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Zhang X, Holbein B, Zhou J, Lehmann C. Iron Metabolism in the Recovery Phase of Critical Illness with a Focus on Sepsis. Int J Mol Sci 2024; 25:7004. [PMID: 39000113 PMCID: PMC11241301 DOI: 10.3390/ijms25137004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Iron is an essential nutrient for humans and microbes, such as bacteria. Iron deficiency commonly occurs in critically ill patients, but supplementary iron therapy is not considered during the acute phase of critical illness since it increases iron availability for invading microbes and oxidative stress. However, persistent iron deficiency in the recovery phase is harmful and has potential adverse outcomes such as cognitive dysfunction, fatigue, and cardiopulmonary dysfunction. Therefore, it is important to treat iron deficiency quickly and efficiently. This article reviews current knowledge about iron-related biomarkers in critical illness with a focus on patients with sepsis, and provides possible criteria to guide decision-making for iron supplementation in the recovery phase of those patients.
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Affiliation(s)
- Xiyang Zhang
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 1X5, Canada; (X.Z.); (J.Z.)
- Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Bruce Holbein
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 1X5, Canada;
| | - Juan Zhou
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 1X5, Canada; (X.Z.); (J.Z.)
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 1X5, Canada; (X.Z.); (J.Z.)
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 1X5, Canada;
- Department of Physiology & Biophysics, Dalhousie University, Halifax, NS B3H 1X5, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Ning Y, He L, Pan K, Zhang W, Luo J, Chen Y, Mei Z, Wang D. Predictors associated with successful weaning of veno-venous extracorporeal membrane oxygenation and mortality in adult patients with severe acute lung failure: Protocol of a pooled data analysis of cohort studies. PLoS One 2024; 19:e0303282. [PMID: 38758742 PMCID: PMC11101029 DOI: 10.1371/journal.pone.0303282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Severe acute lung failure (ALF) often necessitates veno-venous extracorporeal membrane oxygenation (VV-ECMO), where identifying predictors of weaning success and mortality remains crucial yet challenging. The study aims to identify predictors of weaning success and mortality in adults undergoing VV-ECMO for severe ALF, a gap in current clinical knowledge. METHODS AND ANALYSIS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for cohort studies examining the predictive factors of successful weaning and mortality in adult patients on VV-ECMO due to severe ALF. Risk of bias assessment will be conducted using the Newcastle-Ottawa scale for each included study. The primary outcomes will be successful weaning from VV-ECMO and all-cause mortality. Between-study heterogeneity will be evaluated using the I2 statistic. Sensitivity, subgroup, and meta-regression analyses will be performed to ascertain potential sources of heterogeneity and assess the robustness of our results. We will use the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to recommend the level of evidence. DISCUSSION This study seeks to provide clinically significant insights into predictors for weaning and mortality during VV-ECMO treatment for ALF, aiming to support clinical decisions and potentially influence health policy, thereby improving patient outcomes. ETHICS AND DISSEMINATION Given the absence of direct engagement with human subjects or access to personal medical records, ethical approval for this study is deemed unnecessary. The study findings will be shared at a scientific conference either at the global or national level. Alternatively, the results will be presented for publication in a rigorously peer-reviewed journal regarding critical care medicine.
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Affiliation(s)
- Yaxin Ning
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Linya He
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Keqi Pan
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, Quzhou People’s Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Jian Luo
- Department of Critical Care Medicine, Quzhou People’s Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Yan Chen
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zubing Mei
- Department of Anorectal Surgery, Anorectal Disease Institute of Shuguang Hospital, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Danqiong Wang
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
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Cho H, Park Y, Myung SK. Obesity and mortality in patients with COVID-19: A meta-analysis of prospective studies. Asia Pac J Clin Nutr 2024; 33:56-65. [PMID: 38494688 PMCID: PMC11170013 DOI: 10.6133/apjcn.202403_33(1).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 01/30/2023] [Accepted: 07/27/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous prospective studies have reported inconsistent findings on the associ-ation between obesity and mortality in patients with COVID-19. This study aimed to investigate the associa-tion between them by using a meta-analysis of prospective studies. METHODS AND STUDY DESIGN We searched PubMed and EMBASE to retrieve studies using keywords related to this topic on January 3, 2022. Data were extracted for a random-effects meta-analysis to calculate a pooled odds ratio (OR), relative risk (RR), or hazard ratio (HR) with a 95% confidence interval (CI). RESULTS In the meta-analysis of 15 prospective cohort studies, obesity significantly increased the risk of mortality in patients with COVID-19 (OR/RR/HR, 1.52; 95% CI, 1.26 to 1.84; I2 = 90.4%). Most of the included studies were conducted in European (n = 10) and North American (n = 4) countries. In the subgroup meta-analysis by continent, there was a significant association between them in European countries (OR/RR/HR, 1.78; 95% CI, 1.30 to 2.43; I2 = 81.4%). Also, in the subgroup meta-analysis by data source, obesity was significantly associated with the increased mortality in patients with COVID-19 in both population- and hospital-based data. CONCLUSIONS We found that obesity is associated with the increased risk of mortality in patients of COVID-19.
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Affiliation(s)
- Heram Cho
- Department of Medicine, Western Sydney University, Sydney, Australia
| | - Yunseo Park
- Department of Medicine, Monash University, Victoria, Australia
| | - Seung-Kwon Myung
- Department of Cancer AI & Digital Health, National Cancer Center Graduate School of Cancer Science and Policy, Gyeonggi-do, Republic of Korea.
- Cancer Epidemiology Branch, Division of Cancer Data Science, National Cancer Center Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea
- Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Gyeonggi-do, Republic of Korea
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Boz PB, Aslan-Kara K, Şanlı ZS, Peköz MT, Acar D, Bozdemir H. Seizures in COVID-19: the relationship between biomarkers and prognosis. Acta Neurol Belg 2023; 123:1763-1772. [PMID: 35907150 PMCID: PMC9362485 DOI: 10.1007/s13760-022-02054-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/20/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the prevalence of seizure, associated risk factors, and prognosis in patients with SARS-CoV-2 infection and identify predictive biomarkers in SARS-CoV-2 patients with seizure. METHODS A cohort of 17,806 patients with SARS-CoV-2 infection admitted to two university hospitals in Adana between March 11, 2020 and January 1, 2021 was analyzed retrospectively. The patients' demographic characteristics, laboratory findings, and systemic and neurological symptoms at admission and on the day of seizure onset were evaluated. RESULTS Neurological findings were detected in 877 of the 17,806 patients. Of these, 45 patients (0.25%) had seizure (status epilepticus in 4/45 patients, 8.9%). Patients with seizure had a mean age of 55.3 years (range 17-88) and 57.8% were male. Seizure was more common in the 18-44 (24.4%) and ≥ 65 age groups (44.4%) and in those with multiple comorbidity. The case fatality rate for patients with seizure among all SARS-CoV-2 patients was 0.135% (95% CI 80.86-188.71). However, no patient with a previous diagnosis of epilepsy died during SARS-CoV-2 infection. High neutrophil, platelet, and ferritin levels and low lymphocyte and calcium levels on the day of seizure development compared to admission were associated with higher mortality (p = 0.004, 0.008, 0.028, 0003, and 0.002, respectively). CONCLUSIONS Seizures are not uncommon during SARS-CoV-2 infection, with a higher risk of mortality in older patients and those with higher inflammatory markers.
