Risk Factors For ICU Admission Research Articles

Clinical characteristics of COVID-19 in children: a large multicenter study from Iran.

During the COVID-19 pandemic, pediatric cases typically exhibit milder symptoms and lower mortality rates. However, the delay in pediatric vaccination poses major risks for children. This multicenter study aimed to comprehensively analyze demographic characteristics, clinical features, disease severity, and risk factors for ICU admission in Iran. This observational study enrolled children aged 0-21 years with confirmed or probable COVID-19 diagnoses, referred from selected hospitals across 17 counties in Mazandaran province, Iran, between February 19 and August 14, 2021. Patients were categorized into mild, moderate, severe, or critical cases based on clinical and radiographic criteria. Data were extracted from medical records and analyzed using statistical methods. Logistic regression analysis was performed to identify factors associated with ICU admission and disease severity. Among the 1,031 children included in the study, 61 were diagnosed with MIS-C. The distribution of patients by severity was 156 mild, 671 moderate, and 204 severe/critical cases. Age distribution significantly differed across severity groups (P < 0.001), with 55.19% aged over 5 years and 54% being male. 11.44% had underlying diseases. Fever (71.97%) was the most common symptom, followed by cough (34.43%) and dyspnea (24.83%). Within the inpatient group, 19.77% required ICU admission, with 0.91% mortality, including 3 MIS-C cases. Children with underlying diseases, gastrointestinal symptoms, and obesity had 4.16, 3.10-, and 2.17-times higher likelihood of ICU admission, respectively. Our study emphasized the importance of recognizing pediatric COVID-19 severity and symptoms. While fever, cough, and dyspnea prevailed, mortality rates were relatively low. However, comorbidities, obesity, and gastrointestinal symptoms linked to ICU admission, stressing early intervention. BMI also impacted disease severity and admission rate. Vaccination and targeted interventions are essential for protecting vulnerable children and easing healthcare strain.

The Correlation Between the Lactate/Albumin Ratio and Sequential Organ Failure Assessment (SOFA) Score in Patients With Sepsis and Septic Shock.

Background Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, often resulting in severe outcomes such as septic shock and death. Globally, sepsis ranks among the most common causes of illness and death. The Sequential Organ Failure Assessment (SOFA) score is an established marker used to assess and predict the extent of organ failure in septic patients. The introduction of novel markers, such as the lactate/albumin (L/A) ratio, serves as a prognostic indicator in critical care settings, particularly for patients with sepsis. In this context, a higher L/A ratio upon admission aids in assessing disease severity and improving clinical decision-making to reduce mortality and adverse outcomes, which we aim to correlate through our study. Materials and methods This was an observational cross-sectional analysis conducted on 100 patients aged over 18 years who met the "Sepsis-3" guidelines and were admitted to the medical intensive care unit of Dr. D. Y. Patil Hospital, Pune, Maharashtra, India, between October 2022 and May 2024. Patients with chronic liver disease classified as Child-Pugh class C were excluded, as were those with chronic kidney disease (CKD). Written informed consent was obtained from each participant before the study. Data were collected through physical examination, routine laboratory investigations, and radiological assessments. Statistical analysis was performed using IBM SPSS version 20 (IBM Corp., Armonk, NY). Descriptive statistical analyses were conducted using the SPSS data editor. Statistical significance was considered at a p-value of less than 0.05 for all analyses. Results In the study population, 78 patients survived, while 22 patients died. The L/A ratio and SOFA score were significantly higher in non-survivors compared to survivors, both upon admission and thereafter, with statistical significance (p < 0.05). The correlation between the L/A ratio and the SOFA score was examined upon admission at 24 hours, 48 hours, day 7, and day 28. Pearson correlation analysis revealed statistically significant results (p < 0.05) throughout the entire study period. Conclusion A high L/A ratio, along with the SOFA score at ICU admission, was associated with a grave prognosis and poor outcomes, serving as independent risk factors for ICU admission. Therefore, patients with a high L/A ratio and SOFA score should be identified early and managed aggressively to avoid poor outcomes. Our study demonstrates that combining serum lactate and serum albumin levels into the L/A ratio significantly enhances prognostic accuracy compared to using serum lactate alone.

