Non-surviving Patients Research Articles

A cross-sectional study on the role of hematological and inflammatory biomarkers as predictor of mortality at the time of admission among COVID-19 patients

Background: Whole world experienced COVID-19 pandemic with more than 155 million cases and >3.4 million deaths. Vasculitis and immune system activation plays a critical role in pathogenesis, especially in severely ill and non-survivors COVID-19 patients. Aims and Objectives: The aim of the study was to establish the role of hematological indices and inflammatory biomarker as predictors of mortality among non-survivor and survivor COVID-19 cases at the time of admission. Materials and Methods: The cross-sectional study was conducted at a dedicated COVID-19 referral hospital from July 2020 to August 2020, among 300 real time-polymerase chain reaction confirmed COVID-19 cases. Demographic, clinical, comorbidity, laboratory investigation, and outcome data were collected from patient’s medical record. Outcome variables – discharged (survived) or death (non-survived) were considered for comparison of various hematological indices and inflammatory biomarkers. Data are represented as median, IQR (Q1-Q3) and difference between median and proportions were calculated by Mann–Whitney U-test and χ² test. A predictive power of laboratory parameters between survivors and non-survivors was evaluated using receiver operant curve (ROC) analysis and area under the ROC curve (AUC). Results: The median age of non-survivors was significantly higher than survivors. Hypertension was significantly associated with non-survivors. Hematological parameters such as total leukocyte count, absolute neutrophil count, Neutrophil: Lymphocyte ratio were significantly increased with lymphocytopenia (P=0.001), and Inflammatory biomarkers such as C-reactive protein (CRP), lactate dehydrogenase, D-dimer, ferritin, procalcitonin, and NT-Pro BNP, all were significantly increased in non-survivors patients (P=0.001). CRP and neutrophil lymphocyte ratio (NLR) showed “Good” predictive value for mortality with cutoff value of 74.0 mg/l (AUC=0.841, Sensitivity=80.4%, Specificity=73.0%) and 5.65 (AUC=0.805, Sensitivity=76.1%, Specificity=73.0%), respectively. Pro-BNP showed “Fair” predictive value for mortality with cutoff value of 330.5 pg/ml (AUC=0.726, Sensitivity=73.9%, Specificity=58.2%). Conclusion: We suggest that CRP, NLR, and Pro-BNP can be used as a screening tool to predict mortality in COVID-19 patients for timely intervention to save valuable life, especially when sensitivity toward severity of COVID-19 among medical health professionals and general public is on decline.

Procalcitonin levels as a predictor of clinical outcome in sepsis

Background: Sepsis is defined as a life-threatening condition resulting from an inappropriate response of the body to any infection. Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, there are limited studies on the relationship between increased procalcitonin levels and the clinical outcome. Therefore, the present study aimed to determine the serum procalcitonin levels in septic patients and its association with mortality. Methods: This prospective, observational study was conducted from December 2017 to May 2019 and included 75 septic patients aged >18 years. Detailed history, physical, clinical and laboratory (procalcitonin) examination were performed for all the patients, and the clinical outcome was measured by calculating the Acute Physiology and Chronic Health Evaluation (APACHE) II severity score. Chi-square test and Mann-Whitney U test were used to analyze the data. Results: Distribution of procalcitonin levels between the survival or non-survival patients was found to be insignificant (P=0.09545). However, the difference in APACHE II scores between the survivors and non-survivors was observed to be statistically significant (P=0.0001007). Moreover, the area under the ROC curve for serum procalcitonin and APACHE II score was found to be 87.31% and 76.97%, respectively. Conclusion: The present study found that the serum procalcitonin levels were elevated in septic patients, thus establishing its involvement in the prognosis of sepsis. Increased procalcitonin levels were also found to be associated with the increase in the APACHE II severity score. Therefore, both procalcitonin levels and APACHE II severity score can be used as biomarkers for the diagnosis of sepsis.

