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Siregar MEAG, Siregar HS, Lubis MP, Adenin I, Lumbanraja IL. OVERVIEW OF COVID-19 CASES IN PREGNANCY AT THE HOSPITAL UNIVERSITAS SUMATERA UTARA, INDONESIA, WHEN THE PANDEMIC STORM HIT IN THE 2020-2022 PERIOD. Afr J Infect Dis 2023; 17:19-24. [PMID: 37822551 PMCID: PMC10564105 DOI: 10.21010/ajidv17i2s.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 10/13/2023] Open
Abstract
Background COVID-19 (Coronavirus 2019) is caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), an acute infectious disease primarily affecting the respiratory system. Data on COVID-19 exposure during pregnancy and issues associated with COVID-19 during pregnancy remain limited. This research aimed to determine the number of pregnant women infected by COVID-19, laboratory test findings of pregnant women related to COVID-19 infection, infant outcome from mother with or without COVID-19 infection and referential status for COVID-19 and non-COVID-19 pregnant women at the USU Hospital during the 2020-2022 period. Materials and Methods This research was conducted using a descriptive method with a cross-sectional study approach using a non-probability sampling technique by collecting secondary data from COVID-19 and non-COVID-19 pregnant women at the USU Hospital during the 2020-2022 period, where 112 samples were obtained. Results The majority of COVID-19 pregnant women and non-COVID-19 pregnant women have been identified sequentially based on Hb (11.6%-decreased vs 79.5%-normal); Ht (11.6%-decreased vs 76.8%-increased); leukocytes (11.6%-increased vs 83%-normal); thrombocytes (8.9%-normal vs 86.6%-normal); PT (9.8%-normal vs 50.9%-normal); APTT (11.6%-normal vs 87.5%-normal); D-dimer (11.6%-long vs 56.3%-long); procalcitonin (7.1%-increased vs 87.5%-normal); NLR (8%-increased vs 82.1%-normal); CRP (12.5%-increased vs 87.5%-normal) and all of the baby outcomes were non-COVID-19 and the majority of pregnant women were not referred. Conclusion Based on the data in this study, the majority of pregnant women and babies at the USU Hospital during the 2020-2022 period were non-COVID-19 positive and with non-referral status. Laboratory findings of COVID-19 in pregnancy significantly reveals abnormalities.
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Affiliation(s)
| | - Henry Salim Siregar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Muara Panusunan Lubis
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Ichwanul Adenin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Irwin Lamtota Lumbanraja
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Al-Mazedi MS, Rajan R, Al-Jarallah M, Dashti R, Al Saber A, Pan J, Zhanna KD, Abdelnaby H, Aboelhassan W, Almutairi F, Alotaibi N, Al Saleh M, AlNasrallah N, Al-Bader B, Malhas H, Ramadhan M, Brady PA, Al-Zakwani I, Setiya P, Abdullah M, Alroomi M, Tse G. Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study. Ann Med Surg (Lond) 2022; 82:104748. [PMID: 36212733 PMCID: PMC9525242 DOI: 10.1016/j.amsu.2022.104748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/18/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
The goal of this study was to investigate in-hospital mortality in patients suffering from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relative to the neutrophil to lymphocyte ratio (NLR) and to determine if there are gender disparities in outcome. Between February 26 and September 8, 2020, patients having SARS-CoV-2 infection were enrolled in this retrospective cohort research, which was categorized by NLR levels ≥9 and < 9. In total, 6893 patients were involved included of whom6591 had NLR <9, and 302 had NLR ≥9. The age of most of the patients in the NLR<9 group was 50 years, on the other hand, the age of most of the NLR ≥9 group patients was between 50 and 70 years. The majority of patients in both groups were male 2211 (66.1%). The ICU admission time and mortality rate for the patients with NLR ≥9 was significantly higher compared to patients with NLR <9. Logistic regression's outcome indicated that NLR ≥9 (odds ratio (OR), 24.9; 95% confidence interval (CI): 15.5–40.0; p < 0.001), male sex (OR, 3.5; 95% CI: 2.0–5.9; p < 0.001) and haemoglobin (HB) (OR, 0.95; 95% CI; 0.94–0.96; p < 0.001) predicted in-hospital mortality significantly. Additionally, Cox proportional hazards analysis (B = 4.04, SE = 0.18, HR = 56.89, p < 0.001) and Kaplan–Meier survival probability plots also indicated that NLR>9 had a significant effect on mortality. NLR ≥9 is an independent predictor of mortality(in-hospital) among SARS-CoV-2 patients. The main finding of this study is that NLR is an autonomous predictor of in-hospital mortality in patients with SARS-CoV-2. Fatality in SARS-CoV-2 patients with NLR >9 was 25 times higher than that in patients with NLR <9. Patients with NLR >9, the average length of ICU stay was higher. Mortality rate in males was high compared to females with NLR>9.