Analyzing Epidemiology and Hospital Course Outcomes of LeFort Fractures in the Largest National Pediatric Trauma Database.

Retrospective observational study. This study analyzes the epidemiology of pediatric Le Fort fractures and assesses the incidence of concomitant injuries and acute-level hospital course using the largest, national pediatric trauma database to date. Pediatric midface and Le Fort fractures from 2016-2019 were identified in the National Trauma Data Bank. Descriptive analyses of Le Fort compared to non-Le Fort midface fractures were performed. Multivariable regression assessed whether Le Fort fractures were risk factors for ICU admission, intracranial injury, cervical spine (C-spine) fracture, tracheostomy, and mortality. A total of 1489 patients with Le Fort fractures were identified. There were 520 Le Fort I, 632 Le Fort II, and 609 Le Fort III fractures. Fracture incidence increased with age. Le Fort fractures showed higher rates of concomitant intracranial injury (P < 0.001), ICU admission (P < 0.001), C-spine fracture (P < 0.001), and tracheostomy (P < 0.001). Incidence of all the above increased with higher-grade Le Fort fractures. Le Fort III fractures had higher rates of mortality than non-Le Fort midface fractures (7.6% vs 3.2%). Multivariable regression showed that all Le Fort patterns were independent risk factors for tracheostomy and ICU admission, but only Le Fort I for C-spine fractures. The incidence of Le Fort fractures appears to increase with age. Higher category Le Fort fractures are associated with greater morbidity.

OBESITY AND IN-HOSPITAL OUTCOMES AMONG PATIENTS WITH SEVERE COVID-19 IN VIET NAM

Introduction: COVID-19 (Coronavirus disease 2019) is a global pandemic. Overweight and obesity are risk factors related to mortality as well as disease severity. Overweight and obesity are also increasing in Vietnam. Data related to the characteristics of COVID-19 in this vulnerable population was limited in Vietnam. The study was conducted (1) to describe the outcomes of overweight and obese COVID-19 patients, and (2) to investigate factors associated with the outcomes of overweight and obese COVID-19 patients. Methods: A cross-sectional description was conducted at the Hospital for Tropical Diseases from July 2021 to December 2021. Patients who were (1) ≥ 18 years old (2) diagnosed with COVID-19 with a positive RT-PCR SARS-CoV-2 result and (3) had BMI ≥ 23 kg/m2. Female pregnant women or ascites were excluded from this study. To determine factors associated with mortality and ICU admission, chi-square and Fisher's Exact were used. Variables with p &lt; 0.05 were included in the logistic regression model to investigate independent risk factors. Cases directly admitted to the ICU were excluded when analyzing risk factors for ICU admission. Results: 173 patients were recruited (70 patients (40.46%) were overweight, 74 patients (42.77%) were obesity class I and 29 patients (16.76%) were obesity class II). The overall mortality rate was 28.9%. The ICU admission rate was 46.2% with a median ICU stay of 9 (6 – 15.25) days. The rate of respiratory support was 83.8%, of which 31.8% of patients required invasive mechanical ventilation and the median duration of respiratory support was 12 (6.5 – 16.5) days. Independently factors associated with ICU admission were diabetes (OR = 2.92 (1.27 – 6.67)) and a severe or critical condition at admission (OR = 8.82 (2.51 – 31.08). Independently factors associated with death were vaccination (OR = 0.23 (0.08 – 0.63)), a severe or critical at admission (OR = 15.74 (3.46 – 71.55)) and remdesivir usage (OR = 0.78 (0.16 – 0.87)). Recommendation: Vaccination against COVID-19 has been shown to be effective in the obese and overweight population.

