Risk Factors For Intensive Care Unit Admission Research Articles

Impact of vaccination on ICU admissions of hospitalized COVID-19 patients in a country with a heterologous vaccine policy.

Vaccination against coronavirus disease-19 (COVID-19) is highly effective in preventing severe disease and mortality. Adenoviral vector and mRNA vaccines were effective against intensive care unit (ICU) admission, but the effectiveness of inactivated vaccine on ICU admission was unclear. We aimed to evaluate the effect of vaccination status on ICU admission in hospitalized COVID-19 patients in a country with heterologous vaccination policy. This is a retrospective multicenter study conducted in three hospitals in Izmir, Turkey between 1 January 2021 and 31 March 2022. Patients aged ≥ 18 years and hospitalized due to COVID-19 were included in the study. Patients who had never been vaccinated and patients who had been vaccinated with a single dose were considered unvaccinated. A logistic regression analysis was performed for evaluating risk factors for ICU admission. A total of 2,110 patients were included in the final analysis. The median age was 66 years (IQR, 53-76 years) and 54% of the patients were vaccinated. During the study period, 407 patients (19.3%) were transferred to the ICU due to disease severity. Patients who were admitted to the ICU were older (median age 68 vs. 65 years, p < 0.001); and the number of unvaccinated individuals was higher among ICU patients (57% vs. 45%, p < 0.001). In multivariate regression analysis, being unvaccinated was found to be the most important independent risk factor for ICU admission with an OR of 2.06 (95% CI, 1.64-2.59). Vaccination against COVID-19 is effective against ICU admission and hospital mortality.

Hospitalization and Mortality due to Infection among United States Children and Adolescents with Systemic Lupus Erythematosus.

We aimed to determine the frequency and types of infections in hospitalized children with childhood-onset systemic lupus erythematosus (cSLE), and to identify risk factors for intensive care unit (ICU) admission and mortality. We conducted a retrospective study of youth 2-21 years of age with ICD codes for SLE during admission to a hospital participating in the Pediatric Health Information System, a database of United States children's hospitals, from 2009-2021. Generalized linear mixed effect models were used to identify risk factors for ICU admission and mortality among children hospitalized with infection. We identified 8,588 children with cSLE and ≥ 1 hospitalization. Among this cohort, there were 26,269 hospitalizations, of which 13% had codes for infections, a proportion which increased over time (p = 0.036). Bacterial pneumonia was the most common hospitalized infection. In-hospital mortality occurred in 0.4% (n=103) of cSLE hospitalizations for any indication and 2% of hospitalizations for infection (n=60). The highest mortality rates occurred with pneumocystis jirovecii pneumonia (21%) and other fungal infections (21%). Lupus nephritis and end-stage renal disease (ESRD) were associated with increased odds of ICU admission (OR [95% CI] 1.47 [1.2- 1.8]) and 2.4 [1.7-3.4]) among children admitted for serious infection. ESRD was associated with higher mortality, OR 2.34 [1.1-4.9]. Hospitalizations with codes for for infection comprised a small proportion of cSLE admissions but accounted for the majority of mortality. The proportion of hospitalizations for infection increased over time. Lupus nephritis and ESRD were risk factors for poor outcomes.

Risk Factors and Clinical Prognosis Associated With RSV-ALRI Intensive Care Unit Admission in Children

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRIs) in children aged <2 years. Currently, there are limited data on risk factors for very severe RSV-ALRI requiring intensive care unit (ICU) admission. We conducted a case-control study of children aged <2 years admitted with RSV-ALRI to the Sydney Children's Hospital Network, comprising 2 large tertiary pediatric hospitals. Cases were children with laboratory-confirmed RSV-ALRI admitted to ICU, and controls were (1:2, matched on date of admission) children hospitalized with RSV-ALRI but not requiring ICU transfer. Data on risk factors were retrieved from the electronic medical record system. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) associated with risk factors for ICU admission and the association with clinical and treatment factors were determined from logistic regression models. A total of 44 (44%) of 100 cases and 90 (48.1%) of 187 controls were male. Age <6 months and preterm births were associated with a 2.10-fold (95% CI: 1.14-3.79) and 2.35-fold (95% CI: 1.26-4.41) increased risk in ICU admissions, respectively. The presence of any chronic health condition was a significant risk factor for ICU admission. The clinical presentations on admission more commonly seen in cases were apnea (aOR: 5.01, 95% CI: 1.50-17.13) and respiratory distress (aOR: 15.91, 95% CI: 4.52-55.97). Cases were more likely to be hospitalized for longer duration and require respiratory support. Our results can be translated into a clinical risk algorithm to identify children at risk of very severe RSV disease.

