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Yau CE, Lee DYX, Vasudevan A, Goh KJ, Wong E, Ho AFW, Lim DYZ. Performance of the ROX index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis. Crit Care 2023; 27:320. [PMID: 37605238 PMCID: PMC10441756 DOI: 10.1186/s13054-023-04567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/07/2023] [Indexed: 08/23/2023] Open
Abstract
COVID-19 patients with acute hypoxemic respiratory failure (AHRF) benefit from high flow nasal cannula (HFNC) oxygen therapy. However, delays in initiating invasive ventilation after HFNC failure are associated with poorer outcomes. The respiratory oxygenation (ROX) index, combining SpO2/FiO2 and respiratory rate, can predict HFNC failure. This meta-analysis evaluated the optimal ROX index cut-offs in predicting HFNC failure among COVID-19 patients at different measurement timings and clinical settings. Three databases were searched for eligible papers. From each study, we reconstructed the confusion matrices at different cut-offs, fitted linear mixed models to estimate the ROX index distribution function, and derived the area under the summary receiver operator characteristic curve (sAUC) and optimal cut-offs to predict HFNC failure. 24 studies containing 4790 patients were included. Overall sAUC was 0.771 (95% CI: 0.666-0.847) (optimal cut-off: 5.23, sensitivity: 0.732, specificity: 0.690). The cut-off values to achieve 80%, 90% sensitivity, 80%, 90% specificity were 5.70, 6.69, 4.45, 3.37, respectively. We stratified the analysis by ROX measurement time and estimated optimal cut-offs and cut-offs to achieve 80% sensitivity and specificity. For 2-6 h and 6-12 h post-HFNC initiation, we propose the use of 80% specific cut-offs to rule in HFNC failure of < 5.33 and < 3.69, respectively. For 12-24 h post-HFNC initiation, we propose the use of the 80% sensitive cut-off of > 6.07 to rule out HFNC failure. Our analysis confirms the overall utility of the ROX index in risk stratification of COVID-19 patients with AHRF receiving HFNC and provides potentially useful cut-offs for different times from HFNC initiation.
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Affiliation(s)
- Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Adithi Vasudevan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Evelyn Wong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Pre-Hospital and Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore, Singapore.
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Daniel Yan Zheng Lim
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
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Hirabayashi R, Nagata K, Sato Y, Nakagawa A, Tachikawa R, Kuroda H, Seo R, Morimoto T, Tomii K. Reliability of the respiratory rate and oxygenation index for successful high-flow nasal cannula support in coronavirus disease pneumonia: a retrospective cohort study. BMC Pulm Med 2023; 23:294. [PMID: 37559018 PMCID: PMC10413522 DOI: 10.1186/s12890-023-02598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) therapy is an important non-invasive respiratory support in acute respiratory failure, including coronavirus disease (COVID-19) pneumonia. Although the respiratory rate and oxygenation (ROX) index is a simple and useful predictor for HFNC failure and mortality, there is limited evidence for its use in patients with COVID-19 pneumonia. We aimed to evaluate the ROX index as a predictor for HFNC failure in patients with COVID-19 pneumonia. We also evaluated the ROX index as a predictor for 28-day mortality. METHODS In this single-center, retrospective, cohort study, 248 patients older than 18 years of age with COVID-19 pneumonia received HFNC therapy for acute respiratory failure. The ROX index was evaluated within 4 h from the start of HFNC therapy. Past medical history, laboratory data, and the ROX index were evaluated as predictors for HFNC failure and 28-day mortality. RESULTS The ROX index < 4.88 showed a significantly high risk ratio for HFNC failure (2.13 [95% confidence interval [CI]: 1.47 - 3.08], p < 0.001). The ROX index < 4.88 was significantly associated with 28-day mortality (p = 0.049) in patients with COVID-19 pneumonia receiving HFNC therapy. Age, chronic hypertension, high lactate dehydrogenase level, and low ROX index showed significantly high risk ratio for HFNC failure. C-reactive protein level and low ROX index were predictors of 28-day morality. CONCLUSION The ROX index is a useful predictor for HFNC success and 28-day mortality in patients with COVID-19 pneumonia receiving HFNC therapy. TRIAL REGISTRATION An independent ethics committee approved the study (Research Ethics Review Committee of Kobe City Medical Center General Hospital [number: zn220303; date: February 21, 2022]), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.
