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Mueankwan S, Trongtrakul K, Tajarernmuang P, Niyatiwatchanchai N, Kusirisin P, Narongkiatikhun P. Care Bundles to Improve Hemoperfusion Performance in Patients with Severe COVID-19: A Retrospective Study. J Clin Med 2024; 13:3360. [PMID: 38929889 PMCID: PMC11205105 DOI: 10.3390/jcm13123360] [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: 05/01/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Hemoperfusion (HP) is employed to modulate cytokine storms in severe coronavirus disease 2019 (COVID-19) patients, requiring careful attention for success and safety. Therefore, we investigated whether our care bundles could enhance HP performance. Methods: We conducted a retrospective cohort study on adult patients (≥20 years old) with severe COVID-19 pneumonia. In the first wave (Phase I), we identified HP-related issues and addressed them with care bundles in the second wave (Phase II). The care bundles included early temperature control, precise hemodynamic monitoring, and clot prevention measures for the HP membrane. The HP success rate and associated adverse events (AEs) were assessed between the two phases. Results: The study included 60 HP (HA330) sessions from 27 cases (Phase I: 21 sessions from 9 cases; Phase II: 39 sessions from 18 cases). Patient characteristics and treatments for COVID-19 were similar, except for baseline body temperature (BT) and heart rate (HR). Phase II showed a higher success rate (67% vs. 89%, p = 0.19), although it did not reach statistical significance. Phase I recorded a significantly higher frequency of AEs (3 [IQR 1, 4] events/case vs. 1 [IQR 0, 2] events/case, p = 0.014). After implementing the care bundles, hypothermia significantly decreased (78% vs. 33%, p = 0.037), with an adjusted odds ratio of 0.15; 95% CI 0.02-0.95, p = 0.044 for baseline BT. Conclusions: Further exploration with a larger sample size is required to establish the advantages of care bundles. However, the bundles' implementation has significantly improved hypothermia prevention.
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Affiliation(s)
- Sirirat Mueankwan
- Surgical Intensive Care Unit, Division of Nursing Services, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Konlawij Trongtrakul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (N.N.)
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (N.N.)
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.T.); (N.N.)
| | - Prit Kusirisin
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.K.); (P.N.)
| | - Phoom Narongkiatikhun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.K.); (P.N.)
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Sarbazi E, Masoudi N, Mehri A, Esfanjani RM, Azizi H, Soleimanpour M, Pouraghaei M, Soleimanpour H. Trust in primary health care and COVID-19 vaccine uptake among Iranian pediatric: a web-based cross-sectional survey. BMC Pediatr 2024; 24:356. [PMID: 38778272 PMCID: PMC11110261 DOI: 10.1186/s12887-024-04816-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Children are the most vulnerable group to diseases. Thus, it's critical to evaluate parents' or guardians' willingness to vaccinate their children. This study aims to investigate the prevalence and predictors of pediatric COVID-19 vaccination in Iran and its relationship with trust in the Primary Health Care (PHC) system. METHOD A cross-sectional online survey of 549 Iranian parents was conducted between January and March 2023. This study collected data from all provinces of Iran using a questionnaire shared on Google Forms and various social media platforms. After considering various background factors, we used a multivariable logistic regression model. This model explored how trust in the PHC system and parent-related and child-related factors were related to parents' vaccine uptake for their children. RESULTS Of 549 parents aged between 19 and 67 years (median = 38 years), 65.2% (358) were female. The prevalence of vaccine uptake among parents was 46.8%. After adjusting for background features, child's age (adjusted odds ratio [AOR] 0.81, 95% CI 0.71-0.91), vaccine doses (1-dose: AOR 14.72, 95% CI 6.44-33.65, 2-dose: AOR 32.54, 95% CI 15.22-69.57), child's disease (AOR 5.31, 95% CI 2.19-12.85), and trust in PHC (AOR 1.01, 95% CI 1.00-1.02) were associated with parental uptake of the COVID-19 vaccine. CONCLUSIONS The findings of this study suggest that the child's age, vaccine doses received, diseases, and trust in PHC are significant predictors of parental uptake of the COVID-19 vaccine for children in Iran. The results can be used in service planning regarding children's COVID-19 vaccination.
