Prevalence and predictors of in-hospital mortality of patients hospitalized with COVID-19 infection

The Impact of Viral Load on the Severity and Outcome Among Patients With COVID-19: A Cross-Sectional Study

Objectives This study aimed to assess the relationship between illness severity and mortality among COVID-19 patients along with the cycle threshold (Ct) value measured by viral load. Methods A cross-sectional study was conducted based on records of the emergency room at Rashid Hospital located in Dubai, United Arab Emirates. This research was carried out on all of the appropriate records of patients who were hospitalized at Rashid Hospital in Dubai between May 2020 and January 2021. Clinical and laboratory data were used as severity indicators, and in-hospital death was designated as the outcome. Results A total of 1,633 cases were included in the analysis. The percentage of deceased patients was higher in patients with a low Ct value (11.6%) than in patients with a high Ct value (6.9%) (p-value = 0.003). Logistic analysis revealed a statistically significant correlation (OR=2.046; p-value=0.002) between mortality and viral load, as measured by the Ct value. Patients with low Ct values and aberrant laboratory findings had a higher frequency of respiratory problems and required oxygen therapy, according to clinical and laboratory markers. Conclusions A correlation was found between viral load and mortality. Advanced age, history of chronic disease, and abnormal clinical and laboratory findings were all independently linked to a greater mortality rate in COVID-19 patients, indicating that they might be utilized as predictive and prognostic factors along with the viral load.

COVID-19 infection in patients with history of pediatric heart transplant in Germany, Austria, and Switzerland

COVID-19 is a heterogenous infection-asymptomatic to fatal. While the course of pediatric COVID-19 infections is usually mild or even asymptomatic, individuals after adult heart transplantation are at high risk of a severe infection. We conducted a retrospective, multicenter survey of 16 pediatric heart transplant centers in Germany, Austria and Switzerland to evaluate the risk of a severe COVID-19 infection after pediatric heart transplantation between 02/2020 and 06/2021. Twenty-six subjects (11 male) with a median age of 9.77 years at time of transplantation and a median of 4.65 years after transplantation suffered from COVID-19 infection. The median age at time of COVID-10 infection was 17.20 years. Fourteen subjects had an asymptomatic COVID-19 infection. The most frequent symptoms were myalgia/fatigue (n = 6), cough (n = 5), rhinitis (n = 5), and loss of taste (n = 5). Only one subject showed dyspnea. Eleven individuals needed therapy in an outpatient setting, four subjects were hospitalized. One person needed oxygen supply, none of the subjects needed non-invasive or invasive mechanical ventilation. No specific signs for graft dysfunction were found by non-invasive testing. In pediatric heart transplant subjects, COVID-19 infection was mostly asymptomatic or mild. There were no SARS-CoV-2 associated myocardial dysfunction in heart transplant individuals.

Demographic study of patients' mortality rate before and after the COVID-19 outbreak: A cross-sectional study

Background and Aim

To better guide the health policies, it is essential to clarify the socio-demographic and clinical risk factors affecting the mortality rate of patients with coronavirus disease 2019 (COVID-19).

Objective

The purpose of this project is to separate hospital mortality statistics into different groups, which will definitely help in planning to reduce the mortality rate. As well, we aimed to compare factors involved in COVID-19 death between the period before and after its outbreak.

Methods

This cross-sectional study was performed based on all death certificates of archived records in Rasool Akram Hospital during the years 2018 and the first half of 2019. A checklist was completed based on the variables, including death cases by time, gender, age, duration of hospitalization, department of place and time of death, cause of death, cases referred to forensic medicine, information of the patient, including educational and occupational level and birth certificate issuing city, neonatal death, and IUFD, classification of diseases according to the provided version of ICD 10 (international classification of diseases 10th edition).

Results

A number of 2632 deceased patients were included in this study, 1511 (57.4%) patients who died before the start of the COVID-19 outbreak, and 1121 (42.6%) patients died in the hospital after the start of this pandemic. There were statistically significant differences in gender (higher prevalence of males), increased average age, lower occupational status, decreased number of infants, increased cause of death due to COVID-19 and increased hospitalization in Royal ICU in dead patients (p < 0.05).

Conclusion

The findings show that the elderly cases are more at risk of COVID-19 mortality than other age groups, which needs more attention to this group of society and clarifies other epidemiological factors, as well as clinicopathological and public healthcare practices.

The Development of an Oral Solution Containing Nirmatrelvir and Ritonavir and Assessment of Its Pharmacokinetics and Stability

Paxlovid®, a co-packaged medication comprised of separate tablets containing two active ingredients, nirmatrelvir (NRV) and ritonavir (RTV), exhibits good effectiveness against coronavirus disease 2019 (COVID-19). However, the size of the NRV/RTV tablets makes them difficult for some patients to swallow, especially the elderly and those with dysphagia. Therefore, an oral liquid formulation that can overcome this shortcoming and improve patient compliance is required. In this study, we developed a liquid formulation containing NRV and RTV by adopting strategies that used co-solvents and surfactants to enhance the solubility and inhibit possible recrystallization. The in vitro release results showed that NRV and RTV could be maintained at high concentrations in solution for a certain period in the investigated media. In vivo studies in rats showed that the oral bioavailability of NRV/RTV solution was significantly enhanced. Compared to Paxlovid® tablets, the AUC(0-t) of NRV and RTV increased by 6.1 and 3.8 times, respectively, while the Cmax increased by 5.5 times for both. Furthermore, the promoting effect of the absorption of RTV on the bioavailability of NRV was confirmed. Experiments with a beagle showed a similar trend. Stability studies were also conducted at 4 °C, 25 °C, and 40 °C for 90 days, indicating that the oral liquid formulation was physically and chemically stable. This study can be used as a valuable resource for developing and applying oral liquid NRV/RTV formulations in a clinical context.