Effect of ferritin, INR, and D-dimer immunological parameters levels as predictors of COVID-19 mortality: A strong prediction with the decision trees

Background and objectiveA hyperinflammatory environment is thought to be the distinctive characteristic of COVID-19 infection and an important mediator of morbidity. This study aimed to determine the effect of other immunological parameter levels, especially ferritin, as a predictor of COVID-19 mortality via decision-trees analysis. Material and methodThis is a retrospective study evaluating a total of 2568 patients who died (n = 232) and recovered (n = 2336) from COVID-19 in August and December 2021. Immunological laboratory data were compared between two groups that died and recovered from patients with COVID-19. In addition, decision trees from machine learning models were used to evaluate the performance of immunological parameters in the mortality of the COVID-19 disease. ResultsNon-surviving from COVID-19 had 1.75 times higher ferritin, 10.7 times higher CRP, 2.4 times higher D-dimer, 1.14 times higher international-normalized-ratio (INR), 1.1 times higher Fibrinogen, 22.9 times higher procalcitonin, 3.35 times higher troponin, 2.77 mm/h times higher erythrocyte-sedimentation-rate (ESR), 1.13sec times longer prothrombin time (PT) when compared surviving patients. In addition, our interpretable decision tree, which was constructed with only the cut-off values of ferritin, INR, and D-dimer, correctly predicted 99.7% of surviving patients and 92.7% of non-surviving patients. ConclusionsThis study perfectly predicted the mortality of COVID-19 with our interpretable decision tree constructed with INR and D-dimer, especially ferritin. For this reason, we think that it may be important to include ferritin, INR, and D-dimer parameters and their cut-off values in the scoring systems to be planned for COVID-19 mortality.

Neutrophil-to-Lymphocyte Ratio as an Independent Risk Factor for Mortality in Burn Patients With and Without COVID-19

Background: Following the initial appearance of coronavirus disease 2019 (COVID-19) in December 2019, approximately 23 million cases have been documented worldwide, illustrating its devastation. Inflammation plays a role in both COVID-19 and burn pathophysiology. Despite the necessity of understanding this impact, few research studies explore the influence of COVID-19, a novel disease, on burns. The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive test that can be used to detect the overall status of inflammation. The NLR has not been thoroughly examined in people with COVID-19 and burns. In this study, the value of NLR less than 72 hours since a burn accident as a risk factor for mortality in burn patients with and without COVID-19 will be evaluated. Methods: A retrospective study was conducted between April 2020 and March 2022 at the Dr. Soetomo General Academic Hospital in East Java, Indonesia. We collected the following variable data: gender, age, cause of burn, co-morbidities, percentage of the total body surface area (%TBSA), length of stay (LoS), mortality outcome, and neutrophil and lymphocyte counts. The NLR is the ratio between the absolute neutrophil and lymphocyte counts. The data were analysed using Chi-Square and Mann-Whitney tests. The difference will be considered significant if the p value is < 0.05. Results: Based on data from 126 burn patients with and without COVID-19, the mean and standard deviation (SD) NLR for non-survivor patients were higher (12.05 and 9.7, respectively) than those for survivor patients (7.92 and 5.9, respectively). The receiver operating characteristic (ROC) curve analysis showed the area under ROC curve (AUC) for NLR value was 0.626 (95% confidence interval (CI): 0.535-0.71), which was statistically significant, namely the NLR cut-off value > 6.97 with a sensitivity value of 64.3%, a specificity of 59.5%, and a p value of 0.021. The risk of mortality with an NLR > 6.97 has an accuracy of 61.11%, a negative predictive value of 76.92%, and a positive predictive value of 44.26%. Conclusion: Our study showed that NLR is associated with the risk of mortality in burn patients, regardless of the presence or absence of COVID-19, and that it can be used as a low-cost, readily accessible approach to identify indications of intensive care monitoring for patients.

Clinical features of patients who underwent anoplasty for cloacal exstrophy and their functional outcomes: the results of a nationwide survey in Japan.

