVID-19 progresses in a substantial proportion of patients to critical disease that requires intensive care unit (ICU) admission. In a pragmatic, non-blinded trial, 387 patients aged 40-90 years were randomised to receive treatment with SoC plus doxycycline (n = 192) or SoC only (n = 195). The primary outcome was the need for ICU admission as judged by the attending physicians. Three types of analyses were carried out for the primary outcome: "Intention to treat" (ITT) based on randomisation; "Per protocol" (PP), excluding patients not treated according to randomisation; and "As treated" (AT), based on actual treatment received. The trial was undertaken in six hospitals in India with high-quality ICU facilities. An online application serving as the electronic case report form was developed to enable screening, randomisation and collection of outcomes data. Adherence to treatment per protocol was 95.1%. Among all 387 participants, 77 (19.9%) developed critical disease needing ICU admission. In all three primary outcome analyses, doxycycline was associated with a relative risk reduction (RRR) and absolute risk reduction (ARR): ITT 31.6% RRR, 7.4% ARR (P = 0.063); PP 40.7% RRR, 9.6% ARR (P = 0.017); AT 43.2% RRR, 10.8% ARR (P = 0.007), with numbers needed to treat (NTT) of 13.4 (ITT), 10.4 (PP), and 9.3 (AT), respectively. Doxycycline was well tolerated with not a single patient stopping treatment due to adverse events. In hospitalized COVID-19 patients, doxycycline, a safe, inexpensive, and widely available antibiotic with anti-inflammatory properties, reduces the need for ICU admission when added to SoC.

Prognostic factors in acute poisoning with central nervous system xenobiotics: development of a nomogram predicting risk of intensive care unit admission.

Acute intoxication with central nervous system (CNS) xenobiotics is an increasing global problem. Predicting the prognosis of acute toxic exposure among patients can significantly alter the morbidity and mortality. The present study outlined the early risk predictors among patients diagnosed with acute exposure to CNS xenobiotics and endorsed bedside nomograms for identifying patients requiring intensive care unit (ICU) admission and those at risk of poor prognosis or death. This study is a 6-year retrospective cohort study conducted among patients presented with acute exposure to CNS xenobiotics. A total of 143 patients' records were included, where (36.4%) were admitted to the ICU, and a significant proportion of which was due to exposure to alcohols, sedative hypnotics, psychotropic, and antidepressants (P=0.021). ICU admission was associated with significantly lower blood pressure, pH, and HCO3 levels and higher random blood glucose (RBG), serum urea, and creatinine levels (P<0.05). The study findings indicate that the decision of ICU admission could be determined using a nomogram combining the initial HCO3 level, blood pH, modified PSS, and GCS. HCO3 level<17.1mEq/L, pH<7.2, moderate-to-severe PSS, and GCS<11 significantly predicted ICU admission. Moreover, high PSS and low HCO3 levels significantly predicted poor prognosis and mortality. Hyperglycemia was another significant predictor of mortality. Combining initial GCS, RBG level, and HCO3 is substantially helpful in predicting the need for ICU admission in acute alcohol intoxication. The proposed nomograms yielded significant straightforward and reliable prognostic outcomes predictors in acute exposure to CNS xenobiotics.