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Affiliation(s)
- Ryosuke Hirabayashi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan.
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Hirokazu Kuroda
- Department of Infectious Disease, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
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Arruda DG, Kieling GA, Melo-Diaz LL. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:52-65. [PMID: 36741308 PMCID: PMC9854387 DOI: 10.29390/cjrt-2022-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction/Background Coronavirus disease 2019 (COVID-19) has high transmissibility and mortality rates. High-flow nasal cannula therapy (HFNC) might reduce the need for orotracheal intubation, easing the burden on the health system caused by COVID-19. The objective of the present study was to examine the effectiveness of HFNC in adult patients hospitalized with COVID-19. Specifically, the present study explores the effects of HFNC on rates of mortality, intubation and intensive care units (ICU) length of stay. The present study also seeks to define predictors of success and failure of HFNC. Methods A systematic literature search was conducted in the PubMed, EMBASE and SCOPUS databases, and the study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tools. Results The search identified 1,476 unique titles; 95 articles received full-text reviews and 40 studies were included in this review. HFNC was associated with a reduction in the rate of orotracheal intubation, notably when compared to conventional oxygen therapy. Studies reported inconsistency in whether HFNC reduced ICU length of stay or mortality rates. Among the predictors of HFNC failure/success, a ratio of oxygen saturation index of approximately 5 or more was associated with HFNC success. Conclusion In adult patients hospitalized with COVID-19, HFNC may prove effective in reducing the rate of orotracheal intubation. The ratio of the oxygen saturation index was the parameter most examined as a predictor of HFNC success. Low-level research designs, inherent study weaknesses and inconsistent findings made it impossible to conclude whether HFNC reduces ICU length of stay or mortality. Future studies should employ higher level research designs.
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Affiliation(s)
- Daiana Gonçalves Arruda
- Multiprofessional Residency Program in Hospital Care in Adult and Elderly Health – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - George Alvício Kieling
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Lucélia Luna Melo-Diaz
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
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Domjanović J, Domjanović Škopinić T, Radić J, Luketin M, Jeličić I, Matetic A. Performance of Derived Laboratory Biomarkers with Regard to 30-Day Mortality in Kidney Transplant Recipients with COVID-19. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122068. [PMID: 36556433 PMCID: PMC9787399 DOI: 10.3390/life12122068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
There are limited data on the performance of laboratory-derived biomarkers in kidney transplant recipients (KTR) with COVID-19. This observational study enrolled 65 KTR with COVID-19 who were treated at the University Hospital of Split up to March 2022. Laboratory-derived biomarkers (neutrophile-to-lymphocyte (NLR) ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, De Ritis ratio, C-reactive protein (CRP)-to-albumin ratio, lactate dehydrogenase (LDH)-to-hemoglobin ratio, CRP-to-lymphocyte ratio, red cell distribution width-to-albumin ratio, platelet-to-albumin ratio, D-Dimer-to-albumin ratio, D-Dimer-to-NLR ratio, LDH-to-albumin ratio, and LDH-to-white blood cell (WBC) ratio) were calculated, and their performance with regard to 30-day mortality was determined. Mortality events occurred in 12 patients (18.5%), which was significantly associated with increased De Ritis (HR 3.83, 95% CI 1.57-9.35, p = 0.003), CRP-to-albumin (HR 1.36, 95% CI 1.13-1.64, p = 0.001), LDH-to-hemoglobin (HR 1.44, 95% CI 1.07-1.92, p = 0.015), CRP-to-lymphocyte (HR 1.03, 95% CI 1.01-1.07, p = 0.003), D-dimer-to-albumin (HR 4.94, 95% CI 1.38-7.24, p = 0.038), LDH-to-albumin (HR 1.20, 95% CI 1.05-1.36, p = 0.008), and LDH-to-WBC (HR 1.03 95% CI 1.01-1.05, p = 0.024) ratios. Out of these, the best area-under-the-curve (AUC) values were achieved with De Ritis (AUC 0.691), CRP-to-albumin (AUC 0.764), LDH-to-hemoglobin (AUC 0.877), CRP-to-lymphocyte (AUC 0.739), and LDH-to-albumin (AUC 0.827) ratios, while the best discrimination displayed LDH-to-hemoglobin ratio (Harrell's C 0.808 and Somers' D 0.616). The overall calibration was satisfactory for all models. Derived laboratory biomarkers such as the de Ritis, CRP-to-albumin, LDH-to-hemoglobin, CRP-to-lymphocyte, and LDH-to-albumin ratios show significant association and discrimination with all-cause mortality in KTR with COVID-19, suggesting its potential risk stratification role.