This study was performed to clarify the clinical features of cloacal exstrophy (CE) patients who underwent anoplasty and their functional outcomes based on a nationwide survey in Japan. A questionnaire survey was conducted and data were obtained from 229 CE patients. After the exclusion of non-surviving patients and unknown data, 195 patients were enrolled. We compared the patient characteristics of the no anoplasty group (NAP group) to the anoplasty group (AP group). The defecation function of patients who underwent anoplasty was evaluated. The AP group had significantly lower rates of omphalocele (p = 0.045) and spinal defects (p = 0.003) than the NAP group. Of the 195 patients enrolled in this study, only 17 (8.7%) underwent anoplasty. Of the 17 patients who underwent anoplasty, 7 (41.1%) eventually had a permanent stoma after anoplasty [after ileostomy: n = 3 (60.0%), after colostomy: n = 4 (44.4%)]. Regarding soiling, 4 patients (66.7%) showed the absence of soiling, 2 (33.3%) showed accidental soiling, and no patients showed frequent soiling. In our study, spinal defects may have affected the determination of anoplasty. Anoplasty may improve the quality of life, because defecation can be kept clean, but indications, including colon function, may be carefully considered.

Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal rupture? A monocenter retrospective study.

Ventricular septal rupture (VSR) is an uncommon but life-threatening complication of acute myocardial infarction. Extra corporeal life support (ECLS) use in the preoperative setting allows hemodynamic stabilization for a delayed surgery. We aimed to assess the role of ECLS in the preoperative period of post infarction VSR surgery. We retrospectively analyzed all consecutive patients operated for VSR between January 2007 and August 2019. We assessed baseline characteristics, pre and post-operative clinical status and the use of ECLS in the peri-operative period. A total of 39 patients were included. Mean age was 69.8 years. In-hospital mortality was 48.7%. Survivors and non-survivor patients had similar characteristics except for lower postoperative ejection fraction (32% vs. 42%, P=0.02) and more acute renal failure (71.4% vs. 10%, P=0.0005) in the non-survivor group. Patients who received ECLS preoperatively were younger (72 vs. 65, P=0.02) and had more preoperative invasive ventilation (16% vs. 50%, P=0.04). Cardiopulmonary bypass (CPB, 140 min vs. 75 min, P=0.0008) and cross clamping times (94 min vs. 52 min, P=0.0026) were significantly higher in the ECLS group. There were more bleeding complications in the ECMO group (45.4% vs. 0%, P=0.0019) and more need for reintervention (63.3% vs. 13%, P=0.015). There was no difference in mortality between the two groups. There was no difference in postoperative characteristics between urgent and delayed surgery. In our study, post-operative ECLS use was associated with more bleeding complications and need for reintervention. Although mortality was similar, bleeding complications remain a major limitation for the systematic use of ECLS in the post-operative period.

Changes in the pituitary — thyroid system during extracorporeal membrane oxygenation: a prospective observational study

INTRODUCTION: The severity of the patient's condition that required ECMO and the changes observed in the pituitary — thyroid system (decreased T4 and T3 levels, low-normal or decreased TSH level) can be considered as a lack of body reserves due to the developed critical illness. OBJECTIVES: Study changes of TSH, T3, T4 levels during the ECMO procedure, during weaning/death on the ECMO. MATERIALS AND METHODS: The prospective observational study was performed in intensive care unit (47 patients on ECMO). After connecting ECMO (D0), (D1-D3-D5-D7-D9), and until the completion of ECMO, assessment of TSH, FT4, FT3 levels was carried out. OBJECTIVE: Analysis of changes in thyroid hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) levels in blood plasma during ECMO, at ECMO weaning/death on ECMO. RESULTS: On the day of ECMO (D 0) and every second day, median FT4 levels were D0 (p = 0.03); D1 (p = 0.03); D3 (p = 0.05), D11 (p = 0.02) and last observation day (p = 0.009) between surviving and dying patients respectively. T3 level D5 (3.1–1.9; p = 0.002); D11 (3.7–2.5; p = 0.05), last day of follow-up (3.1–2; p = 0.001), respectively. On the last day of ECMO between the survived and non-survived patients there were the following: differences in TSH levels; negative correlation of lactate levels, SOFA score and FT3, TSH, FT4. The analysis of the ROC curve (low levels of FT3, FT4, TSH in plasma in patients on the last day of ECMO) indicates a prognostically unfavorable outcome. CONCLUSIONS: The moment of ECMO connection initiation is regarded as subacute phase critical illness. Along with a high level of plasma lactate and high score of SOFA scale, the level of decrease in FT3, FT4 and TSH in patients correlates with the lethal outcome. Low levels of TSH, FT4, and FT3 may be considered as a predictor of adverse outcome at the time of weaning/death on ECMO.

