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Zou W, Yao X, Chen Y, Li X, Huang J, Zhang Y, Yu L, Xie B. An elastic net regression model for predicting the risk of ICU admission and death for hospitalized patients with COVID-19. Sci Rep 2024; 14:14404. [PMID: 38909101 PMCID: PMC11193779 DOI: 10.1038/s41598-024-64776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
This study aimed to develop and validate prediction models to estimate the risk of death and intensive care unit admission in COVID-19 inpatients. All RT-PCR-confirmed adult COVID-19 inpatients admitted to Fujian Provincial Hospital from October 2022 to April 2023 were considered. Elastic Net Regression was used to derive the risk prediction models. Potential risk factors were considered, which included demographic characteristics, clinical symptoms, comorbidities, laboratory results, treatment process, prognosis. A total of 1906 inpatients were included finally by inclusion/exclusion criteria and were divided into derivation and test cohorts in a ratio of 8:2, where 1526 (80%) samples were used to develop prediction models under a repeated cross-validation framework and the remaining 380 (20%) samples were used for performance evaluation. Overall performance, discrimination and calibration were evaluated in the validation set and test cohort and quantified by accuracy, scaled Brier score (SbrS), the area under the ROC curve (AUROC), and Spiegelhalter-Z statistics. The models performed well, with high levels of discrimination (AUROCICU [95%CI]: 0.858 [0.803,0.899]; AUROCdeath [95%CI]: 0.906 [0.850,0.948]); and good calibrations (Spiegelhalter-ZICU: - 0.821 (p-value: 0.412); Spiegelhalter-Zdeath: 0.173) in the test set. We developed and validated prediction models to help clinicians identify high risk patients for death and ICU admission after COVID-19 infection.
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Affiliation(s)
- Wei Zou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350013, China
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, 350004, China
| | - Xiujuan Yao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350013, China
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, 350004, China
| | - Yizhen Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350013, China
| | - Xiaoqin Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350013, China
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, 350004, China
| | - Jiandong Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350013, China
| | - Yong Zhang
- Chongqing Nanpeng Artificial Intelligence Technology Research Institute Co., Ltd., Chongqing, 401123, China
| | - Lin Yu
- Chongqing Nanpeng Artificial Intelligence Technology Research Institute Co., Ltd., Chongqing, 401123, China
| | - Baosong Xie
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, 350004, China.
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Ufongene C, Van Hyfte G, Agarwal P, Goldstein J, Mathew B, Navis A, McCarthy L, Kwon CS, Gururangan K, Balchandani P, Marcuse L, Naasan G, Singh A, Young J, Charney A, Nadkarni G, Jette N, Blank LJ. Older adults with epilepsy and COVID-19: Outcomes in a multi-hospital health system. Seizure 2024; 114:33-39. [PMID: 38039805 PMCID: PMC10841585 DOI: 10.1016/j.seizure.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy. METHODS This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS). RESULTS We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001). CONCLUSIONS In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
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Affiliation(s)
- Claire Ufongene
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY, United States
| | - Grace Van Hyfte
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States
| | - Parul Agarwal
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States
| | - Jonathan Goldstein
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY, United States
| | - Brian Mathew
- Department of Neurology, ISMMS, New York, NY, United States
| | - Allison Navis
- Department of Neurology, ISMMS, New York, NY, United States
| | | | - Churl-Su Kwon
- Department of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
| | | | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, United States
| | - Lara Marcuse
- Department of Neurology, ISMMS, New York, NY, United States
| | - Georges Naasan
- Department of Neurology, ISMMS, New York, NY, United States
| | - Anuradha Singh
- Department of Neurology, ISMMS, New York, NY, United States
| | - James Young
- Department of Neurology, ISMMS, New York, NY, United States
| | | | | | - Nathalie Jette
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Leah J Blank
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States.