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Affiliation(s)
- Maryam Salah Al-Mazedi
- Dept. of Medical Laboratory Technology, Public Authority for Applied Education and Training, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
- Corresponding author.
| | - Mohammed Al-Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Ahmad Al Saber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named After V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Department of Medicine, Division of Gastroenterology, Al Sabah Hospital, Kuwait
| | - Wael Aboelhassan
- Department of Medicine, Division of Gastroenterology, Jaber Al Ahmed Hospital, South Surra, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | | | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Emergency Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | - Peter A. Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago, IL, USA
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman & Gulf Health Research, Muscat, Oman
| | - Parul Setiya
- Department of Agrometeorology, College of Agriculture, G.B.Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Gary Tse
- Cardiovascular Analytics Group, Hong Kong, China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
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3
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Alotaibi N, Alroomi M, Aboelhassan W, Hussein S, Rajan R, AlNasrallah N, Al Saleh M, Ramadhan M, Zhanna KD, Pan J, Malhas H, Abdelnaby H, Almutairi F, Al-Bader B, Alsaber A, Abdullah M. In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid. Ann Med Surg (Lond) 2022; 80:104105. [PMID: 35784615 PMCID: PMC9239918 DOI: 10.1016/j.amsu.2022.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate COVID-19 related mоrtаlity according to the use of corticosteroid therapy. Design Retrospective cohort study. Setting Two tertiary hospitals in Kuwait. Participants Overall, 962 patients with confirmed SARS-CoV-2 infection, were stratified according to whether they were treated with corticosteroids (dexamethasone or methylprednisolone). The mean age of the patients was 50.2 ± 15.9 years and 344/962 (35.9%) were female. Main outcome measures In-hospital mortality and cumulative all-cause mortality. Results Compared to non-corticosteroid therapy patients, corticosteroid therapy patients had a higher prevalence of hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease; a longer hospital stay (median [IQR]: 17.0 [5.0–57.3] days vs 14.0 [2.0–50.2] days); and a higher in-hospital mortality (51/199 [25.6%] vs 36/763 [4.7%]). Logistic regression analysis showed a higher in-hospital mortality in the corticosteroid group (adjusted odds ratio [aOR]: 4.57, 95% confidence interval [CI]: 2.64–8.02, p < 0.001). Cox proportional hazards regression showed that corticosteroid use was a significant predictor of mortality (hazard ratio [HR]: 3.96, p < 0.001). Conclusions In-hospital mortality in patients with SARS-CoV-2 on corticosteroid therapy was 4.6 times higher than in those without corticosteroid therapy. In-hospital mortality in patients with SARS-CoV-2 on corticosteroid was evaluated. Risk of mortality was 4.6 times higher in those with corticosteroid therapy. Corticosteroid therapy patients had a longer hospital stay.
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Affiliation(s)
- Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | - Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
- Corresponding author. Department of Infectious Diseases, Infectious Diseases Hospital Shuwaikh Medical Area, P. O. Box 4710, Safat, 13048, Kuwait.