Demographics, clinical characteristics, and outcomes in hospitalized patients during six waves of COVID‑19 in Northern Iran: a large cohort study

Since the first report of coronavirus disease 2019 (COVID-19) in Iran, our country has experienced several waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Northern Iran was one of the most affected regions of the country by COVID-19. In the current study, the demographic and clinical characteristics and outcomes of hospitalized patients were determined over a 2-year period (during six waves of SARS-CoV-2). This is a large cohort study investigating hospitalized patients with suspected and probable, and confirmed SARS-CoV-2 infection in Babol district, northern Iran, during the two years of COVID-19. The study population included patients admitted to four hospitals affiliated with Babol University of Medical Sciences between March 7, 2020 (start of the first wave) and March 20, 2022 (end of the sixth wave). Epidemiological and demographic characteristics, real-time PCR, cycle thresholds, clinical data and outcomes of COVID-19 were analyzed in 24,287 hospitalized patients. A total of 24,287 hospitalized patients were included in the study: 13,250 (46.6%) patients were suspected of having COVID-19, 11037(45.4%) were confirmed COVID-19 cases. The mean age of confirmed COVID-19 patients was 54.5 ± 18.9 years and 5961 (54%) were female. The median length of hospitalization for COVID-19 survivors and non-survivors was 5 (interquartile range [IQR] 4-8) and 7 (IQR 3-15) days, respectively. Of the patients with confirmed COVID-19, 714 (6.5%) died during hospitalization. In addition, the mortality rate from the first to the sixth wave was 22.9%, 8.1%, 9.9%, 6.8%, 2.7% and 3.5% in confirmed COVID-19 patients. The patients in the fifth wave were significantly younger than the others (mean age and SD of 51.1 ± 17.4 versus 59.2 ± 16.9, 54.7 ± 19.9, 58.4 ± 17.9, 53.5 ± 16.8 and 58.5 ± 25.1 years; p<0.001). The highest in-hospital mortality rate was 22.9% (126/551) in the first wave and the lowest in the fifth wave was 2.7% (96/3573) of cases. In conclusion, in the present study, the in-hospital mortality rate was 6.5% and more than half of the deceased patients were ≥65 years old. Male gender, advanced age and comorbidities significantly increased the mortality rate. The patients in the fifth wave were significantly younger than those in the other waves, and the lowest mortality rate and intensive care unit admission were also observed in the fifth wave.

Epidemiological, clinical, therapeutic features and predictors of death among COVID-19 patients hospitalized in Parakou: a cross-sectional study in Northern Benin

BACKGROUND

COVID-19 is an emerging contagious infection with polymorphic clinical manifestations. The purpose of this study was to describe the epidemiological, clinical, therapeutic features and identify the predictors of mortality among COVID-19 hospitalized cases in Parakou.

METHODS

This was a cross-sectional, descriptive and analytic study. Systematic recruitment was used to include all patients hospitalized with COVID-19 from May 8, 2020, to December 31, 2021, whose medical records were available and usable. The variables studied were clinical and paraclinical signs, diagnostic and therapeutic means, evolution under treatment and prognostic factors. This study was approved by the Local Ethical Committee. The data were analyzed using Stata/MP 14.1 software.

RESULTS

A total of 198 cases of COVID-19 were identified, 117 of whom were men. The mean age was 51.53 ± 19.51 years. The presenting signs were fever 146 (74.11%), cough 157 (79.70%) and dyspnea 118 (53.90%). It was severe COVID-19 in 108 cases (54.55%). Therapeutically, 95 patients (47.98%) had received the combination of Lopinavir/ritonavir and Ribavirin and 95 others (47.98%) received chloroquine. Recovery was noted in 151 (76.26%) patients. Mortality rate was 18.18%. Predictors of death were high blood pressure, presence of signs of severity, high-concentration mask ventilation used, and elevated transaminases.

CONCLUSION

COVID-19 was a reality in Parakou, with a significant number of severe cases requiring hospitalization. Several factors are associated with the prognosis of the disease.

Low Rate of Bacterial Coinfections and Antibiotic Overprescribing During COVID-19 Pandemic: A Retrospective Study from Oman

Objectives

The recommended treatment for COVID-19 includes antiviral drugs, corticosteroids, immunomodulatory drugs, low molecular weight heparin, as well as antibiotics. Although COVID-19 is a viral disease, many studies indicate that antibiotics are prescribed frequently, mainly to treat suspected bacterial coinfection. At the same time, the prevalence of bacterial coinfections during COVID-19 is rather low indicating the significant antibiotic overuse in these patients. It is well known that this can trigger antibiotic bacterial resistance, and once it emerges the reversal of resistance is a complex and long-lasting process. The aims of this study were to estimate the prevalence of bacterial coinfections during the COVID-19 and to analyze the antibiotic treatment justification during this pandemic in Oman.

Methods

This retrospective analysis was conducted using the Royal Hospital COVID-19 Registry Database. The study analyzed demographic and clinical characteristics, as well as laboratory parameters and antibiotic treatment of hospitalized patients.

Results

During the study period, 584 patients were enrolled in the analysis. Coinfection was rare as it was confirmed in 0.9% of patients. Superinfections were present in 15.2% of patients. Gram-negative bacteria were isolated in 95 (69.9%) samples, gram-positive bacteria in 25 (18.4%) samples, while Candida spp. was found in 16 (11.8%) samples. On admission, empirical antibiotic treatment was started in 543 (93.0%) patients.

Conclusions

During COVID-19, coinfections are rarely seen and the overuse of antibiotics is not justified. The incidence of superinfections is the same as in other patients in healthcare settings caused by the same resistant microorganisms, which implies the use of even more.

Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2

The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm³; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm³ or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.

DATA SOURCES

A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.

STUDY SELECTION

Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.