Risk factors for intensive care admission in pediatric patients with COVID-19 - results of the German na-tionwide inpatient sample

Abstract Funding Acknowledgements None. Background In December 2019 first patient-cases of pneumonia caused by an unknown virus were detected in Wuhan, China. From this day on, SARS-CoV-2 spread throughout the world with an enormous pace causing the deadliest pandemic of the twenty-first century. First infection cases in Germany were reported at the end of January 2020 in Bavaria and sustained transmission of SARS-CoV-2 resulted also in Germany in a strong spread of COVID-19 in the population. Although children and young people aged ≤18 years represent approximately 2%-5% of the SARS-CoV-2 cases globally, research efforts regarding COVID-19 pandemic have mainly focused on disease course of adults. Thus, early identification of children who must be monitored for life-threatening severe COVID-19 course remains difficult. Understanding of risk factors for ICU admission as one important bottleneck of adequate management regarding escalated treatment of COVID-19 pandemic is of outstanding interest to understand determinants, which are both crucial factors for adequate health care planning, decision making and pandemic management. Purpose We aimed to close this gap with identification of associated factors with pediatric ICU admissions in Germany. Methods We used the German nationwide inpatient sample analysing all hospitalised children ≤18 years with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st, 2020 stratified fur ICU admission (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations). Results Overall, 3,360 cases of hospitalised children ≤18 years with COVID-19 infection were diagnosed in Germany 2020 (median age 7.0 [IQR 0.0-15.0] years, 49.8% of female sex); among them 4.3% had to be admitted on ICU. In-hospital death occurred in five patients with and three without ICU admission (3.5% vs. 0.1%, P&amp;lt;0.001) and ICU admission was independently associated with increased case-fatality (OR 21.573 [95%CI 4.191-111.044], P&amp;lt;0.001). Obesity (OR 3.419 [95%CI 1.300-8.993], P=0.013), diabetes mellitus (OR 6.929 [95%CI 3.327-14.432], P&amp;lt;0.001), pneumonia (OR 7.373 [95%CI 4.823-11.271], P&amp;lt;0.001), ARDS (OR 48.058 [95%CI 11.689-197.588], P&amp;lt;0.001) and multi-segmental Inflammatory syndrome caused by COVID-19 (OR 9.573 [95%CI 3.036-30.191], P&amp;lt;0.001), heart failure (OR 64.509 [95%CI 24.462-170.121], P&amp;lt;0.001), myocarditis (OR 4.682 [95%CI 1.278-17.149], P=0.020), acute and/or chronic kidney failure (OR 7.946 [95%CI 3.606-17.508], P&amp;lt;0.001), cancer (OR 5.220 [95%CI 2.599-10.485], P&amp;lt;0.001) and liver diseases (OR 5.501 [95%CI 2.177-13.899], P&amp;lt;0.001) were associated with ICU admission. Conclusions The proportion of hospitalized paediatric COVID-19 patients admitted on ICU in Germany was low with 4.3% accompanied by 3.5% case-fatality rate. Independent factors for ICU admission comprised cardio-vascular risk factors, comorbidities and complications of COVID-19.

COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group.

Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.

Respiratory Syncytial Virus-Associated Hospitalizations Among Children

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.

Extra pulmonary versus pulmonary presentation of COVID-19 patients: comparative study

BackgroundThe respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality.AimThis study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined.MethodsIn this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19.ResultThis study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group.ConclusionAtypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility.

Blood Stream Infections in Burns: A 14-Year Cohort Analysis.

Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007-2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p < 0.001). Pathogen groups differed significantly mean TBSA, ICU admission, need for surgery, and mortality (p < 0.001). Multivariate analysis showed flame (OR 2.84) and electric burns (OR 4.58) were independent risk factors for ICU admission and surgical intervention (p < 0.001). Gram-negative bacterial infection was found to be an independent predictor of mortality (OR = 9.29, p < 0.001). Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy.