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Affiliation(s)
- Josipa Domjanović
- Department of Nephrology, University Hospital of Split, 21000 Split, Croatia
| | | | - Josipa Radić
- Department of Nephrology, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Mirko Luketin
- Department of Nephrology, University Hospital of Split, 21000 Split, Croatia
| | - Ivo Jeličić
- Department of Nephrology, University Hospital of Split, 21000 Split, Croatia
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia
- Correspondence:
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Association between Brain Injury Markers and Testosterone in Critically-Ill COVID-19 Male Patients. Microorganisms 2022; 10:microorganisms10112095. [PMID: 36363686 PMCID: PMC9697553 DOI: 10.3390/microorganisms10112095] [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: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Accumulating data suggest that various neurologic manifestations are reported in critically-ill COVID-19 patients. Although low testosterone levels were associated with poor outcomes, the relationship between testosterone levels and indices of brain injury are still poorly understood. Therefore, we aimed to explore whether testosterone levels are associated with glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), biomarkers of brain injury, in patients with a severe form of COVID-19. The present study was conducted on 65 male patients aged 18−65 with severe COVID-19. Blood samples were collected at three time points: upon admission to ICU, 7 days after, and 14 days after. In patients with neurological sequels (n = 20), UCH-L1 serum concentrations at admission were markedly higher than in patients without them (240.0 (155.4−366.4) vs. 146.4 (92.5−243.9) pg/mL, p = 0.022). GFAP concentrations on admission did not differ between the groups (32.2 (24.2−40.1) vs. 29.8 (21.8−39.4) pg/mL, p = 0.372). Unlike GFAP, UCH-L1 serum concentrations exhibited a negative correlation with serum testosterone in all three time points (r = −0.452, p < 0.001; r = −0.430, p < 0.001 and r = −0.476, p = 0.001, respectively). The present study suggests that the traumatic brain injury biomarker UCH-L1 may be associated with neurological impairments seen in severe COVID-19. Moreover, a negative correlation between UCH-L1 and serum testosterone concentrations implies that testosterone may have a role in the development of neurological sequels in critically-ill COVID-19 patients.
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Prognostic Value of Catestatin in Severe COVID-19: An ICU-Based Study. J Clin Med 2022; 11:jcm11154496. [PMID: 35956112 PMCID: PMC9369405 DOI: 10.3390/jcm11154496] [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: 07/08/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023] Open
Abstract
Catestatin is a pleiotropic peptide with a wide range of immunomodulatory effects. Considering that patients with a severe COVID-19 infection have a major immunological dysregulation, the aim of this study was to evaluate catestatin levels in patients with COVID-19 treated in the intensive care unit (ICU) and to compare them between the fatal and non-fatal outcomes. The study included 152 patients with severe COVID-19, out of which 105 had a non-fatal outcome and 47 had a fatal outcome. Serum catestatin levels were estimated by an enzyme-linked immunosorbent assay in a commercially available diagnostic kit. The results show that catestatin levels were significantly lower in the fatal group compared to the non-fatal group (16.6 ± 7.8 vs. 23.2 ± 9.2 ng/mL; p < 0.001). Furthermore, there was a significant positive correlation between serum catestatin levels and vitamin D levels (r = 0.338; p < 0.001) while there was also a significant positive correlation between serum catestatin levels and growth differentiation factor-15 (GDF-15) levels (r = −0.345; p < 0.001). Furthermore, multivariate logistic regression showed that catestatin, GDF-15 and leukocyte count were significant predictors for COVID-19 survival. These findings imply that catestatin could be playing a major immunomodulatory role in the complex pathophysiology of the COVID-19 infection and that serum catestatin could also be a predictor of a poor COVID-19 outcome.