DATA EXTRACTION

Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.

DATA SYNTHESIS

One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021.

CONCLUSIONS

We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.

Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection

OBJECTIVES

This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).

METHODS

NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.

RESULTS

Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6-7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4-0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3-0.7)] were protected from in-hospital mortality.

CONCLUSIONS

WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.

Factors associated with mortality in patients hospitalized for COVID-19 admitted to a tertiary hospital in Lambayeque, Peru, during the first wave of the pandemic

INTRODUCTION

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide, becoming a long-term pandemic.

OBJECTIVES

To analyze the factors associated with mortality in patients hospitalized for COVID-19 in a tertiary hospital in the Lambayeque region of Peru.

METHODS

A retrospective cohort study of patients with a diagnosis of COVID-19, hospitalized in a hospital in northern Peru, was conducted from March to September 2020.

RESULTS

Of the 297 patients studied, 69% were women, the mean age was 63.99 years (SD = ±15.33 years). Hypertension was the most frequent comorbidity (36.67%), followed by diabetes mellitus (24.67%) and obesity (8.33%). The probability of survival at 3 days of ICU stay was 65.3%, at 7 days 24.2%, and 0% on day 14. Risk factors associated with mortality in patients hospitalized for COVID-19 are age, male sex, tachypnea, low systolic blood pressure, low peripheral oxygen saturation, impaired renal function, elevated IL-6 and elevated D-dimer.

CONCLUSIONS

Mortality in hospitalized patients with COVID-19 was 51.18 per 100 persons, Mortality was found to be associated with hypertension, type of infiltrating, and sepsis.

Predictive Factors of Death and the Clinical Profile of Hospitalized Covid-19 Patients in Morocco: A One-Year Mixed Cohort Study

Background Since the onset of the Covid-19 pandemic, several studies have been conducted around the world in an attempt to understand this heterogeneous and unpredictable disease and to prevent related death. It was therefore necessary to study the associated risk factors of Covid-19-related mortality. Objectives The aim of this study was to describe the clinical profile and to identify the factors associated with mortality of patients with Covid-19 in Morocco. Methods We performed a mixed cohort study (retrospective and prospective) of 615 in-patients with Covid-19 disease, enrolled between August 2020 and October 2021. We followed the cohort throughout the hospitalization until discharge and 30 days thereafter. Results The median age was 64 years old; 62.1% of the patients were male. The mean time from symptom onset to hospitalization was 8.5 days (±4.67), and 68.1% of patients had comorbidities. On admission, the most common symptoms were dyspnea (82.2%), cough (80.3%), and fever (76.8%). The main follow-up complication was secondary infection (56.9%). Based on univariate analysis, male gender (p<0.008 and brut relative risk {_bRR}=1.57), advanced age (p<0.001), lung involvement (p<0.001), lymphopenia (p<0.001 and _bRR=2.32), D-dimers of >500 µg/l (p<0.007 and _bRR=2.47), C-reactive protein (CRP) of >130 mg/l (p<0.001 and _bRR=2.45), elevated creatinine (p<0.013 and _bRR=1.61), lactate dehydrogenase (LDH) of >500 U/l (p<0.001 and _bRR=7.16), receiving corticosteroids (p<0.001 and _bRR=5.08), invasive ventilation (p<0.001 and _bRR=30.10), the stay in the resuscitation unit (p<0.001 and _bRR=13.37), and acute respiratory distress syndrome (ARDS) (p<0.001 and _bRR=10.98) were associated with a higher risk of death. In the opposite, receiving azithromycin and hydroxychloroquine (p<0.001 and _bRR=0.28) and pre-admission anticoagulants (p<0.005 and _bRR=0.46) was associated with a lower risk of mortality. Multivariate regression analysis showed that age of >60 years (p<0.001 and adjusted odds ratio {aOR}=4.90), the use of invasive ventilation (p<0.001 and aOR=9.60), the stay in the resuscitation unit (p<0.001 and aOR=5.09), and acute respiratory distress syndrome (p<0.001 and aOR=6.49) were independent predictors of Covid-19 mortality. Conclusion In this cohort study focusing on Covid-19 in-patient's mortality, we found that age of >60 years, the use of invasive ventilation, the stay in the resuscitation unit, and acute respiratory distress syndrome were independent predictors of Covid-19 mortality. The results of this study can be used to improve knowledge for better clinical management of Covid-19 in-patients.

The Impact of Demographic, Clinical Characteristics and the Various COVID-19 Variant Types on All-Cause Mortality: A Case-Series Retrospective Study

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a pandemic affecting virtually every country in the world. We evaluated the demographic, clinical, laboratory, and all-cause mortality of moderate and severe COVID-19 patients admitted to a tertiary care hospital in Oman during the different COVID-19 waves and variant types. (2) Methods: A case-series retrospective study was carried out between 12 March 2020 and 30 June 2022. All adults over the age of 18 with laboratory-confirmed COVID-19 were enrolled. Analyses were performed using univariate and multivariate statistics. (3) Results: A total of 1462 confirmed cases enrolled with the mean age of the cohort was 55 ± 17 years with significant differences among the groups (p = 0.006). A total of 63% and 80% of the patients were males and citizens of Oman, respectively. Patients infected with the Alpha COVID-19 variant type were more likely to have acute respiratory distress syndrome (ARDS) (p < 0.001), stay longer in the hospital (p < 0.001), and get admitted to the intensive care unit (ICU) (p < 0.001). At the same time, those who had the Omicron COVID-19 type were more likely to have renal impairment (p < 0.001) and less likely to be associated with non-invasive ventilation (NIV) (p = 0.001) compared with other COVID-19 variant types. The Delta (adjusted odds ratio (aOR), 1.8; 95% confidence interval (CI): 1.22−2.66; p = 0.003) and Omicron (aOR, 1.88; 95% CI: 1.09−3.22; p = 0.022) COVID-19 variant types were associated with higher all-cause mortality when compared to the initial COVID-19 variant. Old age (aOR, 1.05; 95% CI: 1.04−1.06; p < 0.001), the presence of respiratory disease (aOR, 1.58; 95% CI: 1.02−2.44; p = 0.04), ICU admission (aOR, 3.41; 95% CI: 2.16−5.39; p < 0.001), lower eGFR (aOR, 1.61; 95% CI: 1.17−2.23; p = 0.004), and ARDS (aOR, 5.75; 95% CI: 3.69−8.98; p < 0.001) were also associated with higher mortality while NIV requirements were associated with lower odds of dying (aOR, 0.65; 95% CI: 0.46−0.91; p = 0.012). (4) Conclusions: Alpha and Delta variants were associated with a longer hospital stay, need for intensive care, mechanical ventilation, and increased mortality. Old age, cardiac renal dysfunction were commonly associated with Omicron variants. Large-scale national studies to further assess the risk factors for mortality related to COVID-19 waves are warranted.