786: IMPACT OF FRONT-LOADING PHENOBARBITAL CUMULATIVE DOSE AND ICU ADMISSION FOR ALCOHOL WITHDRAWAL

Introduction: Alcohol withdrawal syndrome is a common reason for hospitalization and progression to severe alcohol withdrawal is associated with ICU admission. Recent evidence suggests symptom triggered use of phenobarbital in the ED is associated with reductions in ICU admission, duration of mechanical ventilation, and hospital length of stay. The objective of our study is to identify if larger cumulative phenobarbital doses in the ED are associated with ICU admission in the absence of strict ICU admission criteria (e.g. mechanical ventilation, hemodynamically unstable). Methods: This was a single center, retrospective analysis of patients with alcohol withdrawal, given symptom triggered doses of phenobarbital in the ED, and subsequently admitted to ICU or non-ICU care areas. We compared cumulative doses of phenobarbital administered in the ED and if higher doses were associated with ICU admission. Secondary outcomes included occurrence of seizure and hospital length of stay. Risk factors for ICU admission were assessed in univariate analyses and multivariable modeling. Results: 200 patients were included (100 ICU and 100 non-ICU) in the study. There was no significant difference in cumulative phenobarbital doses received in the ED between patients admitted to ICU or non-ICU areas (811 mg vs. 780 mg, p=0.6). Secondary outcomes were similar between the groups except a longer hospital length of stay in the ICU group (5.4 days vs 3.6 days, p=0.04). Multivariable analysis identified higher average ED symptom triggered alcohol withdrawal scores (SEWS, aOR 1.44, 95% CI 1.26-1.64, p< 0.0001) and positive blood alcohol concentration on admission (aOR 2.01, 95% CI 1.04-3.89, p=0.04) as predictors of ICU admission. Conclusions: There was no difference in cumulative phenobarbital requirements in patients who were admitted to ICU or non-ICU areas for alcohol withdrawal. Additional risk factors such as higher alcohol withdrawal score and positive blood alcohol concentration may be predictors of more severe withdrawal needing ICU level of care. Additional prospective studies are needed to identify predictors of severe alcohol withdrawal syndrome.

COVID-19 Clinical Features and Outcomes in Elderly Patients during Six Pandemic Waves.

Many elderly patients with severe SARS-CoV-2 infections and COVID-19 infections are admitted to intensive care units. Age was previously identified as an independent risk factor for death and contributed to the greater severity of COVID-19. The elderly may have diminished lung functions, poor reactions to artificial ventilation, and compromised immune systems. However, it is yet uncertain how each pandemic wave and the predominant SARS-CoV-2 strains contribute to varying results and how patient groups such as the elderly are impacted. Comparing six COVID-19 pandemic waves, the objective of this study was to examine the variation in case severity, symptomatology, ICU hospitalizations, and mortality among SARS-CoV-2-infected elderly individuals. The study followed a retrospective design, including 60 eligible patients older than 70 years in each of the six pandemic wave groups, after matching them by the number of comorbidities and gender. SARS-CoV-2 infection during the first, third, and fourth pandemic waves had a significantly higher risk of mortality for hospitalized patients. Confusion and dyspnea at admission were significant risk factors for ICU admission in elderly patients (β = 1.92, respectively β = 3.65). The laboratory parameters identified decreased lymphocytes (β = 2.11), elevated IL-6 (β = 1.96), and procalcitonin (β = 2.46) as the most significant risk factors. The third and fourth COVID-19 waves had considerably more severe infections (31.7% and 26.7%) than the sixth wave (13.3%). Median ICU stay and percentage of patients receiving oxygen support also differed across pandemic waves. However, mortality rates between the six pandemic waves were similar. The average length of hospitalization varied dramatically among the six pandemic waves. Although senior patients are more likely to have worse COVID-19 outcomes after hospitalization, this risk is mitigated by the greater prevalence of comorbidities and frailty among the elderly. The six pandemic waves that were specifically evaluated did not reveal considerably disproportionate variations in terms of patient mortality; however, during the fourth pandemic wave, there were likely more hospitalized patients with severe COVID-19 in Romania. It is probable that certain circulating SARS-CoV-2 strains were more infectious, resulting in an increase in infections and a strain on healthcare systems, which might explain the variations found in our research.

Etiology of Emergency Visit and In-Hospital Outcomes of Patients with COPD.