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Affiliation(s)
- Ehsan Sarbazi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Masoudi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hosein Azizi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Soleimanpour
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahboub Pouraghaei
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Tekantapeh ST, Nader ND, Ghojazadeh M, Fereidouni F, Soleimanpour H. Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews. Eur J Med Res 2024; 29:63. [PMID: 38245784 PMCID: PMC10799467 DOI: 10.1186/s40001-024-01661-6] [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: 12/22/2022] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients. METHODS We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05. RESULTS Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[- 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[- 4.441, 7.723]; P-value = 0.597). CONCLUSION Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42022326951. Registered 25 April 2022.
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Affiliation(s)
- Sepideh Tahsini Tekantapeh
- Student Research Committee, Department of Rheumatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Departments of Anesthesiology and Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Fereidouni
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Integrated Aging Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Li W, Chen Y, Li D, Meng X, Liu Z, Liu Y, Fan H. Hemoadsorption in acute respiratory distress syndrome patients requiring venovenous extracorporeal membrane oxygenation: a systematic review. Respir Res 2024; 25:27. [PMID: 38217010 PMCID: PMC10785465 DOI: 10.1186/s12931-024-02675-8] [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: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (VV ECMO) has been widely used for severe acute respiratory distress syndrome (ARDS) in recent years. However, the role of hemoadsorption in ARDS patients requiring VV ECMO is unclear. METHODS Therefore, we conducted a systematic review to describe the effect of hemoadsorption on outcomes of ARDS patients requiring VV ECMO and elucidate the risk factors for adverse outcomes. We conducted and reported a systematic literature review based on the principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The systematic review searched Embase, CINHAL, and Pubmed databases for studies on ARDS patients receiving hemoadsorption and VV ECMO. The demographic data, clinical data and biological data of the patients were collected. RESULTS We ultimately included a total of 8 articles including 189 patients. We characterized the population both clinically and biologically. Our review showed most studies described reductions in inflammatory markers and fluid resuscitation drug dosage in ARDS patients with Coronavirus disease 2019 (COVID-19) or sepsis after hemoadsorption. CONCLUSION Because most of the studies have the characteristics of high heterogeneity, we could only draw very cautious conclusions that hemoadsorption therapy may enhance hemodynamic stability in ARDS patients with COVID-19 or sepsis receiving VV ECMO support. However, our results do not allow us to draw conclusions that hemoadsorption could reduce inflammation and mortality. Prospective randomized controlled studies with a larger sample size are needed in the future to verify the role of hemoadsorption in ARDS patients requiring VV ECMO.
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Affiliation(s)
- Wenli Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yuansen Chen
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Duo Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Xiangyan Meng
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Ziquan Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yanqing Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
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Yavuz T, Orhan S, Rollas K, Toksoy CK, Kazan ED, Bozkurt E, Cosgun İG, Yavasoglu F. Evaluation of clinical features and laboratory findings in critical intensive care unit patients with severe coronavirus disease-19 who underwent extracorporeal cytokine adsorption. Ther Apher Dial 2023; 27:890-897. [PMID: 37177852 DOI: 10.1111/1744-9987.14001] [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: 11/15/2022] [Revised: 02/03/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
AIM To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA). METHODS Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated. RESULTS Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2 /FiO2 ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2 /FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2 /FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%. CONCLUSION CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.
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Affiliation(s)
- Tunzala Yavuz
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Semiha Orhan
- Intensive Care Unit, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kazim Rollas
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cansu Koseoglu Toksoy
- Department of Neurology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Elif Dizen Kazan
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Erhan Bozkurt
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - İbrahim Guven Cosgun
- Department of Chest Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavasoglu
- Department of İnternal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Jarvas G, Szerenyi D, Jankovics H, Vonderviszt F, Tovari J, Takacs L, Foldes F, Somogyi B, Jakab F, Guttman A. Microbead-based extracorporeal immuno-affinity virus capture: a feasibility study to address the SARS-CoV-2 pandemic. Mikrochim Acta 2023; 190:95. [PMID: 36808576 PMCID: PMC9937867 DOI: 10.1007/s00604-023-05671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/22/2023] [Indexed: 02/20/2023]
Abstract
In this paper, we report on the utilization of micro-technology based tools to fight viral infections. Inspired by various hemoperfusion and immune-affinity capture systems, a blood virus depletion device has been developed that offers highly efficient capture and removal of the targeted virus from the circulation, thus decreasing virus load. Single-domain antibodies against the Wuhan (VHH-72) virus strain produced by recombinant DNA technology were immobilized on the surface of glass micro-beads, which were then utilized as stationary phase. For feasibility testing, the virus suspension was flown through the prototype immune-affinity device that captured the viruses and the filtered media left the column. The feasibility test of the proposed technology was performed in a Biosafety Level 4 classified laboratory using the Wuhan SARS-CoV-2 strain. The laboratory scale device actually captured 120,000 virus particles from the culture media circulation proving the feasibility of the suggested technology. This performance has an estimated capture ability of 15 million virus particles by using the therapeutic size column design, representing three times over-engineering with the assumption of 5 million genomic virus copies in an average viremic patient. Our results suggested that this new therapeutic virus capture device could significantly lower virus load thus preventing the development of more severe COVID-19 cases and consequently reducing mortality rate.