Clinical Characteristics and Mortality-Associated Factors in COVID-19 Critical Patients in a Portuguese ICU

INTRODUCTION

Severe COVID-19 is associated with serious complications and poor outcomes. Older age and underlying comorbidities are known risk factors for severe COVID-19, but a better understanding of baseline characteristics and outcomes of patients with severe COVID-19 is urgently needed.

METHODS

This study was a retrospective case series of 227 consecutive patients with laboratory-confirmed COVID-19 admitted to the intensive care unit (ICU) at our institution between March 2020 and December 2021. Demographic and clinical data were collected.

RESULTS

The median age of patients was 65 years, and 180 (79.3%) were male. Cardiovascular comorbidities were frequent and included hypertension (n=148; 65.2%), dyslipidemia (n=116; 51.1%), obesity (n=114; 50.2%), and diabetes mellitus (n=80; 35.2%). About 20% of the patients had the chronic respiratory disease, with sleep apnea being the most common. Immunosuppression was identified in 13% of the patients, with autoimmunity, post-transplantation, and neoplasms being the most represented causes. Most patients were admitted to the ICU at six to 15 days after symptom onset, corresponding to stages IIb (pulmonary involvement/hypoxia) and III (hyperinflammatory). All patients received systemic steroids, with an average treatment duration of 22 days. Several ventilatory support strategies were used; 80 patients were supported entirely noninvasively with high flow nasal oxygenation and noninvasive ventilation, while 164 patients were invasively ventilated. Most intubations (65%) occurred in the first 24 hours after admission, and the mean duration of mechanical ventilation was 14 days. The reintubation rate was 10%, occurring on average two to three days after planned extubation. Thirty-two tracheostomies were performed. Bacterial co-infection was treated in 75% of patients, and Aspergillus co-infection complicating COVID-19 pneumonia was diagnosed in eight patients. Median ICU and hospital stays were 15 and 25 days, respectively, and the 28-day mortality rate was 38%. Patients over 75 years experienced a higher mortality rate (56%). Increased age and multimorbidity, particularly comprising cardiovascular disease and associated risk factors, were significantly more common in patients who died within 28 days after ICU admission.

CONCLUSIONS

A large proportion of critically ill COVID-19 patients required prolonged mechanical ventilation. ICU/hospital stay and mortality were particularly elevated in older patients and patients with cardiovascular risk factors. Considerable discrepancy existed between the proportion of patients with microbiological documentation of bacterial infections and those receiving antimicrobials. Improved methods for adequate microbiological diagnosis are needed and stewardship programs should be reinforced.

Morbidity and mortality pattern of COVID-19 patients and its associated risk factors: A cross-sectional study

Background

Early identification of patients with poor prognosis may facilitate the provision of proper supportive treatment in advance and reduce mortality due to Coronavirus Disease 2019 (COVID-19). The present study estimates the recovery and mortality rates among in-house COVID-19 patients admitted to a tertiary care center and also determines any association between mortality and variables of interest.

Methods and Material

This cross-sectional study was conducted in June to December 2021 among the COVID-19 patients admitted to the hospital based on their case sheets. A sample size of 1500 was calculated which was obtained by simple random sampling. Descriptive statistics were generated. Association between mortality and other variables was tested by using bivariate logistic regression and multiple logistic regression analysis.

Results

The overall recovery rate was 80.1%. Vaccination status was significantly associated with mortality, with the AOR (95% CI) of getting both vaccine doses and a single dose being 0.18 (0.05-0.70) and 0.28 (0.15-0.55), respectively, when compared to the unvaccinated group. Also, patients who sought admission on their own were found to be having more chances of recovery compared to those who were referred from other health facilities. The risk of dying was found to be increased nearly 5-fold among those who used Non-Rebreathing machines. The use of Non-Invasive ventilation and Bain Circuit was significantly associated with a bad prognosis. None on the mechanical ventilation survived.

Conclusions

The mortality rate of COVID-19 patients admitted to the tertiary care hospital was found to be one-fifth and the ICU-specific mortality rate was 83.6% while other factors like age and gender were not found to be associated with mortality. Among comorbidities, only liver diseases were found to be a significant determinant of mortality. Finally, patients who needed more flow rate of oxygen had a significant association with mortality.