Pulmonary embolism and risk factors of ICU admission: systematic review

In order to forecast mortality and identify adult patients who required admission to an intensive care unit, we compared the efficacy of the most widely used Early Warning Scores. The present review assessed the pulmonary embolism and risk factors of intensive care unit (ICU) admission; systematic review. A search of the literature was conducted in the bibliographic databases PubMed and EMBASE between 2009 and 2022. Each reviewer verified independently that each possibly relevant title and abstract qualified. There were nine studies that were included in the review. NEWS was the best indicator of ICU admission; however, the Modified Early Warning Score performed better in sepsis patients. According to Emergency Department (ED) Mortality, the National Early Warning Score was the most accurate score for predicting mortality in the entire ED population, and the Mortality in Emergency Department Sepsis score was the most accurate measure for patients with sepsis. For all endpoints, National Early Warning Score and Modified Early Warning Score had good outcomes in the ICU and ED. numerous investigations should be conducted utilizing various prognostic scores on ED and ICU patients. Anemia in patients with venous thrombosis was associated with a higher risk of ICU admission and mortality.

151 How Do Mortality Rates From COVID-19 Differ Between Vaccinated and Unvaccinated People in a Tertiary Centre of Bangladesh

Abstract Aim To find out the difference in mortality rates between vaccinated and unvaccinated COVID-19 positive patients who admitted in a tertiary center (Ward Vs Intensive care) of Bangladesh. Method Retrospective analysis of data over 6 weeks (February- March 2021). 100 confirmed COVID-19 positive patients were included- 50 from ICU (Intensive Care Unit) and 50 from ward irrespective of age, gender, vaccination status and comorbidities. Results 75% of all confirmed COVID 19 positive patients were vaccinated. Mortality among vaccinated people was less compared to unvaccinated 41.3% Vs 52%. Interestingly pregnancy was found to be the most significant risk factor in child-bearing age female group- 86.7% of pregnant and peripartum female required ICU admission and mortality was 40% although none of them had any co-morbidities. Again, mortality among vaccinated was significantly less (35.7%) compared to 100% mortality among unvaccinated. Mortality rate among ICU admitted patients was significantly high- 72% Vs 16%. 83% of patients who died in ICU were vaccinated (90% had 2 doses, 10% had 3 doses). 87.5% who died in ward were unvaccinated. Among the survivors from ICU - 93% were vaccinated (Vs 7% unvaccinated). Overall, pre-existing comorbidities increased mortality by 18.1% (59% Vs 40.9%). Conclusions Vaccination against COVID-19 reduces mortality irrespective of co-morbidities or disease severity. Recovery rate was significantly increased in vaccinated ICU admitted patients. Pregnancy was found to be the most important risk factor for ICU admission and mortality in otherwise healthy child-bearing age females and mortality was 100% (limited data availability) in unvaccinated. These results require further revalidation on larger population.

Difference in determinants of ICU admission and death among COVID-19 hospitalized patients in two epidemic waves in Portugal: possible impact of healthcare burden and hospital bed occupancy on clinical management and outcomes, March-December 2020.