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Affiliation(s)
- Gabor Jarvas
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Dora Szerenyi
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Hajnalka Jankovics
- Bio-Nanosystems Laboratory, Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Ferenc Vonderviszt
- Bio-Nanosystems Laboratory, Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Jozsef Tovari
- Department of Experimental Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Laszlo Takacs
- Laboratory of Monoclonal Antibody Proteomics, Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Fanni Foldes
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Balazs Somogyi
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Ferenc Jakab
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Andras Guttman
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary.
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Darban M, Yarmohamadi M, Mohammadkhani MM, Jazaeri SM. Outcome and Complications of Hemoperfusion in Patients with COVID-19 in Intensive Care Unit: A Cross-Sectional Study. Cardiovasc Hematol Agents Med Chem 2023; 21:60-66. [PMID: 35570551 DOI: 10.2174/1871525720666220514164855] [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: 10/12/2021] [Revised: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND & OBJECTIVE The use of the hemoperfusion method is recommended for treating cytokine storms and reducing complications in patients with COVID-19. The side effects of this treatment are not known; therefore, this study was performed to determine the final outcome and complications of hemoperfusion in patients with COVID-19 hospitalized in ICU. METHODS In this retrospective cross-sectional study, all patients with severe COVID-19 without any comorbidities or organ failure underwent hemoperfusion treatment in ICU at Kosar Hospital in Semnan, Iran, from March to November 2021 were included. The clinical data and short-term complications up to 10 days after hemoperfusion and the final outcome were extracted from medical files. RESULTS The mean age of 40 patients with severe COVID-19 undergoing hemoperfusion was 57.5±15.9 years. Most (24, 60%) patients were male. The time interval from hospitalization to hemoperfusion and the time interval between hemoperfusion and final outcome was 4.85 days and 8.30 days, respectively. Arrhythmia, bleeding, thrombocytopenia, and coagulation disorders were the most common short-term complications of hemoperfusion in patients with COVID-19, respectively. Most complications occurred on the second and third days after hemoperfusion. Mortality occurred in 20 (50 %) patients with severe COVID-19 undergoing hemoperfusion in ICU. CONCLUSION It seems that the short-term complications and deaths due to hemoperfusion are relatively high in patients with COVID-19 admitted to the ICU. Further studies are recommended.
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Affiliation(s)
- Mahboobeh Darban
- Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maliheh Yarmohamadi
- Department of Internal Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mir Mohammadkhani
- Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran
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Dianaty S, Khodadadi S, Alimoghaddam R, Mirzaei A. Comparison of outcomes and costs of extracorporeal blood purification therapies in critically ill COVID-19 patients. Ther Apher Dial 2022; 27:505-516. [PMID: 36324189 PMCID: PMC9878110 DOI: 10.1111/1744-9987.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Plasmapheresis and hemoperfusion are used against cytokine release syndrome in COVID-19. This study aims to compare their outcomes, costs, and side-effects. METHODS Survival, costs and side-effects were compared in intensive care unit (ICU) patients receiving plasmapheresis (n = 49), hemoperfusion (n = 20), or none (n = 107), followed until death or discharge. RESULTS Plasmapheresis survival time was higher than hemoperfusion or controls (HR = 0.764, p = 0.397 and HR = 0.483, p = 0.002, respectively), although the latter diminished after controlling for age and disease severity (p = 0.979). There was no significant difference in ICU costs for plasmapheresis and hemoperfusion (p = 0.738) while both costed more than controls (both p < 0.001). Hypocalcemia and thrombocytopenia incidence did not differ between two groups (p = 0.124 and p = 0.389, respectively) while being higher than controls in plasmapheresis (both p < 0.001) and hemoperfusion (p < 0.001 and p = 0.056, respectively). CONCLUSION Plasmapheresis and hemoperfusion do not differ significantly in patient survival, ICU costs and side-effects with a higher incidence of hypocalcemia and thrombocytopenia compared witcontrols.