Albumin levels, mean platelet volume, and neutrophil lymphocyte ratio as predictors of COVID-19 outcomes

Coronavirus Disease 2019 (COVID-19) is a respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 spreads very quickly to various countries and causes a high mortality rate. According to this urgency, a study was conducted on albumin levels, mean platelet volume (MPV), and neutrophil-lymphocyte ratio (NLR) as predictors of COVID-19 outcome. This research was an analytic observational study conducted cross-sectional at Dr. Moewardi Hospital Surakarta, Indonesia, from June-October 2021. Data analysis used the logistic regression test and ROC analysis to determine the cut-off point for each variable. The total samples used in this study were 123 samples, with 68 survival patients and 55 nonsurvival patients. Logistic regression test results received p values for MPV and NLR, respectively, 0.048 and 0.001, and OR values 1.369 and 1.186 with Nagelkerke R Square 0.186. The cut-off point of MPV is 9.05 (sensitivity 76.4%; specificity 48.5%; p=0.019), and the cut-off point of NLR is 3.27 (sensitivity 92.7%; specificity 55.9%; p=0.001). In conclusion, MPV and NLR can be used as predictors of COVID-19 outcomes.

Efficacy of serum apelin and galectin-3 as potential predictors of mortality in severe COVID-19 patients.

Apelin is a cardioprotective biomarker while galectin-3 is a pro-inflammatory and profibrotic biomarker. Endothelial dysfunction, hyperinflammation, and pulmonary fibrosis are key mechanisms that contribute to the development of adverse outcomes in Coronavirus disease 2019 (COVID-19)infection. This study aims to analyze the prognostic value of serum apelin and galectin-3 levels to early predict patients at high risk of mortality in patients hospitalized for severe COVID-19 pneumonia.The study included 78 severe COVID-19 patients and 40 healthy controls. The COVID-19 patients were divided into two groups, survivors and nonsurvivors, according to their in-hospital mortality status. Basic demographic and clinical data of all patients were collected, and blood samples were taken before treatment.In our study, serum apelin levels were determined to be significantly lower in both nonsurvivor and survivor COVID-19 patients compared to the control subjects (for both groups, p < 0.001). However, serum apelin levels were similar in survivor and nonsurvivor COVID-19 patients (p > 0.05). Serum galectin-3 levels were determined to be higher in a statistically significant way in nonsurvivors compared to survivors and controls (for both groups; p < 0.001). Additionally, serum galectin-3 levels were significantly higher in the survivor patients compared to the control subjects (p < 0.001). Positive correlations were observed between galectin-3 and age, ferritin, CK-MB and NT-proBNP variables (r = 0.32, p = 0.004; r = 0.24, p = 0.04; r = 0.24, p = 0.03; and r = 0.33, p = 0.003, respectively) while a negative correlation was observed between galectin-3 and albumin (r = -0.31, p = 0.006). Multiple logistic regression analysis revealed that galectin-3 was an independent predictor of mortality in COVID-19 patients (odds ratio [OR] = 2.272, 95% confidence interval [CI] = 1.106-4.667; p = 0.025). When the threshold value for galectin-3 was regarded as 2.8 ng/ml, it was discovered to predict mortality with 80% sensitivity and 57% specificity (area under the curve = 0.738, 95% CI = 0.611-0.866, p = 0.002).Galectin-3 might be a simple, useful, and prognostic biomarker that can be utilized to predict patients who are at high risk of mortality in severe COVID-19 patients.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism.

Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/ dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