Backgrounds Patients with COPD often visit the emergency department (ED) due to exacerbation of respiratory symptoms (dyspnea, cough, and sputum production). Because manifestations of acute exacerbation of COPD (AECOPD) are nonspecific, differential diagnosis is critical in this acute setting. The causes for emergency visiting and the in-hospital outcomes are varied in patients with COPD. This study aimed to investigate the distributions of etiologies and the in-hospital outcomes of patients with COPD who presented to the ED because of exacerbation of respiratory symptoms. Methods This was a retrospective study on COPD patients who had visited the ED and been hospitalized in a tertiary hospital because of worsening respiratory symptoms including cough, sputum production, and dyspnea from January 2017 to April 2020. Demographics, clinical manifestations, and laboratory studies in the ED were collected as the baseline data. The primary diagnosis at discharge or death was recorded. The hospitalization settings (general wards and ICU), the in-hospital outcomes, and associated factors were analyzed. Results During the study period, 392 patients with COPD (male 302 (77.0%)), with a median age of 78 years, visited the ED and hospitalized in this hospital. The first 3 causes for emergency visit were AECOPD (n = 314, 80.1%), acute coronary artery syndrome with or without congestive heart failure (n = 24, 6.1%), and pulmonary embolism (n = 13, 3.3%). For patients with AECOPD (n = 314), 51.6% (n = 162) was admitted to ICU, and 6.4% (n = 20) died. Multivariate logistic analysis showed that age, atrial fibrillation, NT-pro BNP ≥300 pg/ml, and blood pH <7.3 were independent risk factors for ICU admission. Age, comorbid malignancy, NT-pro BNP ≥1800 pg/ml, and pneumonia on CT scan were independent risk factors for hospital mortality in patients with AECOPD. Conclusion In COPD patients visiting the ED because of worsening respiratory symptoms, nearly 20% were due to non-AECOPD causes. For those with AECOPD, age, atrial fibrillation, NT-pro BNP ≥300 pg/ml, and blood pH <7.3 were independent risk factors for ICU admission, while advanced age, underlying malignancy, elevated NT-pro BNP, and pneumonia on CT scan were risk factors for hospital mortality.

The Utility of Laboratory Parameters for Cardiac Inflammation in Heart Failure Patients Hospitalized with SARS-CoV-2 Infection.

COVID-19 has been associated with cardiovascular consequences, including myocardial infarction, thromboembolic events, arrhythmia, and heart failure. Numerous overlapping mechanisms, such as the IL-6 dependent cytokine storm and unopposed angiotensin II stimulation, could be responsible for these consequences. Cardiac damage is hypothesized to be a consequence of the direct viral infection of cardiomyocytes, resulting in increased metabolic demand, immunological activation, and microvascular dysfunction. Patients with pre-existing chronic heart failure are therefore at increased risk of decompensation, further heart damage, and significant health deterioration. Based on the aforementioned assumptions, we developed a study aiming to provide a detailed description of changes in biological parameters and cardiac injury markers of patients with heart failure and SARS-CoV-2 infection by correlating them with the clinical presentation and COVID-19 vaccination status, to predict the probability of ICU admission based on their initial hospital presentation. A two-year retrospective study was performed on heart failure patients with a history of SARS-CoV-2 infection and detailed records of biological biomarkers; a total of 124 eligible patients with COVID-19 and 236 without COVID-19 were recruited. Patients with heart failure and SARS-CoV-2 infection had significantly elevated baseline biological parameters and cardiac markers compared to those without COVID-19. Several cardiac injury markers were identified as significant independent risk factors for ICU admission: CK-MB (HR = 4.1, CI [2.2–6.9]), myoglobin (HR = 5.0, CI [2.3–7.8]), troponin-I (HR = 7.1 [4.4–9.6]), troponin-T (HR = 4.9, CI [1.7–7.4]). The elevation of a basic panel of acute inflammation markers (CRP, IL-6, fibrinogen), D-dimers, and BNP was also a significant risk factor. The follow-up of survivors at four weeks after viral clearance determined a worsened clinical picture by NYHA classification, worsened cardiac ultrasound findings, and a mild improvement in cardiac and inflammatory markers. Increased levels of myocardial damage parameters in association with cardiac ultrasound findings and basic inflammatory markers may enable early risk assessment and triage in hospitalized heart failure patients infected with SARS-CoV-2.