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Affiliation(s)
- Soroush Dianaty
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran,Universal Scientific Education and Research Network (USERN)TehranIran
| | - Sanaz Khodadadi
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Rojina Alimoghaddam
- Student Research Committee, Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran
| | - Abasat Mirzaei
- Department of Health Care Management, Faculty of Health, Tehran Medical ScienceIslamic Azad UniversityTehranIran,Health Economic Policy Research Center, Tehran Medical SciencesIslamic Azad UniversityTehranIran,Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical SciencesIslamic Azad UniversityTehranIran
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9
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Apheresis and COVID-19 in intensive care unit (ICU). Transfus Apher Sci 2022; 61:103593. [PMID: 36335074 PMCID: PMC9624107 DOI: 10.1016/j.transci.2022.103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, and on March 2020 the World Health Organization (WHO) declared it as pandemic, causing a public health crisis. Symptoms of COVID-19 are variable, ranging from mild symptoms like fever, cough, and fatigue to severe illness. Elderly patients and those with comorbidities like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop severe forms of the disease. Asymptomatic infections have been well documented. Accumulating evidence suggests that the severity of COVID-19 is due to high levels of circulating inflammatory mediators including cytokines and chemokines leading to cytokine storm syndrome (CSS). Patients are admitted in ICU with severe respiratory failure, but can also develop acute renal failure and multi organ failure. Advances in science and technology have permitted the development of more sophisticated therapies such as extracorporeal organ support (ECOS) therapies that includes renal replacement therapies (RRTs), venoarterial (VA) or veno-venous (VV) extracorporeal membrane Oxygenation (ECMO), extracorporeal CO2 removal (ECCO2R), liver support systems, hemoperfusion, and various blood purification devices, for the treatment of ARDS and septic shock.
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Varol F, Guney Sahin E, Cengiz M, Kilic A, Altas ZM, Guven S, Çam H. Can charcoal hemoperfusion treatment be an option for pediatric
MIS‐C
patients? A single‐center experience in a tertiary pediatric intensive care unit. J Clin Apher 2022; 37:489-496. [DOI: 10.1002/jca.22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/04/2022] [Accepted: 08/04/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Fatih Varol
- The University of Health Science, Head of Department of Pediatrics at Prof. Ilhan Varank Sancaktepe Training & Research Hospital Pediatric Intensive Care Unit Istanbul Turkey
| | - Ebru Guney Sahin
- The University of Health Science, Head of Department of Pediatrics at Prof. Ilhan Varank Sancaktepe Training & Research Hospital Pediatric Intensive Care Unit Istanbul Turkey
| | - Mehmet Cengiz
- The University of Health Science Head of Department of Pediatrics at Prof. Ilhan Varank Sancaktepe Training & Research Hospital Istanbul Turkey
| | - Aziz Kilic
- Department of Pediatrics Ankara University Faculty of Medicine Ankara Turkey
| | - Zeynep Meva Altas
- Department of Public Health Marmara University Faculty of Medicine İstanbul Turkey
| | - Sirin Guven
- The University of Health Science Head of Department of Pediatrics at Prof. Ilhan Varank Sancaktepe Training & Research Hospital Istanbul Turkey
| | - Halit Çam
- The University of Health Science, Head of Department of Pediatrics at Prof. Ilhan Varank Sancaktepe Training & Research Hospital Pediatric Intensive Care Unit Istanbul Turkey