The Associations of Iron Related Biomarkers with Risk, Clinical Severity and Mortality in SARS-CoV-2 Patients: A Meta-Analysis

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly around the world and has led to millions of infections and deaths. Growing evidence indicates that iron metabolism is associated with COVID-19 progression, and iron-related biomarkers have great potential for detecting these diseases. However, the results of previous studies are conflicting, and there is not consistent numerical magnitude relationship between those biomarkers and COVID-19. Thereby, we aimed to integrate the results of current studies and to further explore their relationships through a meta-analysis. We searched peer-reviewed literature in PubMed, Scopus and Web of Science up to 31 May 2022. A random effects model was used for pooling standard mean difference (SMD) and the calculation of the corresponding 95% confidence interval (CI). I2 was used to evaluate heterogeneity among studies. A total of 72 eligible articles were included in the meta-analysis. It was found that the ferritin levels of patients increased with the severity of the disease, whereas their serum iron levels and hemoglobin levels showed opposite trends. In addition, non-survivors had higher ferritin levels (SMD (95%CI): 1.121 (0.854, 1.388); Z = 8.22 p for Z < 0.001; I2 = 95.7%, p for I2 < 0.001), lower serum iron levels (SMD (95%CI): −0.483 (−0.597, −0.368), Z = 8.27, p for Z < 0.001; I2 = 0.9%, p for I2 =0.423) and significantly lower TIBC levels (SMD (95%CI): −0.612 (−0.900, −0.324), Z = 4.16, p for Z < 0.001; I2 = 71%, p for I2 = 0.016) than survivors. This meta-analysis demonstrates that ferritin, serum iron, hemoglobin and total iron banding capacity (TIBC) levels are strongly associated with the risk, severity and mortality of COVID-19, providing strong evidence for their potential in predicting disease occurrence and progression.

Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients

(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.

Incidence and predictors of death from COVID-19 among patients admitted to treatment center of Wollega University Referral Hospital, Western Ethiopia: A retrospective cohort study

INTRODUCTION

Currently, COVID-19 contributes to mortality and morbidity in developed as well as in developing countries since December 2019. However, there is scarcity of evidence regarding the incidence and predictors of death among patients admitted with COVID-19 in developing country including Ethiopia, where the numbers of deaths are under-reported. Hence, this study aimed to assess the incidence and predictors of death among patients admitted with COVID-19 in Wollega University Referral Hospital (WURH), western Ethiopia.

METHODS

An institution based retrospective cohort study design was conducted among 318 patients admitted with COVID-19 in WURH treatment center. Patients who were tested positive for COVID-19 by using rRT-PCR test and admitted with the diagnosis of severe COVID-19 cases from September 30, 2020 to June 10, 2021 were a source population. Epidata version 3.2 was used for data entry, and STATA version 14 for analysis. A Cox proportional hazard regression analysis was used to determine factors associated with mortality from COVID-19. Multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of mortality from COVID-19 at p-value < 0.05.

RESULTS

A total of 318 patients were included in final analysis with mean age of 44 (SD±16.7) years and about two third (67.9%) were males. More than half (55.7%) of patients had no comorbidity on admission. The majority, 259 (81.45%) of patients recovered from COVID-19 and 267 (84%) of patients were censored at the end of follow up. The incidence rate of mortality was 14.1 per/1000 (95%CI: 10.7, 18.5) person days observation. Age ≥ 59 years (AHR: 5.76, 95%CI: 2.58, 12.84), low oxygen saturation (AHR: 2.34, 95% CI: (2.34, 4.17), and delayed presentation (AHR: 5.60, 95%CI: 2.97, 10.56) were independent predictors of mortality among COVID-19 patients.

CONCLUSION

The mortality rate of COVID-19 pandemic was high in the study area, and most of death was happened during the first 10 days. Being old age, low oxygen saturation and delayed presentation were factors which predict mortality due to COVID-19. Hence, strengthening the health care delivery system to satisfy the need of the patients should get due attention to reduce the incidence of mortality from COVID-19 cases.

Mechanism of COVID-19 Causing ARDS: Exploring the Possibility of Preventing and Treating SARS-CoV-2

Novel coronavirus pneumonia (COVID-19) is spreading worldwide, causing great harm and stress to humans. Since patients with novel coronavirus (SARS-CoV-2) have a high probability of developing acute respiratory distress syndrome (ARDS) in severe cases, the pathways through which SARS-CoV-2 causes lung injury have become a major concern in the scientific field. In this paper, we investigate the relationship between SARS-CoV-2 and lung injury and explore the possible mechanisms of COVID-19 in ARDS from the perspectives of angiotensin-converting enzyme 2 protein, cytokine storm, activation of the immune response, triggering of Fas/FasL signaling pathway to promote apoptosis, JAK/STAT pathway, NF-κB pathway, type I interferon, vitamin D, and explore the possibility of prevention and treatment of COVID-19. To explore the possibility of SARS-CoV-2, and to provide new ideas to stop the development of ARDS in COVID-19 patients.

Routine laboratory parameters, including complete blood count, predict COVID-19 in-hospital mortality in geriatric patients

To reduce the mortality of COVID-19 older patients, clear criteria to predict in-hospital mortality are urgently needed. Here, we aimed to evaluate the performance of selected routine laboratory biomarkers in improving the prediction of in-hospital mortality in 641 consecutive COVID-19 geriatric patients (mean age 86.6 ± 6.8) who were hospitalized at the INRCA hospital (Ancona, Italy). Thirty-four percent of the enrolled patients were deceased during the in-hospital stay. The percentage of severely frail patients, assessed with the Clinical Frailty Scale, was significantly increased in deceased patients compared to the survived ones. The age-adjusted Charlson comorbidity index (CCI) score was not significantly associated with an increased risk of death. Among the routine parameters, neutrophilia, eosinopenia, lymphopenia, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, procalcitonin, IL-6, and NT-proBNP showed the highest predictive values. The fully adjusted Cox regressions models confirmed that high neutrophil %, NLR, derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), and low lymphocyte count, eosinophil %, and lymphocyte-to-monocyte ratio (LMR) were the best predictors of in-hospital mortality, independently from age, gender, and other potential confounders. Overall, our results strongly support the use of routine parameters, including complete blood count, in geriatric patients to predict COVID-19 in-hospital mortality, independent from baseline comorbidities and frailty.