ICU admission and mortality classifiers for COVID-19 patients based on subgroups of dynamically associated profiles across multiple timepoints

The coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is consistently causing profound wounds in the global healthcare system due to its increased transmissibility. Currently, there is an urgent unmet need to identify the underlying dynamic associations among COVID-19 patients and distinguish patient subgroups with common clinical profiles towards the development of robust classifiers for ICU admission and mortality. To address this need, we propose a four step pipeline which: (i) enhances the quality of multiple timeseries clinical data through an automated data curation workflow, (ii) deploys Dynamic Bayesian Networks (DBNs) for the detection of features with increased connectivity based on dynamic association analysis across multiple points, (iii) utilizes Self Organizing Maps (SOMs) and trajectory analysis for the early identification of COVID-19 patients with common clinical profiles, and (iv) trains robust multiple additive regression trees (MART) for ICU admission and mortality classification based on the extracted homogeneous clusters, to identify risk factors and biomarkers for disease progression. The contribution of the extracted clusters and the dynamically associated clinical data improved the classification performance for ICU admission to sensitivity 0.83 and specificity 0.83, and for mortality to sensitivity 0.74 and specificity 0.76. Additional information was included to enhance the performance of the classifiers yielding an increase by 4% in sensitivity and specificity for mortality. According to the risk factor analysis, the number of lymphocytes, SatO2, PO2/FiO2, and O2 supply type were highlighted as risk factors for ICU admission and the percentage of neutrophils and lymphocytes, PO2/FiO2, LDH, and ALP for mortality, among others. To our knowledge, this is the first study that combines dynamic modeling with clustering analysis to identify homogeneous groups of COVID-19 patients towards the development of robust classifiers for ICU admission and mortality.

Role of blood urea nitrogen and serum albumin ratio in predicting severity of community acquired pneumonia (CAP).

Blood urea nitrogen and serum albumin levels are independent risk factors for poor clinical outcome in CAP. However, there is a paucity in the literature on the role of Blood urea nitrogen and albumin ratio(B/A) in CAP. This was a prospective observational study in which 112 admitted patients with the diagnosis of CAP underwent routine blood examinations, ABG, procalcitonin and Chest X-ray. Univariate analysis among various risk factors, CURB-65 scores, blood parameters including B/A ratios and clinical outcomes were carried out followed by multiple logistic regression. Cox regression was done to look at B/A values and time to mortality. In the logistic regression, age, CURB -65 score, B/A ratio and procalcitonin came out to be independent risk factors for ICU admission and mortality. Odds ratio of B/A in predicting mortality and ICU admission came out to be 67.8 (49.2-95.4) and 11.2 (8.4-14), respectively. Cox regression showed B/A values were also found to have a statistically significant relationship with time to mortality (p=0.001). B/A ratio has the potential to become a veritable predictor of poor clinical outcomes in patients with CAP.

Risk Factors and Outcomes of ICU Admission Following Allogeneic Hematopoietic Stem Cell Transplantation