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Tahsini Tekantapeh S, Ghojazadeh M, Ghamari AA, Mohammadi A, Soleimanpour H. Therapeutic and anti-inflammatory effects of baricitinib on mortality, ICU transfer, clinical improvement, and CRS-related laboratory parameters of hospitalized patients with moderate to severe COVID-19 pneumonia: a systematic review and meta-analysis. Expert Rev Respir Med 2022; 16:1109-1132. [PMID: 35981253 DOI: 10.1080/17476348.2022.2114899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Due to the high incidence and mortality of the worldwide COVID-19 pandemic, beneficial effects of effective antiviral and anti-inflammatory drugs used in other diseases, especially rheumatic diseases, were observed in the treatment of COVID-19. METHODS Clinical and laboratory parameters of eight included cohort studies and five Randomized Control Trials between the baricitinib group and the control group were analyzed on the first day of admission and days 7, 14, and 28 during hospitalization. RESULTS According to the meta-analysis result of eight included cohort studies with 2088 patients, the Pooled Risk Ratios were 0.46 (P<0.001) for mortality, 6.14 (P< 0.001) for hospital discharge, and the mean differences of 76.78 (P< 0.001) for PaO2/FiO2 ratio was -47.32 (P= 0.02) for CRP, in the baricitinib group vs. control group on the seventh or fourteenth day of the treatment compared to the first day. Based on the meta-analysis of five RCT studies with 11825 patients, the pooled RR was 0.84 (P= 0.001) for mortality and 1.07 (P= 0.014) for patients' recovery. The mean differences were -0.80 (P<0.001) for hospitalization days, -0.51(P= 0.33) for time to recovery in the baricitinib group vs. control group. CONCLUSIONS Baricitinib prescription is strongly recommended in moderate to severe COVID-19. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42021254541.
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Affiliation(s)
| | - Morteza Ghojazadeh
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Ghamari
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aida Mohammadi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Road Traffic Injury research center, Tabriz university of medical sciences, Tabriz, Iran
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12
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Alavi Darazam I, Kazempour M, Pourhoseingholi MA, Hatami F, Rabiei MM, Javandoust Gharehbagh F, Amirdosara M, Hajiesmaeili M, Shabani M, Shokouhi S, Lotfollahi L, Mardani M, Haghighi-Morad M, Nassiri AA, Rangraz D, Falahaty H, Syami H, Irannejad Y, Fallah M, Zangi M, Shafigh N. Efficacy of Hemoperfusion in Severe and Critical Cases of COVID-19. Blood Purif 2022; 52:8-16. [PMID: 35580567 PMCID: PMC9393767 DOI: 10.1159/000524606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Uncontrolled overproduction of inflammatory mediators is predominantly observed in patients with severe COVID-19. The excessive immune response gives rise to multiple organ dysfunction. Implementing extracorporeal therapies may be useful in omitting inflammatory mediators and supporting different organ systems. We aimed to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients. METHOD We conducted a single-center, matched control retrospective study on patients with confirmed SARS-CoV-2 infection. Patients were treated with hemoperfusion in combination with standard therapy (hemoperfusion group) or standard treatment (matched group). Hemoperfusion or hemoperfusion and continuous renal replacement therapies were initiated in the hemoperfusion group. The patients in the matched group were matched one by one with the hemoperfusion group for age, sex, oxygen saturation (SPO2) at the admission, and the frequency of using invasive mechanical ventilation during hospitalization. Two types of hemoperfusion cartridges used in this study were Jafron© (HA330) and CytoSorb® 300. RESULT A total of 128 COVID-19-confirmed patients were enrolled in this study; 73 patients were allotted to the matched group and 55 patients received hemoperfusion. The median SPO2 at the admission day in the control and hemoperfusion groups was 80% and 75%, respectively (p value = 0.113). The mortality rate was significantly lower in the hemoperfusion group compared to the matched group (67.3% vs. 89%; p value = 0.002). The median length of ICU stay was statistically different in studied groups (median, 12 days for hemoperfusion group vs. 8 days for the matched group; p < 0.001). The median final SPO2 was statistically higher in the hemoperfusion group than in the matched group, and the median PaCO2 was lower. CONCLUSION Among critically ill COVID-19 patients, based on our study, the use of hemoperfusion may reduce the mortality rate and improve SPO2 and PaCO2.
