1
|
Santos TA, Oliveira JED, Fonseca CDD, Barbosa DA, Belasco AGDS, Miura CRM. Sepsis and COVID-19: outcomes in young adults in intensive care. Rev Bras Enferm 2023; 76:e20230037. [PMID: 38055486 DOI: 10.1590/0034-7167-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables. METHODS a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records. RESULTS sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis. CONCLUSIONS there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.
Collapse
|
2
|
Ramos FJDS, Atallah FC, de Souza MA, Ferreira EM, Machado FR, Freitas FGR. Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil. J Bras Pneumol 2023; 48:e20220083. [PMID: 36629631 PMCID: PMC9747148 DOI: 10.36416/1806-3756/e20220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/07/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave. METHODS This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death. We assessed factors associated with in-hospital mortality using logistic regression models. RESULTS We included 645 patients with a mean age of 61.4 years. Of those, 387 (60.0%) were male, 12.9% (83/643) had undergone solid organ transplant, and almost 10% (59/641) had nosocomial COVID-19 infection. During ICU stay, 359/644 patients (55.7%) required invasive mechanical ventilation, 225 (34.9%) needed renal replacement therapy, 337 (52.2%) received vasopressors, and 216 (33.5%) had hospital-acquired infections (HAIs), mainly caused by multidrug-resistant gram-negative bacteria. HAIs were independently associated with a higher risk of death. The major causes of death were refractory shock and multiple organ dysfunction syndrome but not ARDS, as previously reported in the literature. CONCLUSIONS In this study, most of our cohort required invasive mechanical ventilation and almost one third had HAIs, which were independently associated with a higher risk of death. Other factors related to death were Charlson Comorbidity Index, SOFA score at admission, and clinical complications during ICU stay. Nosocomial COVID-19 infection was not associated with death. The main immediate causes of death were refractory shock and multiple organ dysfunction syndrome.
Collapse
Affiliation(s)
- Fernando Jose da Silva Ramos
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Hospital BP Mirante, São Paulo (SP) Brasil
| | - Fernanda Chohfi Atallah
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Hospital BP Mirante, São Paulo (SP) Brasil
| | - Maria Aparecida de Souza
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Elaine Maria Ferreira
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Flavia Ribeiro Machado
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Flavio Geraldo Resende Freitas
- . Serviço de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Hospital SEPACO, São Paulo (SP) Brasil
| |
Collapse
|
3
|
Singh M, Pushpakumar S, Bard N, Zheng Y, Homme RP, Mokshagundam SPL, Tyagi SC. Simulation of COVID-19 symptoms in a genetically engineered mouse model: implications for the long haulers. Mol Cell Biochem 2023; 478:103-119. [PMID: 35731343 PMCID: PMC9214689 DOI: 10.1007/s11010-022-04487-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
The ongoing pandemic (also known as coronavirus disease-19; COVID-19) by a constantly emerging viral agent commonly referred as the severe acute respiratory syndrome corona virus 2 or SARS-CoV-2 has revealed unique pathological findings from infected human beings, and the postmortem observations. The list of disease symptoms, and postmortem observations is too long to mention; however, SARS-CoV-2 has brought with it a whole new clinical syndrome in "long haulers" including dyspnea, chest pain, tachycardia, brain fog, exercise intolerance, and extreme fatigue. We opine that further improvement in delivering effective treatment, and preventive strategies would be benefited from validated animal disease models. In this context, we designed a study, and show that a genetically engineered mouse expressing the human angiotensin converting enzyme 2; ACE-2 (the receptor used by SARS-CoV-2 agent to enter host cells) represents an excellent investigative resource in simulating important clinical features of the COVID-19. The ACE-2 mouse model (which is susceptible to SARS-CoV-2) when administered with a recombinant SARS-CoV-2 spike protein (SP) intranasally exhibited a profound cytokine storm capable of altering the physiological parameters including significant changes in cardiac function along with multi-organ damage that was further confirmed via histological findings. More importantly, visceral organs from SP treated mice revealed thrombotic blood clots as seen during postmortem examination. Thus, the ACE-2 engineered mouse appears to be a suitable model for studying intimate viral pathogenesis thus paving the way for identification, and characterization of appropriate prophylactics as well as therapeutics for COVID-19 management.