Efficacy and Safety of Extracorporeal Membrane Oxygenation in Patients under Mechanical Ventilation with COVID-19 and Severe Acute Respiratory Distress Syndrome: A Health Technology Assessment

We aimed to assess the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients under mechanical ventilation with COVID-19 and severe acute respiratory distress syndrome (ARDS). A systematic review of the literature published in PubMed, Cochrane Library and LILACS databases, was performed. A manual search was also conducted using the reference lists of the studies included in the full-text assessment, as well as a grey-literature search on Google. Additionally, websites of state institutions and organizations developing clinical practice guidelines and health technology assessments were reviewed. The ClinicalTrials.gov website was screened along with the websites of the International Clinical Trial Registry Platform and the National Registry of Health Research Projects of the Peruvian National Institute of Health. No restrictions were applied in terms of language, time, or country. A total of 13 documents were assessed, which included 7 clinical practice guidelines, 3 health technology assessments, 1 systematic review, 1 randomized clinical trial, and 1 observational study. A critical appraisal was conducted for each document. After this, we considered that the currently available evidence is insufficient for a conclusion supporting the use of ECMO in patients under mechanical ventilation with severe ARDS associated to COVID-19 in terms of mortality, safety, and quality of life.

Incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia; A retrospective cohort study, 2021

Background

Currently, coronavirus disease 2019 (COVID-19) is the leading cause of death and the rate of mortality is rapidly increasing over time. There is a paucity of information regarding the incidence and predictors of mortality among COVID-19 patients from low-income countries, particularly in Ethiopia.

Objective

To assess incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia.

Methods

An institution-based retrospective cohort study was conducted among 552 laboratory-confirmed COVID-19 cases at Debre Markos University and Tibebe Ghion Hospital COVID-19 treatment centers in North West Ethiopia from March 2020 to March 2021. Data were collected from patients' medical records using a structured data extraction tool. Cox-proportional hazards regression models was fitted to identify significant predictors of mortality.

Result

The overall mortality rate of COVID-19 was 4.7, (95 % CI: 3.3-6.8) per 1000 person day observations. Older age (AHR: 4.9; 95% CI: 1.8, 13.5), rural residence (AHR: 0.18; 95% CI: 0.05, 0.64), presence of hypertension (AHR: 3.04; 95% CI: 1.18, 7.8), presence of diabetes mellitus (AHR: 8.1; 95% CI: 2.9, 22.4) and cardiovascular disease (AHR: 5.2; 95% CI: (1.69, 16.2) were significantly associated with mortality.

Conclusions

The rate of mortality among hospitalized COVID-19 patients in this study was low. COVID-19 patients from urban residences, older patients, and patients with comorbidity have a high risk of death. These high risk groups should be prioritized for COVID-19 vaccinations, and early screening and appropriate intervention should be established on presentation to health facility.

Demographics, clinical characteristics, and outcomes of 27,256 hospitalized COVID-19 patients in Kermanshah Province, Iran: a retrospective one-year cohort study

BACKGROUND

Since the first official report of SARS-CoV-2 infection in Iran on 19 February 2020, our country has been one of the worst affected countries by the COVID-19 epidemic in the Middle East. In addition to demographic and clinical characteristics, the number of hospitalized cases and deaths is an important factor for evidence-based decision-making and disease control and preparing the healthcare system to face the future challenges of COVID-19. Therefore, this cohort study was conducted to determine the demographics, clinical characteristics, and outcomes of hospitalized COVID-19 patients in Kermanshah Province, west of Iran.

METHODS

This multicenter retrospective cohort study included all suspected, probable, and confirmed cases of COVID-19 hospitalized in Kermanshah Province, Iran during the first year of the COVID-19 pandemic. Demographics, clinical characteristics, outcomes and other additional information of hospitalized patients were collected from the COVID-19 database of the Medical Care Monitoring Center (MCMC) of Kermanshah Province.

RESULTS

Kermanshah Province experienced three waves of COVID-19 infection considering the hospitalization and mortality rates between February 20, 2020 and February 19, 2021. A total of 27,256 patients were included in the study: 5203 (19.09%) subjects were suspected, 9136(33.52%) were probable, and 12,917 (47.39%) were confirmed COVID-19 cases. The mean age of the patients was 53.34 ± 22.74 years and 14,648 (53.74%) were male. The median length of hospital stay among COVID-19 survivors and non-survivors patients were 4 (interquartile range [IQR] 1-6) and 4 (IQR 1-8) days, respectively. Among patients with COVID-19, 2646 (9.71%) died during hospitalization. A multivariable logistic regression revealed that odds of death among patients ≥ 85 years was significantly greater than among patients < 15 years (adjusted odds ratio [aOR] 4.79, 95% confidence interval [CI] = 3.43-6.71, p≤ 0.001). Patients with one (aOR 1.38, 95% CI 1.21-1.59, p = 0.04), two (aOR 1.56, 95% CI 1.27-1.92, p = 0.001) or more (aOR 1.50, 95% CI 1.04-2.17, p = 0.03) comorbidities had higher odds of in-hospital death compared to those without comorbidities. The male sex (aOR 1.20, 95% CI 1.07- 1.35, p = 0.002), ICU admission (aOR 4.35, 95% CI 3.80-4.97, p < 0.001), intubation (aOR 11.09, 95% CI 9.58-12.84, p < 0.001), respiratory distress (aOR 1.40, 95% CI 1.22-1.61, p < 0.001), loss of consciousness (aOR 1.81, 95% CI 1.45-2.25, p < 0.001), anorexia (aOR 1.36, 95% CI 1.09-1.70, p = 0.006) and peripheral oxygen saturation (SpO2) < 93(aOR 2.72, 95% CI 2.34-3.16, p < 0.001) on admission were associated with increased risk of death in patients with SARS-CoV-2 infection. Having cough (aOR 0.82, 95% CI 0.72-0.93, p = 0.003) and headache (aOR 0.70, 95% CI 0.50-0.97, p = 0.03) decreased the odds of death.