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Mohammadi T, Rezaee M, Shahnematollahi SM, Yaseri AF, Ghorbani S, Namin SD, Mohammadi B. The importance of predictors for in-hospital COVID-19 mortality changes over one month. J Natl Med Assoc 2023; 115:500-508. [PMID: 37659883 DOI: 10.1016/j.jnma.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Risk stratification enables care providers to make the proper clinical decision for the management of patients with COVID-19 infection. We aimed to explore changes in the importance of predictors for inpatient mortality of COVID-19 over one month. METHODS This research was a secondary analysis of data from in-hospital patients with COVID-19 infection. Individuals were admitted to four hospitals, New York, USA. Based on the length of hospital stay, 4370 patients were categorized into three mutually exclusive interval groups, day 1, day 2-7, and day 8-28. We measured changes in the importance of twelve confirmed predictors for mortality over one month, using principal component analysis. RESULTS On the first day of admission, there was a higher risk for organ dysfunction, particularly in elderly patients. On day 1, serum aspartate aminotransferase and sodium were also associated with an increased risk of mortality, while normal troponin opposes in-hospital death. With time, the importance of high aspartate aminotransferase and sodium concentrations decreases, while the variable quality of high troponin levels increases. Our study suggested the importance of maintaining normal blood pressure early in the management of patients. High serum concentrations of creatinine and C-reactive protein remain poor prognostic factors throughout the 28 days. The association of age with mortality increases with the length of hospital stay. CONCLUSION The importance of some patients' characteristics changes with the length of hospital stay. This should be considered in developing and deploying predictive models and the management of patients with COVID-19 infection.
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Affiliation(s)
- Tanya Mohammadi
- School of Mathematics, Statistics, and Computer Science, College of Science, University of Tehran, Tehran, Iran
| | - Mehdi Rezaee
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Soolmaz Ghorbani
- Department of Otorhinolaryngology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Shaghayegh Delshad Namin
- Department of Critical Care, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
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Ufongene C, Van Hyfte G, Agarwal P, Blank LJ, Goldstein J, Mathew B, Lin JY, Navis A, McCarthy L, Gururangan K, Peschansky V, Kwon CS, Cohen A, Chan AHW, Dhamoon M, Deng P, Gutzwiller EM, Hao Q, He C, Heredia Nunez WD, Klenofsky B, Lemus HN, Marcuse L, Roberts M, Schorr EM, Singh A, Tantillo G, Young J, Balchandani P, Festa J, Naasan G, Charney A, Nadkarni G, Jetté N. In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19-A cohort study. Epilepsia 2023; 64:2725-2737. [PMID: 37452760 DOI: 10.1111/epi.17715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) is associated with mortality in persons with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy. METHODS We conducted a retrospective study of patients with COVID-19 admitted to a multicenter health system between March 15, 2020, and May 17, 2021. Patients with epilepsy were identified using a validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM case definition. Logistic regression models and Kaplan-Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least-squares regression model was fitted for length of stay (LOS). RESULTS We identified 9833 people with COVID-19 including 334 with epilepsy. On univariate analysis, people with epilepsy had significantly higher ventilator use (37.70% vs 14.30%, p < .001), intensive care unit (ICU) admissions (39.20% vs 17.70%, p < .001) mortality rate (29.60% vs 19.90%, p < .001), and longer LOS (12 days vs 7 days, p < .001). and fewer were discharged home (29.64% vs 57.37%, p < .001). On multivariate analysis, only non-routine discharge (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 2.00-3.70; p < .001) and LOS (32.50% longer, 95% CI 22.20%-43.60%; p < .001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR 1.05, 95% CI 1.03-1.08; p < .001), ventilator support (aOR 7.18, 95% CI 3.12-16.48; p < .001), and higher Charlson comorbidity index (CCI) (aOR 1.18, 95% CI 1.04-1.34; p = .010). In epilepsy, admissions between August and December 2020 or January and May 2021 were associated with a lower odds of non-routine discharge and decreased LOS compared to admissions between March and July 2020, but this difference was not statistically significant. SIGNIFICANCE People with COVID-19 who had epilepsy had a higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (≥65), ventilator use, and higher CCI were associated with COVID-19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be monitored closely in the setting of COVID-19.