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Affiliation(s)
- Pınar Bengi Boz
- Health Scıences Unıversıty Adana Faculty of Medıcıne Adana Cıty Traınıng and Research Hospıtal Neurology Clınıc, Adana, Turkey.
| | - Kezban Aslan-Kara
- Department of Neurology, Cukurova Unıversıty Faculty of Medıcıne Balcalı Hospıtal, Adana, Turkey
| | - Zeynep Selcan Şanlı
- Health Scıences Unıversıty Adana Faculty of Medıcıne Adana Cıty Traınıng and Research Hospıtal Neurology Clınıc, Adana, Turkey
| | - Mehmet Taylan Peköz
- Department of Neurology, Cukurova Unıversıty Faculty of Medıcıne Balcalı Hospıtal, Adana, Turkey
| | - Dilek Acar
- Health Scıences Unıversıty Adana Faculty of Medıcıne Adana Cıty Traınıng and Research Hospıtal Neurology Clınıc, Adana, Turkey
| | - Hacer Bozdemir
- Department of Neurology, Cukurova Unıversıty Faculty of Medıcıne Balcalı Hospıtal, Adana, Turkey
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Malaeb R, Haider A, Abdulateef M, Hameed M, Daniel U, Kabilwa G, Seyni I, Ahmadana KE, Zelikova E, Porten K, Godard A. High mortality rates among COVID-19 intensive care patients in Iraq: insights from a retrospective cohort study at Médecins Sans Frontières supported hospital in Baghdad. Front Public Health 2023; 11:1185330. [PMID: 37719728 PMCID: PMC10501727 DOI: 10.3389/fpubh.2023.1185330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the challenges of the healthcare system in Iraq, which has limited intensive care unit beds, medical personnel, and equipment, contributing to high infection rates and mortality. The main purpose of the study was to describe the clinical characteristics, the length of Intensive Care Unit (ICU) stay, and the mortality outcomes of COVID-19 patients admitted to the ICU during the first wave and two subsequent surges, spanning from September 2020 to October 2021, in addition to identify potential risk factors for ICU mortality. Methods This retrospective cohort study analyzed data from COVID-19 patients admitted to the COVID-19 ICU at Al-Kindi Ministry of Health hospital in Baghdad, Iraq, between September 2020 and October 2021. Results The study included 936 COVID-19 patients admitted to the ICU at Al-Kindi Hospital. Results showed a high mortality rate throughout all waves, with 60% of deaths due to respiratory failure. Older age, male gender, pre-existing medical conditions, ICU procedures, and complications were associated with increased odds of ICU mortality. The study also found a decrease in the number of complications and ICU procedures between the first and subsequent waves. There was no significant difference in the length of hospital stay between patients admitted during different waves. Conclusion Despite improvements in critical care practices, the mortality rate did not significantly decrease during the second and third waves of the pandemic. The study highlights the challenges of high mortality rates among critical COVID-19 patients in low-resource settings and the importance of effective data collection to monitor clinical presentations and identify opportunities for improvement in ICU care.
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Affiliation(s)
- Rami Malaeb
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | - Amna Haider
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | | | - Mustafa Hameed
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Uche Daniel
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Gabriel Kabilwa
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Ibrahim Seyni
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Khalid E. Ahmadana
- Médecins Sans Frontières, Operational Centre Paris, Dubai, United Arab Emirates
| | - Evgenia Zelikova
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
| | - Klaudia Porten
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Aurelie Godard
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
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Tchamgoué S, Ntep Eboko M, Makamté A, Ngagnia A, Talla-Mba F, Nitcheu Wendi O, Kafando E, Tengang B, Sandjon JP, Tattevin P. Prospective cohort of COVID-19 patients requiring hospital admission in Douala, Cameroon. Infect Dis Now 2023; 53:104713. [PMID: 37116614 PMCID: PMC10131884 DOI: 10.1016/j.idnow.2023.104713] [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: 12/19/2022] [Revised: 03/06/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES To report characteristics and outcome of COVID-19 patients who required hospital admission in sub-Saharan Africa clinics with no access to invasive mechanical ventilation. METHODS Between April and June 2021, documented COVID-19 patients with SaO2 <95% who were admitted in two clinics in Douala (Cameroon) were invited to participate. Data were prospectively collected using a standardized questionnaire. RESULTS We included 67 patients: 39 males (58%), median age 62 years [50-70]. Comorbidities included hypertension (n=38, 57%), obesity (n=26, 38%), and diabetes (n=16, 24%). No patient reported COVID-19 vaccination. On admission, 35 patients (52%) required O2 >6L/min. CT scan demonstrated extended lesions (>50%) in 50/61 cases (82%). Most patients received dexamethasone (n=64, 96%), heparin (n=64, 96%), chloroquine/azithromycin (n=59, 88%), and broad-spectrum antibiotics (n=59, 88%). Sixteen patients died (24%), after a median of 11.5 days [7.5-15.5] post-admission. CONCLUSIONS Despite the lack of invasive mechanical ventilation, 76% of COVID-19 patients survived.
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Affiliation(s)
- S Tchamgoué
- Polyclinique Bordeaux Douala, Douala, Cameroon
| | | | - A Makamté
- Polyclinique Bordeaux Douala, Douala, Cameroon; Interactive Medical Imaging Complex (IMIC), Douala, Cameroon
| | - A Ngagnia
- Polyclinique Bordeaux Douala, Douala, Cameroon; Interactive Medical Imaging Complex (IMIC), Douala, Cameroon; Centre des Maladies Respiratoires, Douala, Cameroon
| | - F Talla-Mba
- Polyclinique Bordeaux Douala, Douala, Cameroon
| | | | - E Kafando
- Interactive Medical Imaging Complex (IMIC), Douala, Cameroon
| | - B Tengang
- Centre des Maladies Respiratoires, Douala, Cameroon
| | | | - P Tattevin
- Services des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Rennes, France.