The Value of Interleukin-17A as a Prognostic Indicator in COVID-19 Patients

Background: SARS-CoV-2 infections (COVID-19) first occurred in Wuhan, China, in December 2019 and spread worldwide, causing significant mortality and morbidity. IL-17A may mediate numerous immunopathological effects secondary to cytokine release syndrome during SARS-CoV-2 infection. However, there has not been enough research on its effect on prognosis. Objectives: This study evaluated the predictive power of serum interleukin (IL)-17A level as a prognostic marker in COVID-19. Methods: The study included 152 patients diagnosed with COVID-19 by real-time polymerase chain reaction analysis of nasopharyngeal swab samples in the infectious diseases department and intensive care unit of our hospital between October 1 and December 31, 2020. The control group consisted of 40 asymptomatic healthcare workers who had negative RT-PCR results during routine COVID-19 screening in our hospital. Samples were collected in anticoagulant-free tubes and left at room temperature for 30 minutes. Afterward, it was centrifuged at 1000 × g for 15 minutes at 4°C per the instructions provided with the enzyme-linked immunoassay (ELISA) kit. Serum IL-17A levels were measured using the Human Interleukin 17A ELISA Kit. Results: Serum IL-17A levels were significantly higher in COVID-19 patients than in controls (P &lt; 0.001). IL-17A levels increased significantly in association with disease severity in patients with the moderate, severe, and critical disease, with a less pronounced difference between severe and critical patients (moderate vs. severe, P &lt; 0.001; severe vs. critical, P = 0.048). IL-17A levels at hospital admission and day 7 were significantly higher in non-surviving patients (P &lt; 0.001). At a cut-off value of 210.25 ng/L, IL-17A at admission had a predictive power of 0.792 (P &lt; 0.001). Compared to baseline, IL-17A values on day seven were significantly increased in non-survivors (P = 0.004) and decreased in survivors (P = 0.014). An increase of 26.17 ng/L or more on day 7 had a predictive mortality power of 0.634 (P = 0.005). Conclusions: The results of this study suggest that IL-17A, an important part of the immune system previously shown to be useful in the treatment and follow-up of COVID-19, may also help predict mortality in COVID-19 patients.

The Effects of Protein Intake on Clinical Outcome in Pediatric Intensive Care Units.

Factors such as increased metabolic needs and inadequate calorie and protein intake increase the risk of malnutrition in critically ill children admitted to the pediatric intensive care unit. This study aimed to determine the risk of malnutrition and associated clinical outcomes. Data from all patients aged 1 month to 18 years in 4 pediatric intensive care units in Adana, Turkey, were prospectively collected. Patient anthropometric data, the duration of mechanical ventilation, the length of stay in pediatric intensive care unit, 60-day mortality, nutritional status, and calorie and protein intake were recorded. A total of 111 patients were included in the study. There was a significant difference between survivor and non-survivor patients in terms of calorie and protein intake 48 hours after admission and protein intake on the seventh day after admission (P = .001, P = .000, and P = .003, respectively). No significant correlation was found between the length of pediatric intensive care unit stay, sepsis, and calorie intake in the first week. It was found that 1 g/kg/ day increase in protein intake on the seventh day of intensive care hospitalization decreased the risk of mechanical ventilation by 0.49 times (P = .035; sensitivity: 83.3%; specificity: 34.5%). Nutritional status should be evaluated fully in patients admitted to the pediatric intensive care unit and early detected malnutrition should be monitored closely to determine the need for early intervention. The risk of developing malnutrition is high in critically ill children. Providing the necessary energy and protein intake with nutritional therapy affects the clinical course in children with critical illness. Protein intake causes prolongation of mechanical ventilation time, delaying clinical recovery.

Pressure‐based beat‐to‐beat right ventricular ejection fraction and Tau from continuous measured ventricular pressures in COVID‐19 ARDS patients

We evaluated pressure-based right ventricular ejection fraction (RVEF) and diastolic isovolumetric relaxation time constant (Tau) from continuously (up to 30 days) invasive measured right ventricular pressures in mechanically ventilated patients with severe COVID-19 acute respiratory distress syndrome(ARDS). We retrospectively calculated beat-to-beat ejection fraction from right ventricular pressures and dp/dt maximum and minimum in 39 patients treated between October 1st, 2020 and June 30th, 2021. After performing a stepwise logistic regression with survival as a dependent variable, we divided the patients into survivors and nonsurvivors based on their 60-day mortality. Independent outcome variables were the values of RVEF and Tau over time after insertion of the right ventricular probe along with right ventricular systolic and diastolic pressures (RVSP) and the estimated pulmonary artery diastolic pressure (ePAD).RVEF increased significantly over time in the survivors (estimate: 0.354; 95% confidence interval,CI: 0.18-0.53; p < 0.001) but remained unchanged in the nonsurvivors. Tau increased significantly in the nonsurvivors (estimate: 0.001; 95% CI: 0.0004-0.0018; p < 0.002) but not in the survivors. On the last measurement day,RVSP and ePAD were significantly lower while RVEF was significantly higher in the survivors compared to the nonsurvivors. In COVID-19 ARDS patient's, calculation of beat-to-beat RVEF and Tau from continuously invasive measured right ventricular pressures seems to unravel contrary trends in RVEF with an increase in the surviving and a decrease in the nonsurviving patients. Tau remained unchanged in the surviving but increased in the nonsurviving patients over time.