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Affiliation(s)
- Claire Ufongene
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | - Grace Van Hyfte
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
| | - Parul Agarwal
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
| | - Leah J Blank
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
| | - Jonathan Goldstein
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | - Brian Mathew
- Department of Neurology, ISMMS, New York, New York, USA
| | - Jung-Yi Lin
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
| | - Allison Navis
- Department of Neurology, ISMMS, New York, New York, USA
| | | | | | - Veronica Peschansky
- Department of Neurology, ISMMS, New York, New York, USA
- Department of Neurology, Columbia University, New York, New York, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University, New York, New York, USA
- Department of Neurosurgery, Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Ariella Cohen
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | | | | | - Pojen Deng
- Department of Neurology, ISMMS, New York, New York, USA
| | | | - Qing Hao
- Department of Neurology, ISMMS, New York, New York, USA
| | - Celestine He
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | | | | | | | - Lara Marcuse
- Department of Neurology, ISMMS, New York, New York, USA
| | | | - Emily M Schorr
- Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gabriela Tantillo
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - James Young
- Department of Neurology, ISMMS, New York, New York, USA
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, ISMMS, New York, New York, USA
| | - Joanne Festa
- Department of Neurology, ISMMS, New York, New York, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, New York, New York, USA
| | - Georges Naasan
- Department of Neurology, ISMMS, New York, New York, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, New York, New York, USA
| | - Alexander Charney
- Department of Psychiatry, ISMMS, New York, New York, USA
- Department of Genetics and Genomic Sciences, ISMMS, New York, New York, USA
| | | | - Nathalie Jetté
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Daenen K, Tong-Minh K, Liesenfeld O, Stoof SCM, Huijben JA, Dalm VASH, Gommers D, van Gorp ECM, Endeman H. A Transcriptomic Severity Classifier IMX-SEV-3b to Predict Mortality in Intensive Care Unit Patients with COVID-19: A Prospective Observational Pilot Study. J Clin Med 2023; 12:6197. [PMID: 37834841 PMCID: PMC10573111 DOI: 10.3390/jcm12196197] [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: 08/11/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The prediction of disease outcomes in COVID-19 patients in the ICU is of critical importance, and the examination of host gene expressions is a promising tool. The 29-host mRNA Inflam-matix-Severity-3b (IMX-SEV-3b) classifier has been reported to predict mortality in emergency department COVID-19 patients and surgical ICU patients. The accuracy of the IMX-SEV-3b in predicting mortality in COVID-19 patients admitted to the ICU is yet unknown. Our aim was to investigate the accuracy of the IMX-SEV-3b in predicting the ICU mortality of COVID-19 patients. In addition, we assessed the predictive performance of routinely measured biomarkers and the Sequential Organ Failure Assessment (SOFA) score as well. This was a prospective observational study enrolling COVID-19 patients who received mechanical ventilation on the ICU of the Erasmus MC, the Netherlands. The IMX-SEV-3b scores were generated by amplifying 29 host response genes from blood collected in PAXgene® Blood RNA tubes. A severity score was provided, ranging from 0 to 1 for increasing disease severity. The primary outcome was the accuracy of the IMX-SEV-3b in predicting ICU mortality, and we calculated the AUROC of the IMX-SEV-3b score, the biomarkers C-reactive protein (CRP), D-dimer, ferritin, leukocyte count, interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT) and the SOFA score. A total of 53 patients were included between 1 March and 30 April 2020, with 47 of them being included within 72 h of their admission to the ICU. Of these, 18 (34%) patients died during their ICU stay, and the IMX-SEV-3b scores were significantly higher in non-survivors compared to survivors (0.65 versus 0.57, p = 0.05). The Area Under the Receiver Operating Characteristic Curve (AUROC) for prediction of ICU mortality by the IMX-SEV-3b was 0.65 (0.48-0.82). The AUROCs of the biomarkers ranged from 0.52 to 0.66, and the SOFA score had an AUROC of 0.81 (0.69-0.93). The AUROC of the pooled biomarkers CRP, D-dimer, ferritin, leukocyte count, IL-6, LDH, NLR and PCT for prediction of ICU mortality was 0.81 (IQR 0.69-0.93). Further validation in a larger interventional trial of a point-of-care version of the IMX-SEV-3b classifier is warranted to determine its value for patient management.