Identify factors associated with COVID-19 intensive care unit (ICU) admission and death among hospitalized cases in Portugal, and variations from the first to the second wave in Portugal, March-December 2020. Determinants of ICU admission and death for COVID-19 need further understanding and may change over time. We used hospital discharge data (ICD-10 diagnosis-related groups) to identify factors associated with COVID-19 outcomes in two epidemic periods with different hospital burdens to inform policy and practice. We conducted a retrospective cohort study including all hospitalized cases of laboratory-confirmed COVID-19 in the Portuguese NHS hospitals, discharged from March to December 2020. We calculated sex, age, comorbidities, attack rates by period, and calculated adjusted relative risks (aRR) for the outcomes of admission to ICU and death, using Poisson regressions. We tested effect modification between two distinct pandemic periods (March-September/October-December) with lower and higher hospital burden, in other determinants. Of 18,105 COVID-19 hospitalized cases, 10.22% were admitted to the ICU and 20.28% died in hospital before discharge. Being aged 60-69 years (when compared with those aged 0-49) was the strongest independent risk factor for ICU admission (aRR 1.91, 95%CI 1.62-2.26). Unlike ICU admission, risk of death increased continuously with age and in the presence of specific comorbidities. Overall, the probability of ICU admission was reduced in the second period but the risk of death did not change. Risk factors for ICU admission and death differed by epidemic period. Testing interactions, in the period with high hospital burden, those aged 80-89, women, and those with specific comorbidities had a significantly lower aRR for ICU admission. Risk of death increased in the second period for those with dementia and diabetes. The probability of ICU admission was reduced in the second period. Different patient profiles were identified for ICU and deaths among COVID-19-hospitalized patients in different pandemic periods with lower and higher hospital burden, possibly implying changes in clinical practice, priority setting, or clinical presentation that should be further investigated and discussed considering impacts of higher burden on services in health outcomes, to inform preparedness, healthcare workforce planning, and pandemic prevention measures.

Multicolored MIS-C, a single-centre cohort study

BackgroundThe aim of this study was to investigate the clinical and laboratory parameters that can predict the severity of Multisystem Inflammatory Syndrome in Children (MIS-C) at admission.MethodsWe conducted a single-center, partly retrospective, partly prospective, observational cohort study between November 1, 2020 and December 31, 2021, which included patients aged from 1 month to 19 years, meeting the diagnostic criteria of MIS-C. We categorized the patients into three subgroups based on clinical and laboratory markers and assessed the predictive value of these factors in terms of ICU administration and cardiac abnormalities.Results53 patients were classified in the following subgroups: Kawasaki-like disease (group 1) (47.2%, n = 25), shock with or without acute cardiac dysfunction (group 2) (32%, n = 17), fever and inflammation (group 3) (20.8%, n = 11). Subgroup analysis revealed that patients with shock and KD at initial presentation had significantly more severe manifestation of MIS-C requiring intensive care unit (ICU) treatment. Of the initial laboratory values, only CRP showed a significant difference between the 3 clinical groups, being lower in group 3. 52.6% of patients were admitted to the ICU. The median length of ICU stay was 3 days (range 3–20). ICU admission was more likely in patients with shortness of breath, renal failure (AKI) and patients with significantly increased concentrations of ferritin, D-dimer, INR and significantly milder increase concentration of fibrinogen. We found that fibrinogen and ferritin levels are independent risk factors for ICU admission. Cardiac abnormalities were found in 56.6% of total (30/53), with the following findings: decreased left ventricular function (32%), coronary abnormality (11.3%), pericardial effusion (17%), arrhythmia (32.1%) and mitral regurgitation (26.6%). Diarrhea and conjunctivitis at the initial presentation with significantly elevated CRP, Pro-BNP and blood pH concentrations were found to be a potential predisposing factor for decreased cardiac function while Pro-BNP and pH were independent risk factors for MIS-C. Regardless of the initial symptoms of MIS-C, the outcome was generally favorable.ConclusionsClinical characteristics and baseline laboratory values ​​may help identify patients at increased risk for severe disease outcome, such as need for intensive care, presence of shock and decreased cardiac function.Trial registrationParticipation consent was not reqired and ethical considerations were unnecessary, since we did not perform any extra interventions, only the necessary and usual therapeutic and diagnostic methods were used.

Characterization and prognosis of autoimmune encephalitis in the neurological intensive care unit: a retrospective study.