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Mikacic M, Kumric M, Baricevic M, Tokic D, Stojanovic Stipic S, Cvitkovic I, Supe Domic D, Ticinovic Kurir T, Bozic J. Dynamic of Serum TWEAK Levels in Critically Ill COVID-19 Male Patients. J Clin Med 2022; 11:jcm11133699. [PMID: 35806986 PMCID: PMC9267298 DOI: 10.3390/jcm11133699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 02/04/2023] Open
Abstract
Although the number of cases and mortality of COVID-19 are seemingly declining, clinicians endeavor to establish indicators and predictors of such responses in order to optimize treatment regimens for future outbreaks of SARS-CoV-2 or similar viruses. Considering the importance of aberrant immune response in severe COVID-19, in the present study, we aimed to explore the dynamic of serum TNF-like weak inducer of apoptosis (TWEAK) levels in critically-ill COVID-19 patients and establish whether these levels may predict in-hospital mortality and if TWEAK is associated with impairment of testosterone levels observed in this population. The present single-center cohort study involved 66 men between the ages of 18 and 65 who were suffering from a severe type of COVID-19. Serum TWEAK was rising during the first week after admission to intensive care unit (ICU), whereas decline to baseline values was observed in the second week post-ICU admission (p = 0.032) but not in patients who died in hospital. Receiver-operator characteristics analysis demonstrated that serum TWEAK at admission to ICU is a significant predictor of in-hospital mortality (AUC = 0.689, p = 0.019). Finally, a negative correlation was found between serum TWEAK at admission and testosterone levels (r = −0.310, p = 0.036). In summary, serum TWEAK predicts in-hospital mortality in severe COVID-19. In addition, inflammatory pathways including TWEAK seem to be implicated in pathophysiology of reproductive hormone axis disturbance in severe form of COVID-19.
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Affiliation(s)
- Marijana Mikacic
- Intensive Care Unit of the Department of Internal Medicine, University Hospital of Split, 21000 Split, Croatia; (M.M.); (M.B.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (I.C.); (T.T.K.)
| | - Martina Baricevic
- Intensive Care Unit of the Department of Internal Medicine, University Hospital of Split, 21000 Split, Croatia; (M.M.); (M.B.)
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia; (D.T.); (S.S.S.)
| | - Sanda Stojanovic Stipic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia; (D.T.); (S.S.S.)
| | - Ivan Cvitkovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (I.C.); (T.T.K.)
| | - Daniela Supe Domic
- Department of Health Studies, University of Split, 21000 Split, Croatia;
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (I.C.); (T.T.K.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Split, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (I.C.); (T.T.K.)
- Correspondence:
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Kurzeder L, Jörres RA, Unterweger T, Essmann J, Alter P, Kahnert K, Bauer A, Engelhardt S, Budweiser S. A simple risk score for mortality including the PCR Ct value upon admission in patients hospitalized due to COVID-19. Infection 2022; 50:1155-1163. [PMID: 35218511 PMCID: PMC8881702 DOI: 10.1007/s15010-022-01783-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
Purpose To develop a simple score for the outcomes from COVID-19 that integrates information obtained at the time of admission including the Ct value (cycle threshold) for SARS-CoV-2. Methods Patients with COVID-19 hospitalized from February 1st to May 31st 2021 in RoMed hospitals, Germany, were included. Clinical and laboratory parameters upon admission were recorded and patients followed until discharge or death. Logistic regression analysis was used to determine predictors of outcomes. Regression coefficients were used to develop a risk score for death. Results Of 289 patients (46% female, median age 66 years), 29% underwent high-flow nasal oxygen (HFNO) therapy, 28% were admitted to the Intensive Care Unit (ICU, 51% put on invasive ventilation, IV), and 15% died. Age > 70 years, oxygen saturation ≤ 90%, oxygen supply upon admission, eGFR ≤ 60 ml/min and Ct value ≤ 26 were significant (p < 0.05 each) predictors for death, to which 2, 2, 1, 1 and 2 score points, respectively, could be attributed. Sum scores of ≥ 4 or ≥ 5 points were associated with a sensitivity of 95.0% or 82.5%, and a specificity of 72.5% or 81.7% regarding death. The high predictive value of the score was confirmed using data obtained between December 15th 2020 and January 31st 2021 (n = 215). Conclusion In COVID-19 patients, a simple scoring system based on data available shortly after hospital admission including the Ct value had a high predictive value for death. The score may also be useful to estimate the likelihood for required interventions at an early stage. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01783-1.