CONCLUSION

The mortality rate of the patients admitted to the general wards and ICU can be a guide for allocating resources and making appropriate plans to provide better medical interventions during the COVID-19 pandemic. Several risk factors are associated with the in-hospital mortality of COVID-19, including advanced age, male sex, ICU admission, intubation, having comorbidity, SpO2 < 93, respiratory distress, loss of consciousness, headache, anorexia, and cough. These risk factors could help clinicians identify patients at high risk for death.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) IgG-antibody seroprevalence among quarantined population, during the first wave of COVID-19 pandemic, In North West Ethiopia (from 30 April to 30 May 2020)

Objective:

The spread of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths as compared with other regions of the Sub-Saharan African (SSA) countries. We aimed to investigate the seroprevalence of SARS-CoV-2 specific IgG antibodies, using the Abbott anti-nucleocapsid IgG chemiluminescent microparticle immunoassay, in two COVID-19 diagnosed and treatment centers of quarantined population during the first wave of the COVID-19 pandemic (since 30 April–30 May 2020).

Methods:

We analyzed data of 446 quarantined individuals during the first wave of COVID-19 pandemic. The data were collected using both interviewed and blood sample collection. Participants asked about demographic characteristics, COVID-19 infection symptoms, and its practice of preventive measures. Seroprevalence was determined using the severe acute respiratory syndrome coronavirus 2 IgG test.

Results:

The mean (± standard deviation) age of the respondent was 37.5 (±18.5) years. The estimated SARS-CoV-2 infection seroprevalence was found 4.7% (95% confidence interval: 3.1–6.2) with no significant difference on age and gender of participants. Severe acute respiratory syndrome coronavirus 2 antibody seroprevalence was significantly associated with individuals who have been worked by moving from home to work area (adjusted odds ratio = 7.8, 95% confidence interval: 4.2–14.3, p < 0.019), not wearing masks (adjusted odds ratio = 2.4, 95% confidence interval: 1.9–3.8, p < 0.02), and baseline comorbidity (adjusted odds ratio = 6.3, 95% confidence interval: 2.3–17.1, p < 0.01) as compared to their counter groups, respectively.

Conclusion:

Our study concluded that lower coronavirus disease 2019 seroprevalence, yet the large population in the community to be infected and insignificant proportion of seroprevalence, was observed between age and sex of respondents. Protective measures like contact tracing, face covering, and social distancing are therefore vital to demote the risk of community—strengthening factors should be continued as effect modification of anticipation for severe course of coronavirus disease 2019.

Computed tomography-defined body composition as prognostic markers for unfavourable outcomes and in-hospital mortality in coronavirus disease 2019

BACKGROUND

Low skeletal muscle mass (LSMM) and visceral fat areas can be assessed by cross-sectional images. These parameters are associated with several clinically relevant factors in various disorders with predictive and prognostic implications. Our aim was to establish the effect of computed tomography (CT)-defined LSMM and fat areas on unfavourable outcomes and in-hospital mortality in coronavirus disease 2019 (COVID-19) patients based on a large patient sample.

METHODS

MEDLINE library, Cochrane, and Scopus databases were screened for the associations between CT-defined LSMM as well as fat areas and in-hospital mortality in COVID-19 patients up to September 2021. In total, six studies were suitable for the analysis and included into the present analysis.

RESULTS

The included studies comprised 1059 patients, 591 men (55.8%) and 468 women (44.2%), with a mean age of 60.1 years ranging from 48 to 66 years. The pooled prevalence of LSMM was 33.6%. The pooled odds ratio for the effect of LSMM on in-hospital mortality in univariate analysis was 5.84 [95% confidence interval (CI) 1.07-31.83]. It was 2.73 (95% CI 0.54-13.70) in multivariate analysis. The pooled odds ratio of high visceral fat area on unfavourable outcome in univariate analysis was 2.65 (95% CI 1.57-4.47).

CONCLUSIONS

Computed tomography-defined LSMM and high visceral fat area have a relevant association with in-hospital mortality in COVID-19 patients and should be included as relevant prognostic biomarkers into clinical routine.

COVID-19 Mortality in Patients with Rheumatic Diseases: A Real Concern

BACKGROUND

Coronavirus disease 2019 (COVID 19) is a worldwide pandemic that has devastated the world in a way that has not been witnessed since the Spanish Flu in 1918. In this study, we aim to investigate the outcomes of patients with rheumatic diseases infected with COVID-19 in Oman.

METHODS

A multi-center retrospective cohort study included patients with underlying rheumatological conditions and COVID-19 infection. Data were collected through the electronic record system and by interviewing the patients through a standard questionnaire.

RESULTS

113 patients with different rheumatic diseases were included with the following rheumatological diagnoses: rheumatoid arthritis (40.7%), systemic lupus erythematosus (23.1%), psoriatic arthritis (8%), Behcet's disease (7%), ankylosing spondylitis (6.2%), other vasculitides, including Kawasaki disease (4.4%), and other diagnoses (10.6%). The mean (SD) age of patients was 43 (14) years, and 82.3% were female. The diagnosis of COVID-19 was confirmed by PCR test in 84.1% of the patients. The most common symptoms at the time of presentation were fever (86%), cough (81%), headache (65%), and myalgia (60%). Hospitalization due to COVID-19 infection was reported in 24.1% of the patients, and 52.2% of these patients had received some form of treatment. In this cohort, the intake of immunosuppressive and immunomodulating medications was reported in 91.1% of the patients. During the COVID-19 infection, 68% of the patients continued taking their medications. Comorbidities were present in 39.8% of the patients. Pregnancy was reported in 2% of the patients. The 30 days mortality rate was found to be 3.5%. Diabetes, obesity, and interstitial lung diseases (ILD) were the strongest risk factor for mortality (p-value 0.000, 0.000, and 0.001, respectively). Rituximab was given in 3.8% of the patients, and it was significantly associated with increased mortality among the patients (p-value <0.001).