Patients diagnosed with autoimmune encephalitis (AE) require admission to the neurological intensive care unit (ICU) when they exhibit clinical manifestations such as status epilepticus, central hypoventilation, and severe involuntary movements. In order to determine the predictors of ICU admission and prognosis for patients with AE admitted to the neurological ICU, we analyzed the clinical characteristics of this patient population. This retrospective study analyzed 123 patients admitted to the First Affiliated Hospital of Chongqing Medical University between 2012 and 2021 who were diagnosed with AE based on serum and/or cerebrospinal fluid (CSF) AE-related antibody positivity. We divided these patients into two groups: those who received ICU treatment and those who did not. We evaluated patient's prognosis using the modified Rankin scales (mRS). Univariate analysis revealed that epileptic seizures, involuntary movements, central hypoventilation, symptoms of vegetative neurological disorders, increased neutrophil-to-lymphocyte ratio (NLR), abnormal electroencephalogram (EEG) findings, and different treatments were associated with ICU admission for patients with AE. Multivariate logistic regression analysis showed that hypoventilation and NLR were independent risk factors for ICU admission in AE patients. Univariate analysis showed that age and sex were related to prognosis in ICU-treated AE patients, and logistic regression analysis indicated that age was the only independent risk factor for prognosis in ICU-treated AE patients. Increased NLR, except for hypoventilation, is an indicator of ICU admission in AE patients. Although a large number of patients with AE require ICU admission, the overall prognosis is good, particularly in younger patients.

Impact of pre-transplant individual comorbidities on risk of ICU admission and survival outcomes following allogeneic hematopoietic stem cell transplantation.

Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-hsct) can require intensive care unit (ICU) admission in the post-transplant period. Whereas outcomes of ICU admission are poor, little is known about the pre-transplant risk factors leading to them. We conducted a retrospective analysis to investigate the impact of pre-transplant individual comorbidities on acute inpatient complications, focusing on ICU admission, ventilator support and multi-system organ failure, following allo-hsct. During the initial hospitalization, 33 (11%) patients required ICU admission, 29 (10%) required ventilator support and 33 (11%) developed multi-system organ failure. Risk factors for ICU admission and ventilator support included pre-transplant infection, pre-transplant diabetes, time to neutrophil engraftment, donor type and older transplant decade (2008-2010). Risk factors for multi-system organ failure included pre-transplant diabetes, time to neutrophil engraftment and older transplant decade (2008-2010). For ICU patients, the 60-day and 6-month mortality was 58% and 67%, respectively and the median overall survival was 1.4 months. Patients with diabetes and infection at the time of HSCT and longer time to neutrophil engraftment during transplant are at an increased risk for ICU admission, ventilator support and multi-system organ failure. Patients admitted to the ICU are also at a high risk for mortality leading to poor survival.

Measures of Structural Racism Predict ICU Admission Following Intensive Chemotherapy for AML