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Gomez AC, Ortiz T, Valenzuela A, Egoávil-Espejo R, Huerto-Huanuco R, Pinto JA, Lagos J, Ruiz J. Super-infection by multiple microorganisms in COVID-19 patients. Front Mol Biosci 2023; 10:1113969. [PMID: 36994427 PMCID: PMC10040592 DOI: 10.3389/fmolb.2023.1113969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: This study aimed to describe the clinical characteristics of patients with COVID-19 co-infected with multiple multidrug-resistant bacteria.Methods: Patients hospitalized in the AUNA network between January and May 2021, diagnosed with COVID-19 and at least two other infecting microorganisms, were retrospectively included in the analysis. Clinical and epidemiological data were extracted from clinical records. The susceptibility levels of the microorganisms were determined using automated methods. Antibiotic resistance was established among infecting bacteria accounting for ≥5 isolates.Results: A total of 27 patients (21 male and 6 female patients) met the inclusion criteria, with a maximum of eight co-infecting bacteria or fungi during admission time. Seven patients (25.9%) died, with a higher but not significant lethality among women (50% vs. 19.0%). A total of 15 patients presented at least one established comorbidity, with hypertension being the most frequent. The time elapsed between COVID-19 diagnosis and hospital attendance was 7.0 days, with that of patients with a fatal outcome being longer than that of living patients (10.6 vs. 5.4). Up to 20 different microorganisms were isolated, with Pseudomonas aeruginosa being the most common (34 isolates). In general, antibiotic resistance levels were high, especially in Acinetobacter baumannii isolates, with resistance levels of 88.9% to all antimicrobial agents tested, except colistin (0%).Conclusion: In conclusion, the present results show the presence of multiple microorganisms that co-infect COVID-19 patients. When fatal outcome rates are in the range of other reports, the presence of a series of multidrug-resistant microorganisms is of concern, showing the need to reinforce control measures to limit the expansion of almost untreatable microorganisms.
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Affiliation(s)
- Andrea C. Gomez
- Centro de Investigación Básica y Translacional, AUNA IDEAS, Lima, Peru
| | - Tamin Ortiz
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Angélica Valenzuela
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Rocío Egoávil-Espejo
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
| | - Rosario Huerto-Huanuco
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
| | - Joseph A. Pinto
- Centro de Investigación Básica y Translacional, AUNA IDEAS, Lima, Peru
- *Correspondence: Joseph A. Pinto, ; Joaquim Ruiz,
| | - Jose Lagos
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
- *Correspondence: Joseph A. Pinto, ; Joaquim Ruiz,
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Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
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.
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Leidinger A, Zuckerman SL, Feng Y, He Y, Chen X, Cheserem B, Gerber LM, Lessing NL, Shabani HK, Härtl R, Mangat HS. Predictors of spinal trauma care and outcomes in a resource-constrained environment: a decision tree analysis of spinal trauma surgery and outcomes in Tanzania. J Neurosurg Spine 2023; 38:503-511. [PMID: 36640104 DOI: 10.3171/2022.11.spine22763] [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: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings. METHODS This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated. RESULTS Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26-43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1-6) days; surgery was performed after a further median delay of 22 (IQR 13-39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively. CONCLUSIONS Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors' results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
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Affiliation(s)
- Andreas Leidinger
- 1Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott L Zuckerman
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yueqi Feng
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Yitian He
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Xinrui Chen
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | | | | | - Noah L Lessing
- 6School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hamisi K Shabani
- 7Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and
| | - Roger Härtl
- 8Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Halinder S Mangat
- 9Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, Kansas
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Shumet T, Kebede F. Incidence and Predictors of Inpatient Mortality Rate After Cases Started Care in the Intensive Care Unit in Debre Markos Referral Hospital. Health Serv Res Manag Epidemiol 2023; 10:23333928231208252. [PMID: 37901610 PMCID: PMC10612449 DOI: 10.1177/23333928231208252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background The intensive care unit (ICU) is a separate area in which potential health care services for patients who are in critical condition with detailed observation, monitoring, and advanced treatment than other units. This study aimed to assess the incidence and predictors of inpatient mortality after inpatient treatment was started in Debre Markos Comprehensive Specialized Hospital. Methods A facility-based retrospective cohort study was employed among 384 ICU-admitted patients from December 30, 2020 to January 1, 2022. The collected data were entered into Epi Data version 4.2 and exported to STATA 14.0 for further analysis. The Cox proportional hazard regression model was fitted after checking using the Schoenfeld residual and log-log plot test. A categorical variable with an adjusted hazard ratio of 95% CI was claimed for predictors. Result Overall, 384 admitted adult patients were included in the final analysis with a mean (±SD) age of 42.1 (±17.1) years. At the end of the follow-up period, 150 (39.06%) cases died in the ICU. The overall incidence of the mortality rate was 16.9 (95% CI: 13.7-19.55) per 100 person per day. Epidemiologically, 347 (90.36%) cases were medical illness, 25 (6.51%) surgical, and 12 (3.13%) were obstetric cases, respectively. The median length of inpatient stay was found to be 4.9 (IQR ± 2.8) days. In multivariable analysis; being (+) for human immunodeficiency virus (AHR = 0.59, 95% CI: 0.39-0.91), age ≥65yearas (AHR = 1.61, 95% CI: 1.11-2.32), and admission on weekend-time (AHR = 1.48, 95% CI: 1.06-2.06) were predictors of inpatient death. Conclusion The overall in-hospital mortality rate was significantly higher than in the previous study in this hospital with a short median survival time. The inpatient mortality rate was significantly associated with age ≥65 years, being HIV positive, and admission during weekend time. Therefore, effective intervention strategies should be highly needed for ICU team members for early risk factors prevention.
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Affiliation(s)
- Tesfaye Shumet
- Department of Epidemiology and Biostatics, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Fassikaw Kebede
- Department of Epidemiology and Biostatics, College of Health Science, Woldia University, Woldia, Ethiopia
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Qin R, He L, Yang Z, Jia N, Chen R, Xie J, Fu W, Chen H, Lin X, Huang R, Luo T, Liu Y, Yao S, Jiang M, Li J. Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis. Clin Rev Allergy Immunol 2023; 64:33-65. [PMID: 35040086 PMCID: PMC8763427 DOI: 10.1007/s12016-021-08908-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 01/26/2023]
Abstract
Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4+ T/CD8+ T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3+ T,CD4+T and CD8+T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4+ and CD8+ T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors.