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Affiliation(s)
- Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Ilad Alavi Darazam,
| | - Muhanna Kazempour
- Department of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firouze Hatami
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Rabiei
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Amirdosara
- Anesthesiology Research Center Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Anesthesiology Research Center Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoosh Shabani
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Legha Lotfollahi
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Haghighi-Morad
- Department of Radiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ahmad Nassiri
- Department of Nephrology and Dialysis, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davoud Rangraz
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Falahaty
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Syami
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaghoob Irannejad
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Fallah
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Zangi
- Anesthesiology Research Center Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Shafigh
- Anesthesiology Research Center Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Yang Y, Xiaohui Y, Miao S, Yingshuo Z. The causal relationship between circulating cytokines and critically ill COVID-19: A bidirectional Mendelian randomization analysis. J Glob Health 2022; 12:05010. [PMID: 35356648 PMCID: PMC8934535 DOI: 10.7189/jogh.12.05010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In this study, we performed a bidirectional mendelian randomization analysis on circulating cytokines and critically ill COVID-19. Methods Both the exposure and outcome data were obtained from public genome wide association study (GWAS) database. We extracted independent instrumental variables from exposure at genome level significance (P < 5 × 10−8). Wald ratio or inverse variance weighted (IVW) method were used for estimating the causal relationships between circulating cytokines and critically ill COVID-19. Results Only IL5 (cytokines to critically ill COVID-19 direction) and bNGF, IL8 (critically ill COVID-19 to cytokines direction) showed suggestive causal relations. However, these associations lost significance after FDR correction. Another validation data set of critically ill COVID-19 did not confirm these associations, either. Conclusions Our Mendelian randomization did not find causal relationships between analyzable circulating cytokines and critically ill COVID-19.
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Affiliation(s)
- Yu Yang
- Endocrinology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Yang Xiaohui
- Endocrinology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Sui Miao
- Endocrinology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Zhong Yingshuo
- Endocrinology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
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14
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Surasit K, Srisawat N. The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study. Blood Purif 2022; 51:879-888. [PMID: 35139519 PMCID: PMC9059038 DOI: 10.1159/000521713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
Introduction Currently, the effect of hemoperfusion on outcome in severe COVID-19 patients is still unknown. Therefore, we aimed to investigate the effects of early HA-330 hemoperfusion in severe COVID-19 patients. Methods We conducted a single center, prospective cohort study on patients who were diagnosed with severe COVID-19 patients and admitted to ICU. Patients in hemoperfusion group (defined as patients who were treated with hemoperfusion therapy at least 3 sessions in combination with standard therapy) were compared with the control group (defined as patients who received standard treatment alone or received less than 3 sessions of hemoperfusion therapy). The primary outcome was daily sequential organ failure assessment (SOFA) scores. Secondary outcomes were all-cause mortality at 28 days, mechanical ventilator-free day, daily C-reactive protein (CRP), oxygenation (defined by PaO<sub>2</sub>/FiO<sub>2</sub> ratio), and severity score of lung infiltration on the chest X-ray (CXR RALE score). All outcomes were adjusted by regression analysis to reduce the confounders due to some difference in baseline characteristics. Results A total number of 29 severe and critical COVID-19 confirmed patients were enrolled. Fifteen patients were defined as hemoperfusion group and 14 were control group. The median of CRP and SOFA score at the baseline (the day after severe pneumonia diagnosis or before hemoperfusion) in hemoperfusion and control groups were comparable, 96.79 mg/L and 87.3 mg/L, p = 0.53, 3.53 ± 0.99 versus 4.3 ± 1.89, p = 0.15, respectively. Clinical improvement associated with decreased SOFA score and improvement of CXR RALE score were found in hemoperfusion group compared to control group (p = 0.008 and p = 0.005, respectively). The 28-day mortality rate was significantly lower in hemoperfusion group compared to control group (6.67% vs. 85.71%, p < 0.001) and the adjusted hazard ratio of death was 0.017 (95% confidence interval = 0.008–0.351, p = 0.008). Conclusions The addition of early HA-330 hemoperfusion to standard therapy improved severity of organ failure and might reduce the mortality rate. However, the results were affected by the baseline confounders and limited sample size.