Factors associated with mortality in acute respiratory failure patients without acute respiratory distress syndrome.

Excess tidal volume and driving pressure were associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). Still, the appropriate mechanical ventilation strategy for patients who do not have ARDS needs to be understood. This study aimed to identify risk factors for mortality in acute respiratory failure patients without ARDS. We included all mechanically ventilated patients who did not meet the criteria for ARDS and were admitted to the medical intensive care unit (ICU) from October 2017 to September 2018. Patients who had tracheostomy before admission, were intubated for more than 24 hours before transfer to ICU, or underwent extracorporeal membrane oxygenation within 24 hours of ICU admission were excluded. Clinical and physiologic data were recorded and compared between survived and non-survived patients. Of 289 patients with acute respiratory failure, 134 patients without ARDS were included; 69 (51%) died within 28 days. Demographics, principal diagnosis, and lung injury score on the first day of admission were not significantly different between survived and non-survived patients. In multivariate analysis, higher peak inspiratory pressure (PIP) during the first 3 days of admission [odds ratio (OR) 1.11, 95% confidence interval (CI): 1.01-1.22, P=0.04], higher sequential organ failure assessment score (OR 1.15, 95% CI: 1.04-1.28, P=0.008) and underlying cerebrovascular diseases (OR 7.09, 95% CI: 1.78-28.28, P=0.006) were independently associated with mortality in these patients, whereas dynamic lung compliance (Cdyn) and respiratory rate were not associated with mortality in the multivariate model. Mortality was high in mechanically ventilated patients without ARDS. Higher PIP is a potentially modifiable risk factor for mortality in these patients, independent of the baseline Cdyn. Underlying cerebrovascular diseases and increased disease severity are also independent factors associated with 28-day mortality.

Predictive performance of qSOFA in confirmed COVID-19 patients presenting to the emergency department.

It is critical to quickly and easily identify coronavirus disease 2019 (COVID-19) patients who become severely or even critically ill. Thus, this study was conducted to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting the severity and mortality of COVID-19 patients. This was a prospective observational study of COVID-19 patients admitted to the emergency department (ED) between June 22, 2021, and November 21, 2021. The clinical characteristics of the participants were collected by the emergency physicians. The correlation of the qSOFA, Systemic Inflammatory Response Syndrome criteria (SIRS), Pneumonia Severity Index (PSI), and confusion, urea, respiratory rate, blood pressure, 65 years of age and older (CURB-65) scores for 14-day mortality were evaluated. The area under a receiver operating characteristic (AUROC) curve analysis was calculated to compare the effectiveness of qSOFA, SIRS, PSI, and CURB-65 to predict severe disease. Eight hundred and ninety-four subjects were included. Of them, 721 patients (80.6%) survived after 14 days of admission. The mean age was 58.92 ± 17.80 years, and 551 subjects (61.6%) were male. Nonsurvived patients were significantly older (51.09 ± 23.60 vs. 38.10 ± 18.24, P = 0.004) and had more comorbidities (diabetes mellitus, respiratory, cardiovascular, and cerebrovascular disease) in comparison with survived patients. For COVID-19 mortality prediction, the AUROCs of qSOFA, CURB-65, PSI, and SIRS score were 0.799 (95% confidence interval [CI 0.771-0.825]), 0.829 (95% CI [0.803-0.853]), 0.830 (95% CI [0.804-0.854]), and 0.759 (95% CI [0.730-0.787]), respectively. All scores were good predictors of COVID-19 mortality. The qSOFA was more successful than SIRS in predicting mortality for COVID-19 patients and was similar to CURB-65 and PSI. Therefore, the qSOFA score can be considered a simple and rapid screening tool for identifying high-risk patients.