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Affiliation(s)
- Rundong Qin
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Li He
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Zhaowei Yang
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Nan Jia
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Ruchong Chen
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jiaxing Xie
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Wanyi Fu
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Hao Chen
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Xinliu Lin
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Renbin Huang
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Tian Luo
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yukai Liu
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Siyang Yao
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Mei Jiang
- grid.470124.4National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jing Li
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
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Eldaboosy S, Almoosa Z, Saad M, Al Abdullah M, Farouk A, Awad A, Mahdy W, Abdelsalam E, Nour SO, Makled S, Shaarawy A, Kanany H, Qarah S, Kabil A. Comparison Between Physiological Scores SIPF, CURB-65, and APACHE II as Predictors of Prognosis and Mortality in Hospitalized Patients with COVID-19 Pneumonia: A Multicenter Study, Saudi Arabia. Infect Drug Resist 2022; 15:7619-7630. [PMID: 36582451 PMCID: PMC9793736 DOI: 10.2147/idr.s395095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background A coronavirus pandemic (COVID-19) is associated with catastrophic effects on the world with high morbidity and mortality. We aimed to evaluate the accuracy of physiological shock index (SIPF) (shock index and hypoxemia), CURB -65, acute physiology, and chronic health assessment II (APACHE II) as predictors of prognosis and in-hospital mortality in patients with COVID-19 pneumonia. Methods In Saudi Arabia, a multicenter retrospective study was conducted on hospitalized adult patients confirmed to have COVID-19 pneumonia. Information needed to calculate SIPF, CURB-65, and APACHE II scores were obtained from medical records within 24 hours of admission. Results The study included 1131 COVID-19 patients who met the inclusion criteria. They were divided into two groups: (A) the ICU group (n=340; 30.1%) and (B) the ward group (n=791; 69.9%). The most common concomitant diseases of patients at initial ICU admission were hypertension (71.5%) and diabetes (62.4%), and most of them were men (63.8%). The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001). The SIPF score showed a significantly higher ability to predict both ICU admission and mortality in patients with COVID-19 pneumonia compared with APACHE II and CURB -65; (AUC 0.89 vs 0.87; p < 0.001) and (AUC 0.89 vs 0.84; p < 0.001) for ICU admission and (AUC 0.90 vs 0.65; p < 0.001) and (AUC 0.90 vs 0.80; p < 0.001) for mortality, respectively. Conclusion The ability of the SIPF score to predict ICU admission and mortality in COVID-19 pneumonia is higher than that of APACHE II and CURB-65. The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001).
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Affiliation(s)
- Safwat Eldaboosy
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Department of Pulmonary Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Zainab Almoosa
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Mustafa Saad
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Mohammad Al Abdullah
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Abdallah Farouk
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Amgad Awad
- Department of Nephrology and internal Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Waheed Mahdy
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Eman Abdelsalam
- Department of Internal Medicine, Al-Azhar Faculty of Medicine for Girls, Cairo, Egypt,Department of Internal Medicine, King Khalid Hospital, Hail, Saudi Arabia
| | - Sameh O Nour
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sameh Makled
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shaarawy
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hatem Kanany
- Department of Anesthesia and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Samer Qarah
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ahmed Kabil
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Correspondence: Ahmed Kabil, Department of Chest diseases, Al-Azhar University, Cairo, Egypt, Tel +201006396601, Email
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13
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Osman NA, Hashish MH, Bakr WMK, Osman NA, Omran EA. "Day 25": a temporal indicator of stabilization of mortality risk among COVID-19 patients with high viral load. Trop Med Health 2022; 50:92. [PMID: 36494866 PMCID: PMC9732988 DOI: 10.1186/s41182-022-00483-8] [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: 10/06/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The relationship between SARS-CoV-2 viral load and hospitalization and mortality among COVID-19 patients has been established. However, the estimation of the duration of time after which the risk of mortality of these patients stops escalating was not extensively discussed earlier. Stratifying patients according to their risk of mortality would optimize healthcare services and costs and reduce mortality. METHODOLOGY In this retrospective observational study, hospital records were used to collect data of 519 COVID-19 patients from May through November 2020. Data included the clinical condition of patients, their viral loads, their admission chest computed tomography results (CO-RAD scale), and the duration of their hospitalization. A Kaplan-Meier analysis was constructed to estimate mortality risk concerning viral load. RESULTS By the end of the study, 20.42% of patients were deceased. The cumulative mortality was: 36.1% (75/208) among patients with high viral load, 12.6% (28/222) in those with moderate viral load, and 3.4% (3/89) among those with low viral load. Predictors of mortality were: older age [adjusted hazard ratio (aHR) = 1.02, 95% CI: [1.00-1.03], (p = 0.05)], "being female" [aHR = 1.53 with 95% CI: [1.03-2.26], (p = 0.031), "high CO-RAD scale" [aHR = 1.32 (1.06-1.64), p = 0.013], "high viral load" [aHR = 4.59 (2.38-20.92), p = 0.017, ICU admission [aHR = 15.95; 95%CI:7.22-35.20, p < 0.001] and lymphocytosis [aHR = 1.89 45;95%CI:1.04-3.45, p = 0.036]. In the ICU-admitted patients, the median survival was 19 days and mortality stabilized at "day 25". For patients with high viral load, mortality rates stabilized at "day 25 post-admission" after which the risks of mortality did not change until day 40, while patients with low and moderate viral loads reached the peak and stabilized at day "20 post-admission". CONCLUSIONS Initial high SARS-CoV-2 viral load might be used as an indicator of a delayed stabilization of mortality risk among COVID-19 patients.
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Affiliation(s)
- Nancy A. Osman
- grid.415762.3Ministry of Health and Population, Alexandria, Egypt
| | - Mona H. Hashish
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue, El-Ibrahimia, Alexandria, Egypt
| | - Wafaa M. K. Bakr
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue, El-Ibrahimia, Alexandria, Egypt
| | - Nermin A. Osman
- grid.7155.60000 0001 2260 6941Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eman A. Omran
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue, El-Ibrahimia, Alexandria, Egypt
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Alshehri HH, Wolf A, Öhlén J, Olausson S. Healthcare Professionals' Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study. Glob Qual Nurs Res 2022; 9:23333936221138077. [PMID: 36507302 PMCID: PMC9729985 DOI: 10.1177/23333936221138077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
There is a growing need to integrate palliative care into intensive care units and to develop appropriate knowledge translation strategies. However, multiple challenges persist in attempts to achieve this objective. In this study, we aimed to explore intensive care professionals' perspectives on providing palliative and end-of-life care within an intensive care context. We used an interpretive description approach and interviewed 36 intensive care professionals at four hospitals in Saudi Arabia. Our findings reflect a discourse about end-of-life care driven by a do-not-resuscitate classification and challenges associated with family involvement in care goals. We provide key insights of importance for the development of strategies for the integration and knowledge translation of palliative care into intensive care contexts.