Background: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-hsct) can develop complications such as life-threatening infections, multi-system organ failure, ICU admission and ventilator support in the immediate post-transplant period. Whereas outcomes of these complications, particularly ICU admission and ventilator support, are known to be poor, little is known about the risk factors leading to them.Methods: We conducted a retrospective study to analyze the impact of pre-transplant risk factors on acute inpatient complications, focusing on ICU admission, ventilator support and multi-system organ failure, following allo-hsct at the University of Alabama at Birmingham (UAB) between 2008 and 2016. Mortality rates and survival outcomes of patients admitted to the ICU were also analyzed. Pre-transplant individual comorbidities were defined as per Sorror's HCT-CI.Results: There were 304 patients included with a median age of 52y (18-72y). There were 51% male and 82% Non-Hispanic white patients. The most common indication for transplant was AML (45%). Donor type was matched-unrelated, haploidentical and matched-related in 53%, 35% and 12% of cases, respectively. Majority of the patients received myeloablative conditioning (74%). The prevalence of health behaviors and comorbidities at the time of transplant is shown in Table 1. There were 39% patients with HCT-CI score of ≥3, 23% with moderate pulmonary compromise, 22% with a psychiatric disorder, 13% with severe pulmonary compromise, 13% with diabetes mellitus (DM), 10% with cardiac abnormalities and 6% with infection at the time of transplant.During the initial hospitalization, 33 (11%) patients required ICU admission, 29 (10%) required ventilator support, 33 (11%) developed multi-system organ failure, 79 (26%) developed bacterial infections and 15 (5%) developed fungal infections. The median time to neutrophil engraftment was 13 days (7-48 days).In multivariable analysis (Table 2), risk factors for ICU admission included pre-transplant infection (HR 6.50, 95% CI 1.82-23.26, p=0.004), pre-transplant DM (HR 4.14, 95% CI 1.56-10.97, p=0.004), time to neutrophil engraftment (HR 1.13, 95% CI 1.05-1.21, p=0.0007), donor type (ref: matched related donor; haplo: HR 0.24 95% CI 0.07-0.82, p=0.02) and HSCT era (ref: 2008-2010; 2010-2013: HR 0.18 95% CI 0.04-0.88, p=0.03; 2014-2016: HR 0.12 95% CI 0.03-0.4, p=0.0006). Risk factors for ventilator support included pre-transplant infection (HR 10.09, 95% CI 2.44-41.64, p=0.001), pre-transplant DM (HR 3.61, 95% CI 1.31-9.91, p=0.01), time to neutrophil engraftment (HR 1.17, 95% CI 1.11-1.23, p<0.0001) and HSCT era (ref: 2008-2010; 2010-2013: HR 0.21 95% CI 0.06-0.81, p=0.02; 2014-2016: HR 0.07 95% CI 0.02-0.31, p=0.0005). Risk factors for multi-system organ failure included pre-transplant DM (HR 4.38, 95% CI 1.64-11.74, p=0.003), time to neutrophil engraftment (HR 1.13, 95% CI 1.08-1.19, p<0.0001) and HSCT era (ref: 2008-2010; 2010-2013: HR 0.21 95% CI 0.05-0.80, p=0.003; 2014-2016: HR 0.16 95% CI 0.05-0.48, p=0.001).Risk factor for bacterial infection included HSCT era (ref: 2008-2010; 2010-2013: HR 0.30 95% CI 0.14-0.65, p=0.002; 2014-2016: HR 0.24 95% CI 0.12-0.49, p<0.0001) and for fungal infection included pre-transplant pulmonary compromise (ref: no compromise; severe pulmonary compromise HR 5.16, 95% CI 1.05-25.4, p=0.04). For patients admitted to the ICU, the 60-day and 6-month mortality was 58% and 67%, respectively. No deaths were attributed to relapse disease. The median overall survival for patients admitted to the ICU was 1.4 months (Figure 1).Conclusion: Patients with DM and infection at the time of HSCT and delayed neutrophil engraftment during transplant are at an increased risk for ICU admission, ventilator support and multi-system organ failure following allo-hsct. Patients admitted to the ICU are also at a high risk for early mortality leading to poor survival. Optimizing glycemic control and delaying transplant until resolution of infection, if the underlying disease would allow, may help improve both morbidity and mortality in transplant recipients. [Display omitted] DisclosuresDi Stasi: Syndax Pharmaceutical: Honoraria, Membership on an entity's Board of Directors or advisory committees; University of Alabama at Birmingham: Current Employment.

Prevalence of comorbidities and its impacts in Hospitalized patients with COVID-19

Objective: The purpose of this study is to evaluate the prevalence of comorbidities in hospitalized COVID-19 patients and its effects on the severity of the disease. The coronavirus pandemic has been a challenging problem for health care systems since December 2019. Methods: This was a retrospective, cross-sectional study analyzing data related to the epidemiological characteristics of COVID-19 patients admitted to Razi Hospital in Ahvaz, Iran from&nbsp;&nbsp; November 2020 to February 2021. The data on patient demographic characteristics including age, gender, and underlying diseases were collected from patient records. Patients whose data were unavailable or incomplete were excluded from the study. Results: The mean age of all of the 730 patients studied was 56.30±16.36 years, and 53.7% of them were men. Nearly 40% of the patients reported more than one comorbidity, with diabetes mellitus being the most frequent one (37.5%) followed by hypertension (35.3%) and ischemic heart disease (24.9). In addition, 21.5% of the patients required intensive care unit admission. Finally, 11.9% of the patients had respiratory distress and became intubated, and approximately 13.6% of the patients died. Hyperlipidemia, liver failure, tuberculosis, and elevated inflammatory biomarkers are risk factors for ICU admission and death.&nbsp; Conclusion: we found that male gender, older age, hyperlipidemia, liver failure, TB, having more than one comorbidity, and elevated inflammatory biomarkers were significantly associated with the risk of severe COVID-19 disease.