Plasma microRNAs levels associate with the outcome of ARDS patients

Background: Mesenchymal stem cells (MSC) are stromal cells with renew ability for multilineage differentiation. Therefore MSC has been considered as a therapy method for rebuilding alveoli structure and repairing the function of pulmonary vascular endothelial cells (VEC). However, whether MSC can play a therapeutic role in ARDS patients depends on different ARDS phenotypes. Recent studies about microRNAs (miRNAs) proved that miRNAs played important roles in MSC regulating function and activity of VEC which may affect therapeutic response and outcome to different ARDS patients, but few studies focused on this field. The purpose of our study is that plasma miRNAs regulated VEC’s function and specific miRNAs which were related to MSC and VEC (MSC‑VEC‑miRNAs) expressed differently between survival and non-survival ARDS patients. We aim to find specific MSC‑VEC‑miRNAs which are associated with the outcome of ARDS patients. Methods: We obtained MSC-VEC-miRNAs through searching PUBMED database. A number of 101 ARDS patients were screened and 57 of them were included in our research within 24 hours of admission to ICU. We then collected their clinical data and their blood samples, then we did real-time PCR to test plasma levels of MSC-VEC-miRNAs. Results: Fourteen MSC-VEC-miRNAs were selected in this study. We included 57 ARDS patients and 18(31.6%) of them died on Day 28 after diagnosis. Plasma miR-26a level in non-survival group was significantly lower than that in survival group (0.33[0.09-1.17] vs. 0.97[0.17-3.49], P=0.046). Plasma miR-320 level in non-survival group was significantly higher than that in survival group (0.37[0.16-1.66] vs. 0.18[0.07-0.39], P=0.041). There was no statistical difference of other 12 miRNA between two groups. Conclusion: Plasma miR-26a and miR-320 levels have a certain predictive value for the prognosis of ARDS patients.

YOĞUN BAKIM HASTALARINDA İNFLAMATUAR BELİRTEÇLERİN MORTALİTE ÜZERİNE ETKİLERİNİN BELİRLENMESİ

Abstract Aim: Mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW) plays important role as effective factors in predicting mortality and morbidity in various diseases. In the present study we aimed to assess and compare MPV, NLR, PLR and RDW of survived and non-survived patients by examining the blood samples taken within the first hour after admission to our intensive care unit. Methods: This retrospective study included 672 patients who were hospitalized in a mixed 16 bed intensive care unit (ICU) between January 2019 and January 2020. By examining our hospital's computer-based data system, patient data of the survived and non-survived patients who were treated in the ICU were analyzed. Results: The demographic parameters of the patients (gender), concomitant disease, and laboratory parameters including HTC, PLT, WBC, MPV and PLR were not significantly different between the survived and non-survived patients. RDW, albumin, CRP and NLR were found statistically different between the study groups. Conclusions: The elevated RDW, NLR and CRP levels were found more significant than the other inflammatory markers for determining mortality of the critically ill patients. In addition, evaluation of albumin level was found important in defining the prognosis of the intensive care unit patients.

The use of the news in predicting the clinical status of copd patients presenting to the emergency department with a the complaint of dyspnea

Aim: COPD (Chronic Obstructive Pulmonary Disease) is a lung disease that causes impairment in quality of life. NEWS (National Early Warning Score) is a scoring system that evaluates patients' general condition and mortality. We examined the utility of NEWS in predicting the clinical status of COPD patients. Materials and methods: COPD patients admitted to the emergency department were included in the study. Age, gender, comorbid diseases, occupational exposure status, smoking/tobacco intake, hematological and radiological examinations, vital values, and continuous drug use status of the patients were evaluated. The GCS (Glasgow Coma Scale), CCI (Charlson Comorbidity Index), and NEWS values of the patients were calculated. Chi-square, Fisher's exact, unpaired t-test, or Mann-Whitney U tests were applied according to the normal distribution. Values of p&lt;0.05 were considered statistically significant. Results: Of the patients, 82% (n=205) were male, and 18% (n=45) were female. Of the patients, 67% had comorbid diseases. Coronary artery disease was the most common comorbid disease (n=68, 27%). Low saturation, pH, mean blood pressure, low hemoglobin, high CO2, creatinine, urea, CRP, and INR levels were associated with mortality. In non-survival patients, the GCS was low, whereas the CCI and NEWS were high. Conclusions: The NEWS value should be considered in order to determine the clinical status of patients presenting with a COPD attack, to make the decision for hospitalization, and to predict their mortality. Keywords : Emergency department,COPD exacerbation,NEWS,mortality