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Affiliation(s)
- Hanan Hamdan Alshehri
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Hanan Hamdan Alshehri, University of Gothenburg Sahlgrenska Academy, Box 457 405 30 Göteborg, Goteborg 405 30, Sweden. Emails: ;
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital/Östra, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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15
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Acute Kidney Injury in Non-Intensive Care Unit (ICU) Hospitalizations for Coronavirus Disease (COVID-19). Pathogens 2022; 11:pathogens11111272. [PMID: 36365023 PMCID: PMC9693191 DOI: 10.3390/pathogens11111272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Acute kidney injury (AKI) is a common complication among SARS-CoV-2-positive patients who undergo hospitalization. Abundant evidence exists concerning the epidemiology of AKI in patients hospitalized in the ICU for COVID-19 but limited data are available about the occurrence of AKI in SARS-CoV-2-positive patients being hospitalized in a non-ICU setting. Aim and Methods: We have carried out a retrospective study to evaluate frequency and risk factors for AKI among patients consecutively admitted at a third-level university hospital starting from February 2020 (the beginning of the first wave of the SARS-CoV-2 pandemic); all patients were hospitalized outside the ICU. Results: A total of 387 SARS-CoV-2-positive patients were included in the current study; 372 (96.1%) had SARS-CoV-2-related pneumonia. In-hospital AKI onset was recorded in 119 (30.7%) patients, mainly with AKI stage 1 (n = 74, 62.2%); eighteen (4.6%) patients reported AKI stage 3 and six (1.5%) patients had HD-dependent AKI. There were 235 (60.7%) patients with severe COVID-19, and this was more common in patients developing AKI, 94.5% (86/119) vs. 86.1% (149/268), p = 0.02. Multivariate regression model (n = 144 patients) reported an independent and significant relationship between AKI occurrence and greater levels of ferritin (p = 0.036), IL-6 (p = 0.032), and azotemia at admission (p = 0.0001). A total of 69 (17.8%) SARS-CoV-2-positive patients died and strong predictors of in-hospital death resulted from age (p < 0.0001), serum ferritin (p < 0.0001) and white blood cells (p < 0.001). According to multivariable analysis (n = 163 patients), there was a consistent link between in-hospital death and AKI stage (1) (p = 0.021) and -stage (2) (p = 0.009). Our results support the notion that AKI occurs frequently among hospitalized COVID-19 patients even in a non-ICU setting and plays a pivotal role in the mortality of this population. Further studies are ongoing in order to clearly establish the frequency of AKI in patients with COVID-19; the mechanisms underlying kidney injury in this population are an area of active investigation. These data provide solid evidence to support close monitoring of COVID-19 patients for the development of AKI and measures taken to prevent this.
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Carmo TA, Ferreira IBB, Menezes RC, Pina MLT, Oliveira RS, Telles GP, Machado AFA, Aguiar TC, Caldas JR, Arriaga MB, Akrami KM, Filgueiras Filho NM, Andrade BB. Calibration and validation of the Pneumonia Shock Score in critically ill patients with SARS-CoV-2 infection, a multicenter prospective cohort study. Front Med (Lausanne) 2022; 9:958291. [PMID: 36045919 PMCID: PMC9420902 DOI: 10.3389/fmed.2022.958291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Prognostic tools developed to stratify critically ill patients in Intensive Care Units (ICUs), are critical to predict those with higher risk of mortality in the first hours of admission. This study aims to evaluate the performance of the pShock score in critically ill patients admitted to the ICU with SARS-CoV-2 infection. Methods Prospective observational analytical cohort study conducted between January 2020 and March 2021 in four general ICUs in Salvador, Brazil. Descriptive statistics were used to characterize the cohort and a logistic regression, followed by cross-validation, were performed to calibrate the score. A ROC curve analysis was used to assess accuracy of the models analyzed. Results Six hundred five adult ICU patients were included in the study. The median age was 63 (IQR: 49–74) years with a mortality rate of 33.2% (201 patients). The calibrated pShock-CoV score performed well in prediction of ICU mortality (AUC of 0.80 [95% Confidence Interval (CI): 0.77–0.83; p-value < 0.0001]). Conclusions The pShock-CoV score demonstrated robust discriminatory capacity and may assist in targeting scarce ICU resources during the COVID-19 pandemic to those critically ill patients most likely to benefit.
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Affiliation(s)
- Thomas A. Carmo
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Isabella B. B. Ferreira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Rodrigo C. Menezes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Márcio L. T. Pina
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | | | - Gabriel P. Telles
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | | | | | | | - María B. Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Divisions of Infectious Diseases and Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Nivaldo M. Filgueiras Filho
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Núcleo de Pesquisa, Ensino e Comunicação, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Bruno B. Andrade
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- *Correspondence: Bruno B. Andrade
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Rehatta NM, Chandra S, Sari D, Lestari MI, Senapathi TGA, Nurdin H, Wirabuana B, Pramodana B, Pradhana AP, Isngadi I, Anggraeni N, Sikumbang KM, Halimi RA, Jasa ZK, Nasution AH, Mochamat M, Purwoko P. 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. BMC Geriatr 2022; 22:523. [PMID: 35752756 PMCID: PMC9233386 DOI: 10.1186/s12877-022-03227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.