INTRODUCTION: Recent observational studies have revealed that real-world complications of intensive chemotherapy for frontline treatment of acute myeloid leukemia (AML) far exceed those reported in clinical trials. A 2017 analysis of over 40,000 AML patients found that 26% of patients who received induction chemotherapy were admitted to the intensive care unit (ICU), with increased mortality for non-white patients (Halpern, JAMA Oncology 2016). In a newly created Chicago AML registry (Abraham, Blood 2022), higher ICU admission rate was noted following induction chemotherapy for non-white patients. The current study aims to i) describe treatment complications based on race/ethnicity and ii) examine structural racism (SR) measures as risk factors for ICU admission following intensive chemotherapy in a diverse real-world patient population. METHODS: Using the Chicago AML registry, we compared ethnoracial differences in treatment complications including infections, thrombosis, renal or liver dysfunction (defined as peak creatinine >1.5 g/dL or peak bilirubin >1.2 mg/dL), respiratory failure requiring ventilatory support and hemodynamic instability needing pressor support. We then examined associations of race/ethnicity and previously published measures of census tract disadvantage, affluence, and segregation (referred to as SR measures) with ICU admission. These structural barriers were examined alongside known predictors of treatment mortality including disease characteristics and comorbidities. Additional outcomes included duration of ICU stay and mortality. RESULTS: In this cohort of 573 patients who underwent intensive induction chemotherapy for AML, 30-day complications differed based on race/ethnicity. Renal dysfunction was highest in non-Hispanic black (NHB) patients with an incidence of 27.8% with 6% initiating dialysis compared to 17.6% of non-Hispanic white (NHW) and 11.3% of Hispanic patients with 2% needing dialysis. Hepatotoxicity was highest in Hispanic patients (64%) vs. NHB (51%) and NHW (47%). Infectious complications were highest in NHB with microbiologically documented infections in 50.6% compared to 39.7% in NHW and 32.6% in Hispanic. Venous thrombosis occurred in 14.5% of NHB patients, compared to 14.7% of NHW and 13.3% Hispanic patients. In total, 141 (24.6%) patients required ICU admission during intensive induction with rates differing significantly by race and ethnicity (p = 0.014). Average length of stay in the ICU was 7.8 days for NHB patients, 6.7 days for NHW and 6.0 days for Hispanics. Due to low 30-day mortality, we were unable to detect differences between ethnoracial groups. Mechanical ventilation was utilized in 32% of NHB compared to 26% of NHW and 20% of Hispanic patients admitted to the ICU. Vasopressor were required in 31% of NHB patients vs. 27% of NHW patients. Predictors of ICU admission in our dataset included non-white race, unmarried status, living in a neighborhood with lower % of NHW residents, and WBC > 50,000/µL at diagnosis. Additional census tract variables including higher disadvantage and lower affluence conferred nonsignificant risk. Interestingly, comorbidities, ELN Score and baseline creatinine > 1.5 g/dL were not predictors of ICU admission. CONCLUSIONS: In a real-world population of AML patients, we show variation in the spectrum of treatment complications based on race/ethnicity. Moreover, with detailed individual and neighborhood socioeconomic position (SEP) data, measures of SR predicted ICU admission following induction chemotherapy. Other significant predictors include marital status - an individual measure of SEP, and hyperleukocytosis, which may indicate delay in medical presentation. High comorbidity index did not predict increased rate of ICU admission similar to prior studies (Tawfik, J Geriatr Oncol, 2016), while renal dysfunction was a non-significant predictor. Collectively our results suggest that there is a need to incorporate individual and neighborhood SR measures to identify patients at risk of clinical decline when stressed with intensive therapies. An algorithmic approach to identify 'high risk’ patients based on clinical/molecular and structural factors could prompt more detailed assessment of fitness prior to initiation of chemotherapy and directly influence leukemia outcome disparities. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of BCG vaccination and metabolic risk factors on the severity of SARS-Cov-2 infection: a cross-sectional study from a tertiary care centre in northern India

Background and aims: We present a study on the earliest cohort of patients infected with the SARS-CoV-2 virus who were admitted to the All India Institute of Medical Sciences (AIIMS), New Delhi. The primary objective of the study was to find the difference in the rate of intensive care unit (ICU) admission with coronavirus disease 2019 (COVID-19) in patients based on BCG vaccination status. The secondary objective was to assess risk factors for ICU admission and clinical course of patients with COVID-19. Methods: A cross-sectional observational study was done between 1 May 2020 and 30 July 2020 in AIIMS, New Delhi. Patients aged more than 14 years attending or admitted to the COVID-19 facility with suspected or confirmed SARS-CoV-2 infection were screened and 205 patients with confirmed COVID-19 were included in the study. Patients were managed as per standard protocol. The difference in ICU admission rate with COVID-19 in patients with and without metabolic risk factors was analysed. Results: The study shows higher ICU admission in the age group ≥45-75years (n=16; 68.5%) compared to the age group 15-44 (n=10; 38.5%) which was statistically significant (p=0.01). In multivariate analysis, the age group ≥45-75 years [AOR=3.76, 95% CI (1.10,12.82), p=0.03] and diabetes mellitus [AOR=5.20, 95% CI (1.08,25.16), p=0.04] were significantly associated with higher ICU admission. Of the 26 patients admitted to ICU, 4 (15.3%) were vaccinated in contrast to 22 (84.6%) who were unvaccinated (p&lt;0.001). Conclusion: Diabetes was strongly associated with ICU admission and appears to be a risk factor for severity in patients with COVID-19. BCG vaccination status is positively correlated with fewer ICU admission rates in patients with COVID-19.

Risk factors for intensive care unit admission or mortality in adults hospitalized for COVID-19 at high altitude.