An Easy Parameter That Can Predict Intensive Care Unit Admission in Patients with COVID-19 in the Early Stage: Neutrophil to Lymphocyte Ratio

Background: The COVID-19 pandemic has caused more than 60 million confirmed cases and approximately 1.5 million deaths all over the world as of December 1st, 2020. So it’s important to predict the clinical course of infected patients and to prevent the disease course from worsening with early intervention.&#x0D; Aim: This study aimed to evaluate the new generation inflammation markers such as NLR, MPV and RDW in predicting the need for intensive care of COVID-19 patients.&#x0D; Methods: The retrospective cross-sectional study included 112 patients whose hemogram parameters were checked simultaneously with the diagnosis of COVID-19, hospitalized in public hospitals in Antalya province between March 16th and June 15th, 2020. Patients treated in the intensive care unit and treated only in the ward were compared according to laboratory data, and the predictive effect of study parameters on the need for intensive care was investigated.&#x0D; Results: Of the patients 43.8% were female and 56.3% were male. The average age was 49.48 ± 17.12 years. The percentage of patients admitted to the intensive care unit was 19.6% and, died was 5.4%. While MPV was found to be statistically significantly lower in COVID-19 patients who need intensive care, NLR and RDW were found to be statistically significantly higher. Decreased MPV and increased NLR were determined as independent risk factors for ICU admission. In addition, the optimal cut-off value was calculated as ≤ 10.4 for MPV (with 77.27% sensitivity and 66.67% specificity) and &gt; 5.3 for NLR (with 72.73% sensitivity and 91.11% specificity) in predicting ICU admission.&#x0D; Conclusion: NLR, which is checked at the first admission in patients with suspected COVID-19, is an easy, fast, cheap and very valuable test in determining the severity of SARS-CoV2 infection and predicting the need for intensive care.

STUDY OF OBSTETRIC ADMISSIONS TO THE INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Aim: To determine the causes of the obstetric admission to the intensive care unit and to identify the risk factors responsible for intensive care admission&#x0D; Methods and materials: Obstetrics ICU admissions over the past 3 months from September 2019 to November 2019 at government medical college, Bhavnagar&#x0D; Results: During the study period about 150 patients are admitted to the intensive care unit.53.3% of the cases are in 20-25 year ,followed by30.6% of the patients are in age of 26-30 year ,46.6% of women were in their first pregnancy followed by 31.3%of women who were in their second pregnancy . Majority of the patients are in 37-40 weeks of gestational age followed by 35-36 weeks of gestation .Majority of patient admitted in ICU were postpartum admission(as those requiring delivery were first managed and then shifted to ICU) accounting for 86.6% of cases and 4% are below 20 weeks. The rest of the cases are ectopic, abortion and molar pregnancy which accounts for 4.6%, 2%, 2.6%. The different condition diagnosed on admission to hospital ranged from common condition like preeclampsia to rare disorder like meningitis. About 46.6% patients went in to surgical procedure and most common surgical procedure is caesarean section which accounts for 24% followed by laprotomy which accounts for 6% .&#x0D; Conclusion: Commonest risk factors for ICU admission are obstetrics haemorrhage and hypertensive disorder of pregnancy Other major risk factors are severe anaemia, heart disease, sepsis, rupture uterus etc .&#x0D; Keywords: obstetric admissions, intensive care unit, tertiary care hospital

Early prediction of level-of-care requirements in patients with COVID-19.

This study examined records of 2566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively. Pneumonia severity scores achieve respective accuracies of 73% and 74% for ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.