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Affiliation(s)
- Nancy Margarita Rehatta
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Susilo Chandra
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Djayanti Sari
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mayang Indah Lestari
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine Universitas Sriwijaya, Jenderal Sudirman Street KM. 3.5, Palembang, South Sumatera, 30126, Indonesia.
| | - Tjokorda Gde Agung Senapathi
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Haizah Nurdin
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
| | - Belindo Wirabuana
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bintang Pramodana
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Adinda Putra Pradhana
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Isngadi Isngadi
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Novita Anggraeni
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Riau, Pekanbaru, Riau, Indonesia
| | - Kenanga Marwan Sikumbang
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Radian Ahmad Halimi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Zafrullah Khany Jasa
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Akhyar Hamonangan Nasution
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Mochamat Mochamat
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Purwoko Purwoko
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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19
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Seid S, Adane H, Mekete G. Patterns of presentation, prevalence and associated factors of mortality in ICU among adult patients during the pandemic of COVID 19: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 77:103618. [PMID: 35441008 PMCID: PMC9010017 DOI: 10.1016/j.amsu.2022.103618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 01/28/2023] Open
Abstract
Background There is concern that patients admitted to the intensive care unit (ICU) with Corona Virus Disease 2019 (COVID-19) have variable prevalence reports of mortality. The survival rates are also inconsistently reported due to varying follow-up periods. Even if data on outcomes and baseline characteristics of ICU patients with COVID-19 is essential for action planning to manage complications, it is still left undisclosed in our study setting. Materials and method This cross-sectional study was conducted on 402 samples using a retrospective chart review of patient's data who were admitted in the past 2 years of the adult ICUs. All the data were entered and analyzed with SPSS version 21. A multivariable Logistic regression analysis was used to identify the association between outcome variables with independent factors and a p-value of less than 0.05 was taken as statistically significant with a 95% confidence interval. We used text, tables, and figures for the result. Result The overall prevalence of mortality among adult patients admitted to ICU during COVID-19 pandemics was 67.4%. From the multivariable logistic regression analysis, factors that were shown to have an association with an increase in ICU patient mortality were; lack of Vasopressor support, patients who had confirmed COVID 19 infection, core body temperature at admission greater than 37.5 °c, SPO2 at admission less than 90%, patients who had diagnosed ischemic heart disease (IHD), patients with acute respiratory distress syndrome (ARDS), patients who were intubated and mechanically ventilated (MV), and patient's ICU length of stay longer than two weeks. Conclusion The prevalence of ICU mortality in adult patients was higher in Debre Tabor Comprehensive specialized hospital. Therefore, clinicians need to minimize factors that maximize patient mortalities like ARDS, hyperthermia, Desaturation, Covid infection, IHD, intubation and MV, lack of Vasopressor use, and prolonged ICU stay. The prevalence of mortality in ICU was 67.4% Hyperthermia increases mortality in ICU Use of vasopressor in ICU decreases mortality
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Affiliation(s)
- Shimelis Seid
- Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
- Corresponding author. Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Postal code of the institution: 272, Debre Tabor, Ethiopia.
| | - Habtu Adane
- Department of Anesthesia, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getachew Mekete
- Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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20
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Ahmed MA, Hussein AM, Abdullahi AAM, Ahmed AY, Hussain HM, Ali AM, Barre AA, Yusuf FM, Olum R, Sereke SG, Elfadul MA, Colebunders R, Bongomin F. Cardiovascular risk factors and clinical outcomes of patients hospitalized with COVID-19 pneumonia in Somalia. Ther Adv Infect Dis 2022; 9:20499361221095731. [PMID: 35494493 PMCID: PMC9044783 DOI: 10.1177/20499361221095731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Coronavirus disease-2019 (COVID-19) is a potentially life-threatening illness with no established treatment. Cardiovascular risk factors (CRFs) exacerbate COVID-19 morbidity and mortality. Objective: To determine the prevalence of CRF and clinical outcomes of patients hospitalized with COVID-19 in a tertiary hospital in Somalia. Methods: We reviewed the medical records of patients aged 18 years or older with a real-time polymerase chain reaction (RT-PCR)–confirmed COVID-19 hospitalized at the De Martino Hospital in Mogadishu, Somalia, between March and July 2020. Results: We enrolled 230 participants; 159 (69.1%) males, median age was 56 (41–66) years. In-hospital mortality was 19.6% ( n = 45); 77.8% in the intensive care unit (ICU) compared with 22.2%, in the general wards ( p < 0.001). Age ⩾ 40 years [odds ratio (OR): 3.6, 95% confidence interval (CI): 1.2–10.6, p = 0.020], chronic heart disease (OR: 9.3, 95% CI: 2.2–38.9, p = 0.002), and diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.2, p < 0.001) were associated with increased odds of mortality. Forty-three (18.7%) participants required ICU admission. Age ⩾ 40 years (OR: 7.5, 95% CI: 1.7–32.1, p = 0.007), diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.3, p < 0.001), and hypertension (OR: 2.5, 95% CI: 1.2–5.2, p = 0.014) were associated with ICU admission. For every additional CRF, the odds of admission into the ICU increased threefold (OR: 2.7, 95% CI: 1.2–5.2, p < 0.001), while the odds of dying increased twofold (OR: 2.1, 95% CI: 1.3–3.2, p < 0.001). Conclusions: We report a very high prevalence of CRF among patients hospitalized with COVID-19 in Somalia. Mortality rates were unacceptably high, particularly among those with advanced age, underlying chronic heart disease, and diabetes.
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Affiliation(s)
- Mohammed A.M. Ahmed
- Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, P.O. Box 004 KM4, Mogadishu, Somalia
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | | | | | - Hamdi M.A. Hussain
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Abdiaziz Mohamed Ali
- Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
- De Martino Hospital, Mogadishu, Somalia
| | | | | | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maisa Ahmed Elfadul
- Public and Tropical Health Programs, University of Medical Sciences and Technology, Khartoum, Sudan
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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21
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Bianconi V, Mannarino MR, Figorilli F, Cosentini E, Batori G, Marini E, Banach M, Sahebkar A, Pirro M. The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19. Expert Rev Mol Diagn 2022; 22:469-478. [PMID: 35260036 PMCID: PMC8935458 DOI: 10.1080/14737159.2022.2052047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/08/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels. RESEARCH DESIGN AND METHODS This study aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin-to-Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed. RESULTS In the population examined (mean age 74 ± 15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for noninvasive ventilation were higher in patients with high FIR (≥29.2, the 75th percentile) than in those with low FIR (<29.2, the 75th percentile) (p < 0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017-2.871, p = 0.043) higher risk of ICU admission/in-hospital death. CONCLUSIONS Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.