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | | | | | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Division of Gastroenterology, Department of Medicine, Al Sabah Hospital, Shuwaikh Medical Area, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
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Alroomi M, Rajan R, Alsaber A, Pan J, Abdullah M, Abdelnaby H, Aboelhassan W, AlNasrallah N, Al-Bader B, Malhas H, Ramadhan M, Hussein S, Alotaibi N, Al Saleh M, Zhanna KD, Almutairi F. In-hospital mortality in SARS-CoV-2 stratified by gamma-glutamyl transferase levels. J Clin Lab Anal 2022; 36:e24291. [PMID: 35261080 PMCID: PMC8993645 DOI: 10.1002/jcla.24291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study investigates in-hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relation to serum levels of gamma-glutamyl transferase (GGT). METHODS Patients were stratified according to serum levels of gamma-glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L). RESULTS A total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS-CoV-2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20-3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03-1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19-3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74-5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15-3.68, p=0.016) were significant predictors of all-cause cumulative mortality. A Cox proportional hazards regression model (B = -0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51-times lower risk of all-cause cumulative mortality than patients with GGT≥50 IU/L. CONCLUSION Higher levels of serum GGT were found to be an independent predictor of in-hospital mortality.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Division of Gastroenterology, Department of Medicine, Al Sabah Hospital, Shuwaikh Medical Area, Kuwait
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
| | | | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | - Kobalava D Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
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Uta M, Neamtu R, Bernad E, Mocanu AG, Gluhovschi A, Popescu A, Dahma G, Dumitru C, Stelea L, Citu C, Bratosin F, Craina M. The Influence of Nutritional Supplementation for Iron Deficiency Anemia on Pregnancies Associated with SARS-CoV-2 Infection. Nutrients 2022; 14:nu14040836. [PMID: 35215486 PMCID: PMC8878410 DOI: 10.3390/nu14040836] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women in terms of infection risk and access to care, we developed a study to determine the impact of nutritional supplementation for iron deficiency anemia in correlation with the status of SARS-CoV-2 infection. In a case-control design, we identified 446 pregnancies that matched our inclusion criteria from the hospital database. The cases and controls were stratified by SARS-CoV-2 infection history to observe the association between exposure and outcomes in both the mother and the newborn. A total of 95 pregnant women were diagnosed with COVID-19, having a significantly higher proportion of iron deficiency anemia. Low birth weight, prematurity, and lower APGAR scores were statistically more often occurring in the COVID-19 group. Birth weight showed a wide variation by nutritional supplementation during pregnancy. A daily combination of iron and folate was the optimal choice to normalize the weight at birth. The complete blood count and laboratory studies for iron deficiency showed significantly decreased levels in association with SARS-CoV-2 exposure. Puerperal infection, emergency c-section, and small for gestational age were strongly associated with anemia in patients with COVID-19. It is imperative to screen for iron and folate deficiency in pregnancies at risk for complications, and it is recommended to supplement the nutritional intake of these two to promote the normal development and growth of the newborn and avoid multiple complications during pregnancy in the COVID-19 pandemic setting.
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Affiliation(s)
- Mihaela Uta
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Radu Neamtu
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
- Correspondence: ; Tel.: +40-729-098-886
| | - Elena Bernad
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Adelina Geanina Mocanu
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Adrian Gluhovschi
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Alin Popescu
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - George Dahma
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Catalin Dumitru
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Lavinia Stelea
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Cosmin Citu
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marius Craina
- Discipline of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.U.); (E.B.); (A.G.M.); (A.G.); (A.P.); (G.D.); (C.D.); (L.S.); (C.C.); (M.C.)