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Affiliation(s)
- Katrijn Daenen
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (J.A.H.); (D.G.); (H.E.)
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (E.C.M.v.G.)
| | - Kirby Tong-Minh
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (E.C.M.v.G.)
| | | | - Sara C. M. Stoof
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (J.A.H.); (D.G.); (H.E.)
| | - Jilske A. Huijben
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (J.A.H.); (D.G.); (H.E.)
| | - Virgil A. S. H. Dalm
- Department of Immunology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (J.A.H.); (D.G.); (H.E.)
| | - Eric C. M. van Gorp
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (E.C.M.v.G.)
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands (J.A.H.); (D.G.); (H.E.)
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Gatto MC, Oliva A, Palazzolo C, Picariello C, Garascia A, Nicastri E, Girardi E, Antinori A. Efficacy and Safety of Anticoagulant Therapy in COVID-19-Related Pulmonary Embolism with Different Extension. Biomedicines 2023; 11:biomedicines11051282. [PMID: 37238955 DOI: 10.3390/biomedicines11051282] [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: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Pulmonary embolism (PE) has been associated with SARS-CoV-2 infection, and its incidence is highly variable. The aim of our study was to describe the radiological and clinical presentations, as well as the therapeutic management, of PEs that occurred during SARS-CoV-2 infection in a cohort of hospitalized patients. In this observational study, we enrolled patients with moderate COVID-19 who developed PE during hospitalization. Clinical, laboratory, and radiological features were recorded. PE was diagnosed on clinical suspicion and/or CT angiography. According to CT angiography results, two groups of patients were further distinguished: those with proximal or central pulmonary embolism (cPE) and those with distal or micro-pulmonary embolism (mPE). A total of 56 patients with a mean age of 78 ± 15 years were included. Overall, PE occurred after a median of 2 days from hospitalization (range 0-47 days) and, interestingly, the majority of them (89%) within the first 10 days of hospitalization, without differences between the groups. Patients with cPE were younger (p = 0.02), with a lower creatinine clearance (p = 0.04), and tended to have a higher body weight (p = 0.059) and higher D-Dimer values (p = 0.059) than patients with mPE. In all patients, low-weight molecular heparin (LWMH) at anticoagulant dosage was promptly started as soon as PE was diagnosed. After a mean of 16 ± 9 days, 94% of patients with cPE were switched to oral anticoagulant (OAC) therapy, which was a direct oral anticoagulant (DOAC) in 86% of cases. In contrast, only in 68% of patients with mPE, the prosecution with OAC was indicated. The duration of treatment was at least 3 months from PE diagnosis in all patients who started OAC. At the 3-month follow-up, no persistence or recurrence of PE as well as no clinically relevant bleedings were found in both groups. In conclusion, pulmonary embolism in patients with SARS-CoV-2 may have different extensions. Used with clinical judgment, oral anticoagulant therapy with DOAC was effective and safe.