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Affiliation(s)
- Luis Kurzeder
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Thomas Unterweger
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Julian Essmann
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University of Marburg (UMR), Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Andreas Bauer
- Institute for Anesthesiology and Surgical Intensive Care Medicine, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Sebastian Engelhardt
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany.
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Leszek A, Wozniak H, Giudicelli-Bailly A, Suh N, Boroli F, Pugin J, Grosgurin O, Marti C, Le Terrier C, Quintard H. Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study. J Clin Med 2022; 11:jcm11020365. [PMID: 35054058 PMCID: PMC8779507 DOI: 10.3390/jcm11020365] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
COVID-19 patients often present with rapidly progressing acute hypoxemic respiratory failure, requiring orotracheal intubation with different prognostic issues. However, ICU specialists lack predictive tools to stratify these patients. We conducted a single-center cross-sectional retrospective study to evaluate if the ROX index, measured under non-invasive oxygenation support, can predict ICU mortality in a COVID-19 intubated patient cohort. This study took place in the division of intensive care at the Geneva University Hospitals (Geneva, Switzerland). We included all consecutive adult patients treated by non-invasive oxygenation support and requiring intubation for acute respiratory failure due to COVID-19 between 9 September 2020 and 30 March 2021, corresponding to the second local surge of COVID-19 cases. Baseline demographic data, comorbidities, median ROX between H0 and H8, and clinical outcomes were collected. Overall, 82 patients were intubated after failing a non-invasive oxygenation procedure. Women represented 25.6% of the whole cohort. Median age and median BMI were 70 (60–75) years and 28 (25–33), respectively. Before intubation, the median ROX between H0 and H8 was 6.3 (5.0–8.2). In a multivariate analysis, the median ROX H0–H8 was associated with ICU mortality as a protective factor with an odds ratio (95% CI) = 0.77 (0.60–0.99); p < 0.05. In intubated COVID-19 patients treated initially by non-invasive oxygenation support for acute respiratory failure, the median ROX H0–H8 could be an interesting predictive factor associated with ICU mortality.
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Affiliation(s)
- Alexandre Leszek
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
| | - Hannah Wozniak
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Amélie Giudicelli-Bailly
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Noémie Suh
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Filippo Boroli
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Jérôme Pugin
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Olivier Grosgurin
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Christophe Marti
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Christophe Le Terrier
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Hervé Quintard
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
- Correspondence:
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Association of the novel CROW-65 risk score and mortality in hospitalized kidney transplant recipients with COVID-19 : A retrospective observational study. Wien Klin Wochenschr 2022; 134:842-849. [PMID: 35799015 PMCID: PMC9261897 DOI: 10.1007/s00508-022-02052-9] [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: 01/27/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Kidney transplant recipients (KTR) are a group of patients with heterogeneous risks for adverse outcomes with COVID-19, but risk stratification tools in this patient group are lacking. METHODS AND PARTICIPANTS This retrospective observational, hypothesis-generating study included 49 hospitalized adult KTR patients with COVID-19 at the University Hospital of Split (August 2020 to October 2021) and evaluated the performance of novel risk score CROW-65 (age, Charlson Comorbidity Index [CCI] lactate dehydrogenase to white blood cell [LDH:WBC] ratio, and respiratory rate oxygenation [ROX index]). The primary outcome of the study was 30-day postdischarge all-cause mortality. RESULTS A total of 8 fatal events (16.3%) occurred during the study follow-up. When comparing CROW-65 by survival status, it was significantly increased in patients with fatal event (P < 0.001). Using the Cox proportional hazards regression analysis, the CROW-65 risk score showed statistically significant association with mortality (HR 1.11, 95% CI 1.01-1.23, P = 0.027), while receiving operator characteristics (ROC) showed significant discrimination of all-cause mortality with an AUC of 0.85 (95% CI 0.72-0.94, P < 0.001), and satisfactory calibration (χ2 4.91, P = 0.555 and Harrell's C 0.835). Finally, survival Kaplan-Meier analysis confirmed significantly higher cumulative incidence of mortality with increasing risk score tertiles and curve separation after 13 days (P = 0.009). CONCLUSION A novel risk score CROW-65 showed significant association with all-cause mortality in KTR yielding important hypothesis-generating findings. Further powered studies should reassess the performance of CROW-65 risk score in this population, including predictability, calibration and discrimination.
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