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Alroomi M, Alsaber A, Al-Bader B, Almutairi F, Malhas H, Pan J, Zhanna KD, Ramadhan M, Saleh MA, Abdullah M, Alotaibi N, AlNasrallah N, Rajan R, Hussein S, Aboelhassan W. In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin. Clin Appl Thromb Hemost 2022; 28:10760296221131802. [PMID: 36285386 PMCID: PMC9608030 DOI: 10.1177/10760296221131802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use. METHODS This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome. RESULTS A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality. CONCLUSION Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | | | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
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Yurtsever N, Nandi V, Ziemba Y, Shi PA. Prognostic factors associated with COVID-19 related severity in sickle cell disease. Blood Cells Mol Dis 2021; 92:102627. [PMID: 34823201 PMCID: PMC8595967 DOI: 10.1016/j.bcmd.2021.102627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Equipoise exists regarding sickle cell disease (SCD) as a risk factor for COVID-19 disease severity and variables that increase risk of COVID-19 severity in SCD. Given our health system's large SCD patient catchment, we analyzed our own experience in this regard. STUDY METHODS Retrospective analysis of the clinical course and factors associated with need for hospitalization and ICU admission of SCD patients diagnosed with COVID-19 through the Northwell Health system from March 1 to Dec 31, 2020. RESULTS Of 1098 patients with SCD, 3.3% were diagnosed with COVID-19. Overall rates of hospitalization, ICU admission, cohort mortality, and in-hospital mortality were 80%, 19%, 2.5%,and 3.1%, respectively. By multivariable analysis, hospitalization risk was decreased by 60% for every 1 g/dL increase in admission Hb. ICU admission risk was increased by 84% as a health care worker; increased by 45% for every 1000/uL increase in admission immature granulocyte count; and decreased by 17% with hydroxyurea use. DISCUSSION High hospitalization rates are compatible with worsened severity upon COVID-19 infection in SCD compared to the general population. Patients should be placed on hydroxyurea to increase their Hb and perhaps lower their neutrophil counts. Health care workers with SCD may warrant special safety precautions.
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Affiliation(s)
- Nalan Yurtsever
- Department of Pathology, Zucker School of Medicine, Northwell Health, NY, United States of America.
| | - Vijay Nandi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
| | - Yonah Ziemba
- Department of Pathology, Zucker School of Medicine, Northwell Health, NY, United States of America
| | - Patricia A Shi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America; Department of Medicine, Division of Hematology-Oncology, Zucker School of Medicine, Northwell Health, NY, United States of America.
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Alroomi M, Rajan R, Omar AA, Alsaber A, Pan J, Fatemi M, Zhanna KD, Aboelhassan W, Almutairi F, Alotaibi N, Saleh MA, AlNasrallah N, Al‐Bader B, Malhas H, Ramadhan M, Abdullah M, Abdelnaby H. Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients. Immun Inflamm Dis 2021; 9:1648-1655. [PMID: 34438471 PMCID: PMC8589386 DOI: 10.1002/iid3.517] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. METHODS Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). RESULTS Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43-5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42-7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02-35.45; p < .001) had significance in predicting in-hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan-Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000. CONCLUSION In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Rajesh Rajan
- Department of CardiologySabah Al Ahmad Cardiac Centre, Al Amiri HospitalKuwait CitySharqKuwait
| | | | - Ahmad Alsaber
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Jiazhu Pan
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Mina Fatemi
- Public Health and Commissioning ManagerNottinghamshire County CouncilNottinghamUnited Kingdom
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. MoiseevPeoples' Friendship University of Russia (RUDN University)MoscowRussian Federation
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of MedicineJaber Al Ahmed HospitalSouth SurraKuwait
| | | | | | | | | | | | - Haya Malhas
- Department of Emergency MedicineMubarak Al‐Kabeer HospitalJabriyaKuwait
| | - Maryam Ramadhan
- Department of Obstetrics and GynaecologyMaternity Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Mohammed Abdullah
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Division of Gastroenterology, Department of MedicineAl Sabah Hospital, Shuwaikh Medical AreaKuwait CityKuwait
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Alhasan KA, Shalaby MA, Temsah MH, Aljamaan F, Shagal R, AlFaadhel T, Alomi M, AlMatham K, AlHerbish AJ, Raina R, Sethi SK, Alsubaie S, Hakami MH, Alharbi NM, Shebeli RA, Nur HM, Kashari OF, Qari FA, Albanna AS, Kari JA. Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia. Healthcare (Basel) 2021; 9:1608. [PMID: 34946347 PMCID: PMC8701249 DOI: 10.3390/healthcare9121608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. METHODS This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. RESULTS In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). CONCLUSION In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.