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Affiliation(s)
- Maria Chiara Gatto
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Piazzale Aldo Moro n.5, 00185 Rome, Italy
| | - Claudia Palazzolo
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Claudio Picariello
- UOC Cardiologia, Azienda Ospedaliera Santa Maria della Misericordia, ULSS5 Polesana, 45100 Rovigo, Italy
| | - Andrea Garascia
- Department of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy
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Delgado JF, Vidal M, Julià G, Navarro G, Serrano RM, van den Eynde E, Navarro M, Calvet J, Gratacós J, Espasa M, Peña P. Validation of N Protein Antibodies to Diagnose Previous SARS-CoV-2 Infection in a Large Cohort of Healthcare Workers: Use of Roche Elecsys ® Immunoassay in the S Protein Vaccination Era. Viruses 2023; 15:v15040930. [PMID: 37112910 PMCID: PMC10146079 DOI: 10.3390/v15040930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to validate the detection of anti-nucleocapsid protein (N protein) antibodies for the diagnosis of SARS-CoV-2 infection in light of the fact that most COVID-19 vaccines use the spike (S) protein as the antigen. Here, 3550 healthcare workers (HCWs) were enrolled from May 2020 (when no S protein vaccines were available). We defined SARS-CoV-2 infection if HCWs were found to be positive by RT-PCR or found to be positive in at least two different serological immunoassays. Serum samples from Biobanc I3PT-CERCA were analyzed by Roche Elecsys® (N protein) and Vircell IgG (N and S proteins) immunoassays. Discordant samples were reanalyzed with other commercial immunoassays. Roche Elecsys® showed the positivity of 539 (15.2%) HCWs, 664 (18.7%) were found to be positive by Vircell IgG immunoassays, and 164 samples (4.6%) showed discrepant results. According to our SARS-CoV-2 infection criteria, 563 HCWs had SARS-CoV-2 infection. The Roche Elecsys® immunoassay has a sensitivity, specificity, accuracy, and concordance with the presence of infection of 94.7%, 99.8%, 99.3%, and 0.96, respectively. Similar results were observed in a validation cohort of vaccinated HCWs. We conclude that the Roche Elecsys® SARS-CoV-2 N protein immunoassay demonstrated good performance in diagnosing previous SARS-CoV-2 infection in a large cohort of HCWs.
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Affiliation(s)
- Juan Francisco Delgado
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Mònica Vidal
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Germà Julià
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Gema Navarro
- Epidemiology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Rosa María Serrano
- Occupational Health Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Eva van den Eynde
- Infection Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Marta Navarro
- Infection Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Joan Calvet
- Rheumatology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Mateu Espasa
- Microbiology Section, Laboratory Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Pilar Peña
- Occupational Health Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
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Deng Y, Liu S, Wang Z, Wang Y, Jiang Y, Liu B. Explainable time-series deep learning models for the prediction of mortality, prolonged length of stay and 30-day readmission in intensive care patients. Front Med (Lausanne) 2022; 9:933037. [PMID: 36250092 PMCID: PMC9554013 DOI: 10.3389/fmed.2022.933037] [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: 04/30/2022] [Accepted: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background In-hospital mortality, prolonged length of stay (LOS), and 30-day readmission are common outcomes in the intensive care unit (ICU). Traditional scoring systems and machine learning models for predicting these outcomes usually ignore the characteristics of ICU data, which are time-series forms. We aimed to use time-series deep learning models with the selective combination of three widely used scoring systems to predict these outcomes. Materials and methods A retrospective cohort study was conducted on 40,083 patients in ICU from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Three deep learning models, namely, recurrent neural network (RNN), gated recurrent unit (GRU), and long short-term memory (LSTM) with attention mechanisms, were trained for the prediction of in-hospital mortality, prolonged LOS, and 30-day readmission with variables collected during the initial 24 h after ICU admission or the last 24 h before discharge. The inclusion of variables was based on three widely used scoring systems, namely, APACHE II, SOFA, and SAPS II, and the predictors consisted of time-series vital signs, laboratory tests, medication, and procedures. The patients were randomly divided into a training set (80%) and a test set (20%), which were used for model development and model evaluation, respectively. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Brier scores were used to evaluate model performance. Variable significance was identified through attention mechanisms. Results A total of 33 variables for 40,083 patients were enrolled for mortality and prolonged LOS prediction and 36,180 for readmission prediction. The rates of occurrence of the three outcomes were 9.74%, 27.54%, and 11.79%, respectively. In each of the three outcomes, the performance of RNN, GRU, and LSTM did not differ greatly. Mortality prediction models, prolonged LOS prediction models, and readmission prediction models achieved AUCs of 0.870 ± 0.001, 0.765 ± 0.003, and 0.635 ± 0.018, respectively. The top significant variables co-selected by the three deep learning models were Glasgow Coma Scale (GCS), age, blood urea nitrogen, and norepinephrine for mortality; GCS, invasive ventilation, and blood urea nitrogen for prolonged LOS; and blood urea nitrogen, GCS, and ethnicity for readmission. Conclusion The prognostic prediction models established in our study achieved good performance in predicting common outcomes of patients in ICU, especially in mortality prediction. In addition, GCS and blood urea nitrogen were identified as the most important factors strongly associated with adverse ICU events.