To determine the risk factors for admission to the intensive care unit (ICU) or mortality in patients hospitalized for COVID-19 in a hospital in Puno, Peru. Retrospective cohort study in adults hospitalized between April and December 2020. We evaluated Sociodemographic characteristics, vital functions, comorbidities, treatment received and its association with admission to ICU or mortality (adverse outcome). Poisson regression with robust variance was used to calculate crude and adjusted relative risks (RR) with their 95% confidence intervals (95%CI). A total of 348 medical records were analyzed. The median age in years was 42.5 (IQR: 30.0; 58.0); 38.2% were male, and 35.3% died or were admitted to the ICU. Those admitted with an oxygen saturation ≤ 75% were 2.79 times more likely to have the adverse outcome (p < 0.001), compared to those admitted with a saturation ≥ 85%; those admitted with a value between 75-79% were 2.92 times more likely to have the adverse outcome (p < 0.001); likewise, those admitted with saturation between 80-84% were 1.70 times more likely to have the adverse outcome; however, the difference was not statistically significant (p=0.066). In addition, male patients, RR= 1.75 (p<0.001); those aged > 40 years, RR 3.5 (p=0.001); those with tachypnea, RR=1.66 (p=0.010); or with diabetes, RR = 1.53 (p=0.011) had higher risk of presenting the adverse outcome. The risk factors for ICU admission or mortality due to COVID-19 were male sex, age over 40 years, low saturation, diabetes and tachypnea.

Comorbidities and COVID-19 hospitalization, ICU admission and hospital mortality in Austria : Aretrospective cohort study.

BackgroundThe protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality.MethodsA retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015–2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI).ResultsHemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44–1.79), followed by COPD (OR 1.48, 95% CI 1.43–1.53) and diabetes without complications (OR 1.41, 95% CI 1.37–1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61–1.92), diabetes without complications (OR 1.57, 95% CI 1.46–1.69) and COPD (OR 1.53, 95% CI 1.41–1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints.ConclusionWe contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.

Clinical Characteristics, Risk Factors, and Outcomes Among a Large Midwestern U.S. Cohort of Patients Hospitalized With COVID-19 Prior to Vaccine Availability

The COVID-19 pandemic posed unprecedented demands on health care. This study aimed to characterize COVID-19 inpatients and examine trends and risk factors associated with hospitalization duration, intensive care unit (ICU) admission, and in-hospital mortality. This retrospective study analyzed patients with SARS-CoV-2 infection hospitalized at an integrated health system between February 2, 2020, and December 12, 2020. Patient characteristics and clinical outcomes were obtained from medical records. Backward stepwise logistic regression analyses were used to identify independent risk factors of ICU admission and in-hospital mortality. Cox proportional hazards models were used to evaluate relationships between ICU admission and in-hospital mortality. Overall, 9647 patients were analyzed. Mean age was 64.6 ± 18 years. A linear decrease was observed for hospitalization duration (0.13 days/week, R2=0.71; P<0.0001), ICU admissions (0.35%/week, R2=0.44; P<0.001), and hospital mortality (0.16%/week, R2=0.31; P<0.01). Bacterial co-infections, male sex, history of chronic lung and heart disease, diabetes, and Hispanic ethnicity were identified as independent predictors of ICU admission (P<0.001). ICU admission and age of ≥65 years were the strongest independent risk factors associated with in-hospital mortality (P<0.001). The in-hospital mortality rate was 8.3% (27.4% in ICU patients, 2.6% in non-ICU patients; P<0.001). Results indicate that, over the pandemic's first 10 months, COVID-19 carried a heavy burden of morbidity and mortality in older patients (>65 years), males, Hispanics, and those with bacterial co-infections and chronic comorbidities. Although disease severity has steadily declined following administration of COVID-19 vaccines along with improved understanding of effective COVID-19 interventions, these study findings reflect a "natural history" for this novel infectious disease in the U.S. Midwest.

Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs). MethodsA retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission. Results12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75–0.90, p < 0.001). ConclusionsBTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.

Critical Care in SARS-CoV-2 Infected Pregnant Women: A Prospective Multicenter Study.