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Affiliation(s)
- Khalid A Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Mohamed A Shalaby
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Reem Shagal
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Talal AlFaadhel
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mohammed Alomi
- Prince Mohammed bin Abdulaziz Hospital, King Salman Center for Kidney Diseases, Ministry of Health, Riyadh 14214, Saudi Arabia;
| | - Khalid AlMatham
- King Fahad Medical City, Ministry of Health, Riyadh 11525, Saudi Arabia;
| | - Adi J. AlHerbish
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Rupesh Raina
- Pediatrics Nephrology, Akron Children’s Hospital, Akron, OH 44241, USA;
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH 44241, USA
| | | | - Sarah Alsubaie
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Marwah H Hakami
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Najla M Alharbi
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Razan A Shebeli
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Hanan Mohamed Nur
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Ohoud F Kashari
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Faiza A Qari
- Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia;
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
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Prognostic Role of Anemia in COVID-19 Patients: A Meta-Analysis. Infect Dis Rep 2021; 13:930-937. [PMID: 34842707 PMCID: PMC8628963 DOI: 10.3390/idr13040085] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The prevalence and prognostic implications of anemia in patients infected by the SARS-CoV-2 remains unclear. We performed a systematic review and meta-analysis to assess the prevalence and mortality risk in COVID-19 patients with anemia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 1 September 2021, reporting data on the adjusted OR (aOR) for mortality among COVID-19 patients with anemia. The pooled prevalence of anemia among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (aOR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. RESULTS Five studies, enrolling 9.623 COVID-19 patients [3.707 males (38.5%)], met the inclusion criteria and were included in the final analysis. The pooled prevalence of anemia was 25.6% of cases (95% CI: 8.3-56.5%), with high heterogeneity (I2 = 98.9%). Meta-regression showed that the anemia prevalence was influenced by a direct correlation with age (p = 0.007) and chronic kidney disease (p = 0.004) as moderating variables. Conversely, an inverse relationship was observed with male gender (p < 0.0001). Anemia was significantly associated with higher risk of short-term mortality (aOR: 1.69, 95% CI: 1.28-2.24, p < 0.001), with low heterogeneity (I2 = 0%). CONCLUSIONS Anemia represents a major comorbidity in about 25% of COVID-19 patients and it is associated with about 70% higher risk of short-term mortality.
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Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19. Metabolites 2021; 11:metabo11100653. [PMID: 34677368 PMCID: PMC8540370 DOI: 10.3390/metabo11100653] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
Anemia and disturbances of iron metabolism are frequently encountered in patients with COVID-19 and associated with an adverse clinical course. We retrospectively analyzed 645 consecutive COVID-19 patients hospitalized at the Innsbruck University Hospital. Pre-existing anemia was associated with increased risk for in-hospital death. We further found that the decline in hemoglobin levels during hospital stay is more pronounced in patients with signs of hyperinflammation upon admission, the latter being associated with a nearly two-fold higher risk for new onset anemia within one week. Anemia prevalence increased from 44.3% upon admission to 87.8% in patients who were still hospitalized after two weeks. A more distinct decrease in hemoglobin levels was observed in subjects with severe disease, and new-onset anemia was associated with a higher risk for ICU admission. Transferrin levels decreased within the first week of hospitalization in all patients, however, a continuous decline was observed in subjects who died. Hemoglobin, ferritin, and transferrin levels normalized in a median of 122 days after discharge from hospital. This study uncovers pre-existing anemia as well as low transferrin concentrations as risk factors for mortality in hospitalized COVID-19 patients, whereas new-onset anemia during hospitalization is a risk factor for ICU admission. Anemia and iron disturbances are mainly driven by COVID-19 associated inflammation, and cure from infection results in resolution of anemia and normalization of dysregulated iron homeostasis.
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