CONCLUSION

COVID-19 infection in patients with rheumatic diseases have an increased mortality rate in comparison to the general population, with diabetes, morbid obesity, chronic kidney diseases, interstitial lung disease, cardiovascular disease, obstructive lung disease, and liver diseases as comorbidities being the most severe risk factors associated with death. Greater care should be provided to this population, including the prompt need for vaccination.

Epidemiological Characteristics of Hospitalized Patients with Moderate versus Severe COVID-19 Infection: A Retrospective Cohort Single Centre Study

COVID-19 has a devastating impact worldwide. Recognizing factors that cause its progression is important for the utilization of appropriate resources and improving clinical outcomes. In this study, we aimed to identify the epidemiological and clinical characteristics of patients who were hospitalized with moderate versus severe COVID-19 illness. A single-center, retrospective cohort study was conducted between 3 March and 9 September 2020. Following the CDC guidelines, a two-category variable for COVID-19 severity (moderate versus severe) based on length of stay, need for intensive care or mechanical ventilation and mortality was developed. Data including demographic, clinical characteristics, laboratory parameters, therapeutic interventions and clinical outcomes were assessed using descriptive and inferential analysis. A total of 1002 patients were included, the majority were male (n = 646, 64.5%), Omani citizen (n = 770, 76.8%) and with an average age of 54.2 years. At the bivariate level, patients classified as severe were older (Mean = 55.2, SD = 16) than the moderate patients (Mean = 51.5, SD = 15.8). Diabetes mellitus was the only significant comorbidity potential factor that was more prevalent in severe patients than moderate (n = 321, 46.6%; versus n = 178, 42.4%; p < 0.001). Under the laboratory factors; total white cell count (WBC), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D-dimer and corrected calcium were significant. All selected clinical characteristics and therapeutics were significant. At the multivariate level, under demographic factors, only nationality was significant and no significant comorbidity was identified. Three clinical factors were identified, including; sepsis, Acute respiratory disease syndrome (ARDS) and requirement of non-invasive ventilation (NIV). CRP and steroids were also identified under laboratory and therapeutic factors, respectively. Overall, our study identified only five factors from a total of eighteen proposed due to their significant values (p < 0.05) from the bivariate analysis. There are noticeable differences in levels of COVID-19 severity among nationalities. All the selected clinical and therapeutic factors were significant, implying that they should be a key priority when assessing severity in hospitalized COVID-19 patients. An elevated level of CRP may be a valuable early marker in predicting the progression in non-severe patients with COVID-19. Early recognition and intervention of these factors could ease the management of hospitalized COVID-19 patients and reduce case fatalities as well medical expenditure.

Early report from the Pediatric Heart Transplant Society on COVID-19 infections in pediatric heart transplant candidates and recipients

Background

Reports focused on adult heart transplant (HTx) recipients with COVID-19 suggest an increased risk of severe disease, however; it is unclear if this holds true for pediatric HTx patients, given the typically milder course of illness in children in general with COVID-19. We sought to rapidly implement a system for multi-center data collection on pediatric HTx candidates and recipients, with the aim of describing the patient population and infection related outcomes.

Methods

The Pediatric Heart Transplant Society (PHTS) is a multi-center collaboration that seeks to improve the outcomes of children who are listed and undergo HTx. The society consists of pediatric HTx centers in North America (n = 53), UK (n = 2), and Brazil (n = 1). In response to the pandemic, PHTS developed a web-based platform to collect COVID-19 specific data on pediatric HTx candidates and recipients. Non-PHTS centers were also invited to submit data. Data fields included pre-and post-HTx patient characteristics, presumed versus documented infection, need for hospitalization (including ICU and ventilator use), treatments administered, and 30-day outcome (resolution, death, sequelae, and or unresolved)

Results

Data collection was initiated on 4/30/20. As of 03/15/21 there were 225 patients [19 pre-HTx and 206 post-HTx, median age 14 years (IQR 7, 18)] reported from 41 centers. Hospitalization occurred in 42% (n = 8) of the pre-HTx and 21% (n=43) of the post-HTx patients. Among the patients listed for HTx, 21% (n = 4) required ICU and 10.5% (n = 2) were mechanically ventilated. Among post-HTx patients, 7% (n = 14) required ICU and 1% (n = 3) were mechanically ventilated. At 30 days, the majority of patients had resolution of symptoms (94.7% pre-HTx, 95.6% post-HTx). One death was reported in a post-HTx patient prior to 30 days from onset of COVID-19 illness.

Conclusions

These data demonstrate the ability to rapidly adapt the PHTS data collection infrastructure in response to a novel infection and represent the first known multi-center report of characteristics and early outcomes for patients listed and following pediatric HTx with COVID-19. Hospitalization appears to be more common for both candidates and recipients due to COVID-19 than for the general pediatric population though stays were short and mortality minimal.

Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

BACKGROUND

Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center.

METHODS

This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality.

RESULTS

Out of 16,947 individuals tested in KSUMC, 3480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure <90 mmHg in the first 24h of presentation, lymphocyte count <1 × 109/L and aspartate transaminase level >37 units/L in the first 48 h of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV.

CONCLUSION

Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48h of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.

Epidemiological Risk Factors for Acquiring Severe COVID-19: Prospective Cohort Study

Objectives

We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization.

Methods

A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients.

Results

We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p =0.029).

Conclusions

Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions.