Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy

Elevated High Sensitivity Cardiac Troponin T is Nonlinearly Associated with Poor Prognosis in Aging COVID-19 Patients: A Retrospective Study

Objective

To evaluate the relationship between high-sensitivity cardiac troponin T (hs-cTnT) and prognosis in elderly patients with coronavirus disease 2019 (COVID-19).

Methods

This study recruited 1399 COVID-19 patients aged 65 years or older admitted to Taizhou Hospital or Enze Hospital in Zhejiang Province from December 15, 2022, to January 4, 2023. The Cox regression model was used to evaluate the relationship between hs-cTnT level and in-hospital death. The logistic regression model was used to evaluate the relationship between hs-cTnT level and major adverse events. The restricted cubic spline (RCS) model is used for nonlinear analysis.

Results

The increase of peak hs-cTnT was associated with the increased risk of death (HR 9.49; 95% CI 1.19-75.48; trend p = 0.012) and major adverse events (OR 20.59; 95% CI 10.41-40.71; trend p < 0.001). RCS model showed the association between peak hs-cTnT and death and major adverse events were nonlinear (P for non-line < 0.001). Starting from the limit of quantification of hs-cTnT (3ng/L), the risk of death and major adverse events had a steep S-shaped increase until hs-cTnT reached the 90th percentile point (hs-cTnT = 131 ng/L), followed by a plateau period. Peak hs-cTnT has good predictive value for death and major adverse events, with AUC of 0.834 and 0.804, respectively.

Conclusion

Peak hs-cTnT has high predictive value for the risk of in-hospital death and major adverse events in elderly patients with COVID-19. The association between peak hs-cTnT and death and major adverse events were nonlinear.

Cytokine Levels and Severity of Illness Scoring Systems to Predict Mortality in COVID-19 Infection

Various scoring systems and cytokines have been cited as predicting disease severity in COVID-19 infection. This study analyzed the link between mortality rate, levels of cytokines, and scoring systems such as the Glasgow Coma Scale (GCS), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index in patients infected with COVID-19. Adult patients infected with COVID-19 were followed up in the intensive care unit (ICU) and analyzed prospectively. We measured serum cytokine levels (Interleukin-10 (IL-10), Interleukin-8 (IL-8), Interleukin-6 (IL-6), Interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and High mobility group box 1 (HMGB-1)) and recorded GCS, APACHE II, SOFA, and Charlson comorbidity index scores on admission to the ICU. Receiver operating curve (ROC) analysis was performed to predict mortality from IL-1β, IL-6 IL-10, IL-8, TNF-α, and HMGB-1 values. Study participants were grouped as follows: Group A, survivors, and Group B, deceased, during the 28-day follow-up. The mean age was 65.69 (±13.56) in Group A (n = 36) and 70.85 (±10.06) in Group B (n = 27). The female/male ratio was 23/40. Age, sex, body mass index (BMI), comorbid illnesses, GCS, APACHE II, SOFA, and Charlson scores, duration of hospitalization or ICU admission, therapeutic choices, and lymphocyte, PMNL, NLR, platelet, D-dimer, fibrinogen, GGT, CRP, procalcitonin, and lactate levels were similar between the groups. The frequency of acute kidney injury (AKI) was higher in Group B (p = 0.005). Serum IL-10, IL-8, IL-6, IL-1β, TNF-α, HMGB-1, ferritin, and LDH values were higher, and PaO₂/FiO₂ was lower in Group B than in Group A. ROC analysis showed that there was an association between serum IL-1β (>1015.7), serum IL-6 (>116.7), serum IL-8 (>258.4), serum IL-10 (>247.5), serum TNF-α (>280.7), and serum HMGB-1 (>23.5) and mortality. AKI gave rise to a greater risk of mortality (odds ratio: 7.081, p = 0.014). Mortality was associated with serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1 but not with GCS, APACHE II, SOFA, or Charlson comorbidity index scores. AKI increased the risk of mortality by seven times. Our findings suggest that cytokine levels (serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1) were predictors of mortality in COVID-19 infection. In addition, our results might give an opinion about the course of COVID-19 infection.

Clinical profile, treatment, and outcomes of patients with COVID-19 in a tertiary referral hospital in South Sumatera, Indonesia: A retrospective single-center study

BACKGROUND

Although there are fewer COVID-19 cases in Indonesia, the pandemic is still ongoing. COVID-19 has a significant death rate in Indonesia, but lack of information on the effect of different clinical and demographic factors on COVID-19-related grimness and mortality in Indonesia.

OBJECTIVE

This study examined the clinical profile, treatment, and outcomes of patients with COVID-19 at Lahat Regency Hospital in South Sumatera, Indonesia, to find relevant markers that might be utilized to predict the prognosis of these patients.

METHODS

This was a retrospective single-center study of all medical record files of confirmed patients with COVID-19 admitted to Lahat Hospital from September 2020 to August 2021 (n = 285). Descriptive statistics, Chi-square, Mann-Whitney, Multiple Logistic Regression, and Cox's proportional hazards model were used for data analyses.

RESULTS

This study included 65 non-hospitalized and 220 hospitalized patients. Hospitalized patients were divided into dead and alive groups. The median age was lower in the non-hospitalized group without gender discrimination, and most hospitalized patients had comorbidities. Vital signs and clinical features were significantly different in hospitalized patients compared to non-hospitalized. The survival patients in the hospitalized group showed lower white blood cell (WBC), neutrophil percentages, and neutrophil-lymphocyte ratio (NLR) but higher lymphocyte and eosinophil. Non-survival patients had elevated alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine, blood glucose, and potassium. The use of Favipiravir and Remdesivir was significant between the alive and dead groups. The mean hospital stay for all patients was 9.49 ± 4.77 days, while the median duration of hospital time was 10.73 ± 4.33 days in the survival group and 5.39 ± 3.78 days in the non-survival group. Multiple logistic regression analysis determined respiration rate, WBC, and BUN as predictors of survival.

CONCLUSIONS

Age and comorbidities are significant elements impacting the seriousness of COVID-19. Abnormal signs in laboratory markers can be used as early warning and prognostic signs to prevent severity and death. Potential biomarkers at various degrees in patients with COVID-19 may also aid healthcare professionals in providing precision medicine and nursing.