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Affiliation(s)
- Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Massimo R. Mannarino
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Figorilli
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cosentini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Batori
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ettore Marini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maciej Banach
- Department of Hypertension, Wam University Hospital, Medical University of Lodz, Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mothers Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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22
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Asmarawati TP, Suryantoro SD, Rosyid AN, Marfiani E, Windradi C, Mahdi BA, Sutanto H. Predictive Value of Sequential Organ Failure Assessment (SOFA), Quick Sequential Organ Failure Assessment (qSOFA), Acute Physiology and Chronic Health Evaluation (APACHE II), and New Early Warning Signs (NEWS-2) Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit (ICU). Indian J Crit Care Med 2022; 26:464-471. [PMID: 35656039 PMCID: PMC9067497 DOI: 10.5005/jp-journals-10071-24170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Various mortality predictive score models for coronavirus disease-2019 (COVID-19) have been deliberated. We studied how sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation II (APACHE II), and new early warning signs (NEWS-2) scores estimate mortality in COVID-19 patients. Materials and methods We conducted a prospective cohort study of 53 patients with moderate-to-severe COVID-19. We calculated qSOFA, SOFA, APACHE II, and NEWS-2 on initial admission and re-evaluated on day 5. We performed logistic regression analysis to differentiate the predictors of qSOFA, SOFA, APACHE II, and NEWS-2 scores on mortality. Result qSOFA, SOFA, APACHE II, and NEWS-2 scores on day 5 exhibited a difference between survivors and nonsurvivors (p <0.05), also between ICU and non-ICU admission (p <0.05). The initial NEWS-2 revealed a higher AUC value than the qSOFA, APACHE II, and SOFA score in estimating mortality (0.867; 0.83; 0.822; 0.794). In ICU, APACHE II score revealed a higher AUC value than the SOFA, NEWS-2, and qSOFA score (0.853; 0.832; 0.813; 0.809). Concurrently, evaluation on day 5 showed that qSOFA AUC had higher scores than the NEWS-2, APACHE II, and SOFA (0.979; 0.965; 0.939; 0.933) in predicting mortality, while SOFA and APACHE II AUC were higher in ICU admission than NEWS-2 and qSOFA (0.968; 0.964; 0.939; 0.934). According to the cutoff score, APACHE II on day 5 revealed the highest sensitivity and specificity in predicting the mortality (sensitivity 95.7%, specificity 86.7%). Conclusion All scores signify good predictive values on COVID-19 patients mortality following the evaluation on the day 5. Nonetheless, APACHE-II appears to be the best at predicting mortality and ICU admission rate. How to cite this article Asmarawati TP, Suryantoro SD, Rosyid AN, Marfiani E, Windradi C, Mahdi BA, et al. Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit. Indian J Crit Care Med 2022;26(4):464–471.
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Affiliation(s)
- Tri Pudy Asmarawati
- Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia
- Tri Pudy Asmarawati, Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia, e-mail:
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia
| | - Alfian Nur Rosyid
- Department of Pulmonary and Respiratory Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Erika Marfiani
- Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia
| | - Choirina Windradi
- Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Universitas Airlangga, Faculty of Medicine, Surabaya, East Java, Indonesia
| | - Heri Sutanto
- Department of Internal Medicine, Brawijaya University, Malang, Jawa Timur, Indonesia
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Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, ICU2, Mail Code 1425, PO Box 22490, Riyadh 11426, Saudi Arabia
| | - John Kress
- Section of Pulmonary and Critical Care, Medical ICU, University of Chicago, 5841 South Maryland Avenue, MC 6026, Chicago, IL 60637, USA
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, ICU2, Mail Code 1425, PO Box 22490, Riyadh 11426, Saudi Arabia.
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Kairu A, Were V, Isaaka L, Agweyu A, Aketch S, Barasa E. Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya. BMJ Glob Health 2021; 6:e007168. [PMID: 34876459 PMCID: PMC8655343 DOI: 10.1136/bmjgh-2021-007168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions. METHODS We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results. RESULTS The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya's cost-effectiveness threshold (US$908). CONCLUSION When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.
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Affiliation(s)
- Angela Kairu
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Vincent Were
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lynda Isaaka
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Samuel Aketch
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Alhasan KA, Shalaby MA, Temsah MH, Aljamaan F, Shagal R, AlFaadhel T, Alomi M, AlMatham K, AlHerbish AJ, Raina R, Sethi SK, Alsubaie S, Hakami MH, Alharbi NM, Shebeli RA, Nur HM, Kashari OF, Qari FA, Albanna AS, Kari JA. Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia. Healthcare (Basel) 2021; 9:1608. [PMID: 34946347 PMCID: PMC8701249 DOI: 10.3390/healthcare9121608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. METHODS This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. RESULTS In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). CONCLUSION In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.
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Affiliation(s)
- Khalid A Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Mohamed A Shalaby
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Reem Shagal
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Talal AlFaadhel
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mohammed Alomi
- Prince Mohammed bin Abdulaziz Hospital, King Salman Center for Kidney Diseases, Ministry of Health, Riyadh 14214, Saudi Arabia;
| | - Khalid AlMatham
- King Fahad Medical City, Ministry of Health, Riyadh 11525, Saudi Arabia;
| | - Adi J. AlHerbish
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Rupesh Raina
- Pediatrics Nephrology, Akron Children’s Hospital, Akron, OH 44241, USA;
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH 44241, USA
| | | | - Sarah Alsubaie
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Marwah H Hakami
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Najla M Alharbi
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Razan A Shebeli
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Hanan Mohamed Nur
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Ohoud F Kashari
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Faiza A Qari
- Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia;
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
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26
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Liu X, Zhu L, Lu T, Liu X, Jiao D, Tang X, Chen J, Chen Y, Yu W, Chen Q. Epidemiologic Characteristics of and Prognostic Factors for COVID-19 Among Hospitalized Patients: Updated Implications From Hubei Province, China. Front Public Health 2021; 9:726491. [PMID: 34778170 PMCID: PMC8578829 DOI: 10.3389/fpubh.2021.726491] [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] [Received: 06/17/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: The roles of some indicators in the prognosis of patients with coronavirus disease-19 (COVID-19) remain unclear and controversial. This study aimed to explore the epidemiologic characteristics of and prognostic factors for COVID-19 to provide updated recommendations for its prevention, diagnosis, and treatment. Methods: For this retrospective study, demographic, epidemiologic, and clinical data were extracted from the medical records of patients admitted to the Maternal and Child Hospital of Hubei Province (Optical Valley) with COVID-19 between February 19, 2020, and March 19, 2020. The primary outcome was the prognosis that was determined at discharge as mentioned in the medical records. Descriptive statistics, univariate analyses, and stepwise logistic regression analysis were used for data analysis. Results: Of the 1,765 patients included, 93.1% were cured and the mortality was 1.8%. Univariate analyses identified 63 factors significantly associated with COVID-19 prognosis. Logistic regression analysis revealed that a poorer prognosis was associated with undergoing resuscitation, complex disease manifestations, consultation with outside specialists, elevated basophil or lymphocyte counts, an albumin (ALB)/globulin (A/G) ratio > 2.4, and elevated levels of serum aspartate aminotransferase (AST) or creatinine. Patients had a better prognosis if the following conditions were met: dry cough reported as an initial symptom, fatigue as a clinical manifestation, and a diagnosis based on laboratory testing. Conclusion: To prevent clinical deterioration, clinicians should provide special care to patients who underwent resuscitation, with a critical disease, or requiring consultation with outside specialists. Extra attention should be paid to patients with high basophil or lymphocyte counts, a high A/G ratio, and elevated AST or creatinine levels.