Evidence suggests that pregnant women are at a higher risk of complications compared to the general population when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the reasons that lead them to need intensive care are not clear. This is a prospective multicenter study of SARS-CoV-2 positive pregnant women, registered by the Spanish Obstetric Emergency Group, with the objective to define the characteristics of the mothers who were admitted to the Intensive Care Unit (ICU) and to investigate the causes and risk factors for ICU admission. A total of 1347 infected pregnant women were registered and analyzed, of whom, 35 (2.6%) were admitted to the ICU. No differences in maternal characteristics or comorbidities were observed between ICU and non-ICU patients, except for in vitro fertilization and multiple pregnancies. The main causes of admission to the ICU were non-obstetric causes (worsening of the maternal condition and respiratory failure due to SARS-CoV-2 pneumonia, 40%) and a combination of coronavirus disease 2019 (COVID-19) symptoms and obstetrical complications (31.4%). The multivariable logistic analysis confirmed a higher risk of ICU admission when pre-eclampsia or hemorrhagic events coexist with pneumonia. The incidence of thromboembolic events and disseminated intravascular coagulation were also significantly higher among patients admitted to the ICU. Therefore, surveillance and rapid intervention should be intensified in SARS-CoV-2 infected pregnant women with the mentioned risk factors and complications. Emphasis should always be placed on anticoagulant therapy in these patients due to the increased thromboembolic risk, C-section surgery and immobilization in the ICU.

Digestive system involvement and clinical outcomes among COVID-19 patients: A retrospective cohort study from Qatar.

BACKGROUNDCoronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus most commonly presents with respiratory symptoms. While gastrointestinal (GI) manifestations either at presentation or during hospitalization are also common, their impact on clinical outcomes is controversial. Some studies have described worse outcomes in COVID-19 patients with GI symptoms, while others have shown either no association or a protective effect. There is a need for consistent standards to describe GI symptoms in COVID-19 patients and to assess their effect on clinical outcomes, including mortality and disease severity.AIMTo investigate the prevalence of GI symptoms in hospitalized COVID-19 patients and their correlation with disease severity and clinical outcomes.METHODSWe retrospectively reviewed 601 consecutive adult COVID-19 patients requiring hospitalization between May 1-15, 2020. GI symptoms were recorded at admission and during hospitalization. Demographic, clinical, laboratory, and treatment data were retrieved. Clinical outcomes included all-cause mortality, disease severity at presentation, need for intensive care unit (ICU) admission, development of acute respiratory distress syndrome, and need for mechanical ventilation. Multivariate logistic regression model was used to identify independent predictors of the adverse outcomes. RESULTSThe prevalence of any GI symptom at admission was 27.1% and during hospitalization was 19.8%. The most common symptoms were nausea (98 patients), diarrhea (76 patients), vomiting (73 patients), and epigastric pain or discomfort (69 patients). There was no difference in the mortality between the two groups (6.21% vs 5.5%, P = 0.7). Patients with GI symptoms were more likely to have severe disease at presentation (33.13% vs 22.5%, P < 0.001) and prolonged hospital stay (15 d vs 14 d, P = 0.04). There was no difference in other clinical outcomes, including ICU admission, development of acute respiratory distress syndrome, or need for mechanical ventilation. Drugs associated with the development of GI symptoms during hospitalization were ribavirin (diarrhea 26.37% P < 0.001, anorexia 17.58%, P = 0.02), hydroxychloroquine (vomiting 28.52%, P = 0.009) and lopinavir/ritonavir (nausea 32.65% P = 0.049, vomiting 31.47% P = 0.004, and epigastric pain 12.65% P = 0.048). In the multivariate regression analysis, age > 65 years was associated with increased mortality risk [odds ratio (OR) 7.53, confidence interval (CI): 3.09-18.29, P < 0.001], ICU admission (OR: 1.79, CI: 1.13-2.83, P = 0.012), and need for mechanical ventilation (OR: 1.89, CI:1.94-2.99, P = 0.007). Hypertension was an independent risk factor for ICU admission (OR: 1.82, CI:1.17-2.84, P = 0.008) and need for mechanical ventilation (OR: 1.66, CI: 1.05-2.62, P = 0.028).CONCLUSIONPatients with GI symptoms are more likely to have severe disease at presentation; however, mortality and disease progression is not different between the two groups.