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Affiliation(s)
- Yuhan Deng
- School of Public Health, Peking University, Beijing, China
| | - Shuang Liu
- School of Public Health, Peking University, Beijing, China
| | - Ziyao Wang
- School of Public Health, Peking University, Beijing, China
| | - Yuxin Wang
- School of Public Health, Peking University, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Yong Jiang,
| | - Baohua Liu
- School of Public Health, Peking University, Beijing, China
- *Correspondence: Baohua Liu,
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9
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Ćurčić M, Tarle M, Almahariq H, Hleb S, Havaš J, Pražetina M, Lasić H, Dolenc E, Kukoč A, Mihelčić A, Miko I, Romić A, Tipura D, Drmić Ž, Čučković M, Blagaj V, Lukšić I, Peršec J, Šribar A. Distribution of Pathogens and Predictive Values of Biomarkers of Inflammatory Response at ICU Admission on Outcomes of Critically Ill COVID-19 Patients with Bacterial Superinfections-Observations from National COVID-19 Hospital in Croatia. Diagnostics (Basel) 2022; 12:2069. [PMID: 36140471 PMCID: PMC9497731 DOI: 10.3390/diagnostics12092069] [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: 08/04/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Superinfections contribute to mortality and length of stay in critically ill COVID-19 patients. The aim of this study was to determine the incidence and pathogen distribution of bacterial and fungal superinfections of the lower respiratory tract (LRTI), urinary tract (UTI) and bloodstream (BSI) and to determine the predictive value of biomarkers of inflammatory response on their ICU survival rates. METHODS A retrospective observational study that included critically ill COVID-19 patients treated during an 11-month period in a Croatian national COVID-19 hospital was performed. Clinical and diagnostic data were analyzed according to the origin of superinfection, and multivariate regression analysis was performed to determine the predictive values of biomarkers of inflammation on their survival rates. RESULTS 55.3% critically ill COVID-19 patients developed bacterial or fungal superinfections, and LRTI were most common, followed by BSI and UTI. Multidrug-resistant pathogens were the most common causes of LRTI and BSI, while Enterococcus faecalis was the most common pathogen causing UTI. Serum ferritin and neutrophil count were associated with decreased chances of survival in patients with LRTI, and patients with multidrug-resistant isolates had significantly higher mortality rates, coupled with longer ICU stays. CONCLUSION The incidence of superinfections in critically ill COVID-19 patients was 55.3%, and multidrug-resistant pathogens were dominant. Elevated ferritin levels and neutrophilia at ICU admission were associated with increased ICU mortality in patients with positive LRTI.
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Affiliation(s)
- Maja Ćurčić
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Marko Tarle
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Hani Almahariq
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Sonja Hleb
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Juraj Havaš
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Marko Pražetina
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Hrvoje Lasić
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Emil Dolenc
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Andrea Kukoč
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Antonija Mihelčić
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivan Miko
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Andrea Romić
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Danijela Tipura
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Željka Drmić
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Marcela Čučković
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Vanja Blagaj
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivica Lukšić
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jasminka Peršec
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Andrej Šribar
- Clinical Department for Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Šribar A. Author response to: An outcome study in patients with COVID-19 admitted to ICU: HAS a miss? Heart Lung 2022; 54:97. [PMID: 35307205 PMCID: PMC8885306 DOI: 10.1016/j.hrtlng.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Andrej Šribar
- Clinical department of anesthesiology, resuscitation and intensive care medicine, University hospital Dubrava, Zagreb, Croatia; Zagreb University, School of Dental Medicine.
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Magoon R, Suresh V, Mahajan S. An outcome study in patients with COVID-19 admitted to ICU: HAS a miss? Heart Lung 2022; 54:95-96. [PMID: 35135681 PMCID: PMC8806125 DOI: 10.1016/j.hrtlng.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
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