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Affiliation(s)
- Xiang Liu
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Linzhi Zhu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tingjuan Lu
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China.,The Optics Valley Branch of the Maternal and Child Hospital of Hubei Province, Wuhan, China
| | - Xibang Liu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Demin Jiao
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Xiali Tang
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Jun Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Yu Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingyong Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China.,The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Bastani P, Mohammadpour M, Samadbeik M, Bastani M, Rossi-Fedele G, Balasubramanian M. Factors influencing access and utilization of health services among older people during the COVID - 19 pandemic: a scoping review. Arch Public Health 2021; 79:190. [PMID: 34743747 PMCID: PMC8572573 DOI: 10.1186/s13690-021-00719-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic. METHODS PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly's access and utilization of healthcare services, using Max QDA10, a qualitative analysis software. RESULTS Among articles included in the review (n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an individual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly's access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants. CONCLUSION Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people's health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahnaz Samadbeik
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Misagh Bastani
- Anesthesiologist, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Madhan Balasubramanian
- Research Fellow and Lecturer, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Hou H, Xu J, Li Y, Wang Y, Yang H. The Association of Asthma With COVID-19 Mortality: An Updated Meta-Analysis Based on Adjusted Effect Estimates. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3944-3968.e5. [PMID: 34464749 PMCID: PMC8401144 DOI: 10.1016/j.jaip.2021.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
Background The association of asthma with the risk for mortality among coronavirus disease 2019 (COVID-19) patients is not clear. Objective To investigate the association between asthma and the risk for mortality among COVID-19 patients. Methods We performed systematic searches through electronic databases including PubMed, EMBASE, and Web of Science to identify potential articles reporting adjusted effect estimates on the association of asthma with fatal COVID-19. A random-effects model was conducted to estimate pooled effects. Sensitivity analysis, subgroup analysis, meta-regression, Begg's test and Egger's test were also performed. Results Based on 62 studies with 2,457,205 cases reporting adjusted effect estimates, COVID-19 patients with asthma had a significantly reduced risk for mortality compared with those without it (15 cohort studies: 829,670 patients, pooled hazard ratio [HR] = 0.88, 95% confidence interval [CI], 0.82-0.95, I2 = 65.9%, P < .001; 34 cohort studies: 1,008,015 patients, pooled odds ratio [OR] = 0.88, 95% CI, 0.82-0.94, I2 = 39.4%, P = .011; and 11 cross-sectional studies: 1,134,738 patients, pooled OR = 0.87, 95% CI, 0.78-0.97, I2 = 41.1%, P = .075). Subgroup analysis based on types of adjusted factors indicated that COVID-19 patients with asthma had a significantly reduced risk for mortality among studies adjusting for demographic, clinical, and epidemiologic variables (pooled OR = 0.87, 95% CI, 0.83-0.92, I2 = 36.3%, P = .013; pooled HR = 0.90, 95% CI, 0.83-0.97, I2 = 69.2%, P < .001), but not among studies adjusting only for demographic variables (pooled OR = 0.88, 95% CI, 0.70-1.12, I2 = 40.5%, P = .097; pooled HR = 0.82, 95% CI, 0.64-1.06, I2 = 0%, P = .495). Sensitivity analysis proved that our results were stable and robust. Both Begg's test and Egger's test indicated that potential publication bias did not exist. Conclusions Our data based on adjusted effect estimates indicated that asthma was significantly related to a reduced risk for COVID-19 mortality.
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Affiliation(s)
- Hongjie Hou
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Li
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China.
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Qian Z, Lu S, Luo X, Chen Y, Liu L. Mortality and Clinical Interventions in Critically ill Patient With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:635560. [PMID: 34368175 PMCID: PMC8342953 DOI: 10.3389/fmed.2021.635560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/10/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: The aims of this systematic review and meta-analysis were to summarize the current existing evidence on the outcome of critically ill patients with COVID-19 as well as to evaluate the effectiveness of clinical interventions. Data Sources: We searched MEDLINE, the Cochrane library, Web of Science, the China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data from their inception to May 15, 2021. The search strings consisted of various search terms related to the concepts of mortality of critically ill patients and clinical interventions. Study Selection: After eliminating duplicates, two reviewers independently screened all titles and abstracts first, and then the full texts of potentially relevant articles were reviewed to identify cohort studies and case series that focus on the mortality of critically ill patients and clinical interventions. Main Outcomes and Measures: The primary outcome was the mortality of critically ill patients with COVID-19. The secondary outcomes included all sorts of supportive care. Results: There were 27 cohort studies and six case series involving 42,219 participants that met our inclusion criteria. All-cause mortality in the intensive care unit (ICU) was 35% and mortality in hospital was 32% in critically ill patients with COVID-19 for the year 2020, with very high between-study heterogeneity (I 2 = 97%; p < 0.01). In a subgroup analysis, the mortality during ICU hospitalization in China was 39%, in Asia-except for China-it was 48%, in Europe it was 34%, in America it was 15%, and in the Middle East it was 39%. Non-surviving patients who had an older age [-8.10, 95% CI (-9.31 to -6.90)], a higher APACHE II score [-4.90, 95% CI (-6.54 to -3.27)], a higher SOFA score [-2.27, 95% CI (-2.95 to -1.59)], and a lower PaO2/FiO2 ratio [34.77, 95% CI (14.68 to 54.85)] than those who survived. Among clinical interventions, invasive mechanical ventilation [risk ratio (RR) 0.49, 95% CI (0.39-0.61)], kidney replacement therapy [RR 0.34, 95% CI (0.26-0.43)], and vasopressor [RR 0.54, 95% CI (0.34-0.88)] were used more in surviving patients. Conclusions: Mortality was high in critically ill patients with COVID-19 based on low-quality evidence and regional difference that existed. The early identification of critical characteristics and the use of support care help to indicate the outcome of critically ill patients.
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Affiliation(s)
- Zhicheng Qian
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuya Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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