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Affiliation(s)
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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15
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The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study. New Microbes New Infect 2021; 44:100937. [PMID: 34490065 PMCID: PMC8410636 DOI: 10.1016/j.nmni.2021.100937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
Hemoperfusion is a method of blood filtering to remove toxins and inflammatory factors. Cytokine storms and high levels of inflammatory factors play a role in the pathogenesis of coronavirus disease 2019 (COVID-19). The present study aims to evaluate the effect of hemoperfusion on the clinical and laboratory findings and outcomes of patients with severe COVID-19. Forty-eight patients with severe COVID-19 and a positive PCR test, who were admitted to the intensive care unit (ICU), participated in the study. All patients were treated by routine treatment protocol for COVID-19. Hemoperfusion was performed for 24 patients in addition to treatment with conventional antiviral therapies. The other 24 patients made up the control group. Demographic data, laboratory findings and patient outcomes before and after treatment were retrospectively collected and analysed. There was no significnt difference in mortality or length of hospital stays between the control group and the hemoperfusion group. The breathing rate (P-vaalue = 0.001) and heart beat rate (P-value = 0.028) of patients decreased after hemoperfusion. The hemoperfusion resulted in a significant increase in the SpO2 levels and a significant decrease in the CRP of patients compared to the conventional treatment (P-value = 0.009). Hemoperfusion can improve respiratory distress. It can reduce the CRP in patients with severe COVID-19 but has no effect on mortality.
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16
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Paisey C, Patvardhan C, Mackay M, Vuylsteke A, Bhagra SK. Continuous hemadsorption with cytokine adsorber for severe COVID-19: A case series of 15 patients. Int J Artif Organs 2021; 44:664-674. [PMID: 34128416 DOI: 10.1177/03913988211023782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hyperinflammation and cytokine release has been associated with severe Covid-19. Hemadsorption cartridges may have a potential role in treatment of cytokine storm associated with the development of severe Covid-19. METHODS We retrospectively examined the case records of patients with severe Covid-19 receiving adjunctive hemadsorption (HA) in our ICU. We analyzed inflammatory biomarkers pre- and post- HA. RESULTS Fifteen patients received HA during the study period. All were intubated, ventilated and required renal replacement therapy. 11/15 were supported on ECMO. Mean ferritin 2652 (±3286) ng/ml, mean CRP 154 (±92) mg/ml, median D-dimer 3071 (±2689) ng/ml, mean troponin 236 (±461) ng/L. We found significant difference in pre-and post- treatment ferritin 3622 ng/ml versus 1682 ng/ml (p = 0.022), CRP 222 mg/ml versus 103 mg/ml (p = 0.008, 95% CI 22.4-126.5), lactate 2 mmol/L versus 1.3 mmol/L (p = 0.017), and procalcitonin 15.3 ng/ml versus 4.2 ng/ml (p = 0.023). No significant difference in pre- and post- treatment IL-6 14 pg/ml versus 43 pg/ml (p = 0.32), IL-10 3.4 pg/ml versus 2.6 pg/ml (p = 0.31), IL1 β 0.37 pg/ml versus 0.77 pg/ml (p = 0.75), TNF α 12.77 pg/ml versus 12.49 pg/ml (p = 0.75), VIS 10.04 versus 6.01 (p = 0.31, 95% CI 5.98-17.16) was seen. CONCLUSIONS The use of HA as adjunctive treatment in a critically unwell group of COVID-19 patients lead to a reduction in ferritin, CRP, procalcitonin and lactate with no significant change in other parameters. The use of HA in the treatment of severe COVID-19 requires further larger randomized studies.
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Affiliation(s)
- Christopher Paisey
- Department of Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Chinmay Patvardhan
- Department of Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Michael Mackay
- Department of Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Alain Vuylsteke
- Department of Intensive Care Medicine, Royal Papworth Hospital, Cambridge, UK
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17
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Kafan S, Tadbir Vajargah K, Sheikhvatan M, Tabrizi G, Salimzadeh A, Montazeri M, Majidi F, Maghuli N, Pazoki M. Predicting Risk Score for Mechanical Ventilation in Hospitalized Adult Patients Suffering from COVID-19. Anesth Pain Med 2021; 11:e112424. [PMID: 34336617 PMCID: PMC8314086 DOI: 10.5812/aapm.112424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. Objectives This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. Methods This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. Results A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.091), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. Conclusions A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.
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Affiliation(s)
- Samira Kafan
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiana Tadbir Vajargah
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehrdad Sheikhvatan
- Heidelberg Medical Hospital, Heidelberg, Germany
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Tabrizi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Salimzadeh
- Rheumatology Research Center, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Montazeri
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazeleh Majidi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Maghuli
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pazoki
- Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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