Clinical profile, treatment, and outcomes of patients with COVID-19 in a tertiary referral hospital in South Sumatera, Indonesia: A retrospective single-center study.

Although there are fewer COVID-19 cases in Indonesia, the pandemic is still ongoing. COVID-19 has a significant death rate in Indonesia, but lack of information on the effect of different clinical and demographic factors on COVID-19-related grimness and mortality in Indonesia. This study examined the clinical profile, treatment, and outcomes of patients with COVID-19 at Lahat Regency Hospital in South Sumatera, Indonesia, to find relevant markers that might be utilized to predict the prognosis of these patients. This was a retrospective single-center study of all medical record files of confirmed patients with COVID-19 admitted to Lahat Hospital from September 2020 to August 2021 (n = 285). Descriptive statistics, Chi-square, Mann-Whitney, Multiple Logistic Regression, and Cox's proportional hazards model were used for data analyses. This study included 65 non-hospitalized and 220 hospitalized patients. Hospitalized patients were divided into dead and alive groups. The median age was lower in the non-hospitalized group without gender discrimination, and most hospitalized patients had comorbidities. Vital signs and clinical features were significantly different in hospitalized patients compared to non-hospitalized. The survival patients in the hospitalized group showed lower white blood cell (WBC), neutrophil percentages, and neutrophil-lymphocyte ratio (NLR) but higher lymphocyte and eosinophil. Non-survival patients had elevated alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine, blood glucose, and potassium. The use of Favipiravir and Remdesivir was significant between the alive and dead groups. The mean hospital stay for all patients was 9.49 ± 4.77 days, while the median duration of hospital time was 10.73 ± 4.33 days in the survival group and 5.39 ± 3.78 days in the non-survival group. Multiple logistic regression analysis determined respiration rate, WBC, and BUN as predictors of survival. Age and comorbidities are significant elements impacting the seriousness of COVID-19. Abnormal signs in laboratory markers can be used as early warning and prognostic signs to prevent severity and death. Potential biomarkers at various degrees in patients with COVID-19 may also aid healthcare professionals in providing precision medicine and nursing.

The natural killer cell-associated rs9916629-C allele is a novel genetic risk factor for fatal COVID-19.

The severity of COVID-19 is associated with individual genetic host factors. Among these, genetic polymorphisms affecting natural killer (NK) cell responses, as variations in the HLA-E- (HLA-E*0101/0103), FcγRIIIa- (FcγRIIIa-158-F/V), and NKG2C- (KLRC2wt/del ) receptor, were associated with severe COVID-19. Recently, the rs9916629-C/T genetic polymorphism was identified that indirectly shape the human NK cell repertoire towards highly pro-inflammatory CD56bright NK cells. We investigated whether the rs9916629-C/T variants alone and in comparison to the other risk factors are associated with a fatal course of COVID-19. We included 1042 hospitalized surviving and 159 nonsurviving COVID-19 patients as well as 1000 healthy controls. rs9916629-C/T variants were genotyped by TaqMan assays and were compared between the groups. The patients' age, comorbidities, HLA-E*0101/0103, FcγRIIIa-158-F/V, and KLRC2wt/del variants were also determined. The presence of the rs9916629-C allele was a risk factor for severe and fatal COVID-19 (p < 0.0001), independent of the patients' age or comorbidities. Fatal COVID-19 was more frequent in younger patients (<69.85 years) carrying the FcγRIIIa-158-V/V (p < 0.006) and in older patients expressing the KLRC2del variant (p < 0.003). Thus, patients with the rs9916629-C allele have a significantly increased risk for fatal COVID-19 and identification of the genetic variants may be used as prognostic marker for hospitalized COVID-19 patients.