395. Early Predictors of Intensive Care Unit Admission among COVID-19 Patients in Qatar

BackgroundCoronavirus disease (COVID-19) is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with COVID-19.MethodsThis was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. ResultsA total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p=0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), obesity (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphopenia (aOR=2.69, 95% CI: 1.80-4.02, p< 0.001), high aspartate aminotransferase (AST) (aOR= 2.59, 95% CI: 1.53-4.36, p< 0.001), high ferritin (aOR=1.96, 95% CI: 1.40-2.74, p< 0.001), high C-reactive protein (CRP) (aOR=4.09, 95% CI: 2.81-5.96, p< 0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p< 0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphopenia (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and high AST (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036).Risk Factors for ICU admission among patients with COVID-19 (N=1560) ConclusionHaving CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.Disclosures Adel Abou-Ali, PharmD, PhD, Astellas Pharma Global Development, Inc. (Employee)

The effect of neutrophil-lymphocyte ratio on admission to postoperative intensive care and mortality in elderly patients undergoing hip fracture surgery with spinal anesthesia

Objectives: Hip Fractures (HF) affect the elderly in particular, and are associated with high mortality rates. Most geriatric patients are admitted to Intensive Care Unit (ICU) after HF surgery. In this study, the purpose was to investigate the prognostic value of preoperative NLR (Neutrophil-to-Lymphocyte Ratio) on postoperative ICU admission and mortality in elderly patients with HF. Methods: In the present study, the data of 188 geriatric patients who underwent surgery because of isolated HF (i.e. femur neck and intertrochanteric fracture) were examined retrospectively. The patients over 65 years of age, ASA score 3/4, whose preoperative duration was less than 72 hours, and who underwent spinal anesthesia were included in the study. The patients were divided into two groups as ICU admission (ICU, n = 58), and Non-ICU (Non-ICU, n = 130). The patients were also grouped as Survival (n = 168) and Non-survival (n = 20) according to postoperative mortality rates. NLR values were statistically compared between the groups. Results: The preoperative NLR values of the patients in the ICU Group were significantly higher than those in the Non-ICU Group (p &amp;lt; 0.001). The cut-off value of NLR for ICU admission was found to be 9.65 with 89% sensitivity and 67% specificity in the ROC analysis. The median NLR value was 6.42 (3.55-9.44) in the Survivor Group, and 9.5 (7.23-11.02) in the Non-Survivor Groups (p = 0.015). Conclusions: It was shown in the study that high NLR values in elderly patients may be a risk factor for ICU admission, and for postoperative mortality after HF.

Evaluation of risk factors for postoperative ICU admission in a tertiary care hospital – A case control study

Background & objective: Appropriate decisions regarding admission of potential patients to intensive care unit (ICU) postoperatively are considered very important for the patient care. We evaluated the reasons and the risk factors for postoperative ICU admissions in our hospital. Methodology: This is a case-control study, that was done at Security Forces Hospital, Riyadh, during the period from July 2019 to December 2019. We included all patients who needed ICU admission postoperatively in the study as cases. The controls were the patients who had any surgical procedure during the same study period. Patients’ demographics, ASA status, medical co-morbidities and operation details were recorded. We then did univariate and multivariate logistic regression to analyze the data. A p-value of less than 0.05 was considered as significant. Results: We enrolled a total of 140 patients in the study, with 46 cases and 94 controls. In univariate analysis, age, ASA status, presence of hypertension, diabetes, ischemic heart disease, respiratory disease, renal dysfunction and neurological abnormalities were found to be statistically significant predictors for postoperative ICU admission. In multivariate analysis, ASA status and perioperative neurological abnormalities were the most significant risk factors for ICU admission. Conclusion: ASA status and presence of neurological abnormalities are the most significant risk factors associated with ICU admission in the postoperative period. Key words: Risk factors; ICU; ICU admission; Postoperative period; ASA status Citation: Huda AU, Rabbani U, Yasir M. Evaluation of risk factors for postoperative ICU admission in a tertiary care hospital – A case control study. Anesth. pain intensive care 2021;25(4):501–504. DOI: 10.35975/apic.v25i4.1581 Received: December 23, 2020, Reviewed: January 25, 2021, Accepted: July 7, 2021