Collapse
Affiliation(s)
- Mahavir Singh
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA.
| | - Sathnur Pushpakumar
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Nia Bard
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Yuting Zheng
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Rubens P Homme
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Sri Prakash L Mokshagundam
- Division of Endocrinology, Metabolism and Diabetes and Robley Rex VA Medical Center, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Suresh C Tyagi
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| |
Collapse
|
4
|
Rai DK, Sahay N. Six-month Morbidity and Mortality in Patients after Recovery from COVID-19. Indian J Crit Care Med 2022; 26:1179-1183. [PMID: 36873598 PMCID: PMC9983654 DOI: 10.5005/jp-journals-10071-24347] [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: 07/17/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background This telephonic survey was aimed to identify the proportion of coronavirus disease-2019 (COVID-19) patients who died from any cause, within 6 months of discharge from a tertiary COVID-19 care hospital. We also analyzed whether any clinical and/or laboratory variables were associated with post-discharge mortality. Materials and methods All adult patients (age ≥18 years) who had been discharged during the period between July 2020 and August 2020 from a tertiary COVID-19-care hospital after initial hospitalization for COVID-19 were included. A telephonic interview was conducted 6 months after discharge to assess morbidity and mortality in these patients. Results Out of the 457 patients who responded, 79 patients (17.21%) were symptomatic, and breathlessness was found as most common symptom (6.12%). Fatigue was noted in (5.93%) of study patients, followed by cough (4.59%), sleep disturbances (4.37%), and headache (2.62%). Of the 457 patients who responded, 42 patients (9.19%) required expert medical consultation for their persistent symptoms. Thirty-six patients (7.88%) required re-hospitalization for post-COVID-19 complications within 6 months of discharge. A total of 10 patients (2.18%) succumbed within 6 months of their discharge from the hospital. 6 patients were males and 4 females. Most of these patients (7/10) succumbed in the second month after discharge. Seven patients had moderate-to-severe COVID-19 disease and most of these (7/10) had not been treated in the intensive care unit (ICU). Conclusion Post-COVID-19 mortality figures were not very high in our survey despite the high perceived risk of thromboembolic events after recovery from COVID-19. A significant proportion of patients reported persistent post-COVID-19 symptoms. Breathing difficulty was the most common symptom noted by us, closely followed by fatigue. How to cite this article Rai DK, Sahay N. Six-month Morbidity and Mortality in Patients after Recovery from COVID-19. Indian J Crit Care Med 2022;26(11):1179-1183.
Collapse
Affiliation(s)
- Deependra Kumar Rai
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Nishant Sahay
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
5
|
Jadaun SS, Singh SA, Madan K, Gupta S. "SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?". J Clin Exp Hepatol 2022; 12:384-389. [PMID: 34305351 PMCID: PMC8294560 DOI: 10.1016/j.jceh.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 is associated with higher mortality among patients who have comorbidities. However, evidences related to COVID-19 among post liver transplant recipients are scarce and evolving. METHODS Adult Indian patients who had undergone liver transplantation at our centre since 2006 and were under regular follow-up, were contacted either telephonically or on email. Data were recorded related to symptoms and diagnosis of COVID-19, need for hospitalization, and need for ICU stay and mortality. RESULTS Eighty one (3.71%) of the 2182 adult Liver transplant (LT) recipients on regular follow-up reported SARS-CoV-2 infection between 1st April 2020 and 31st May 2021. Mean age was 51.3(±9.8) years, and 74(91.4%) were males. Thirty five (43.2%) patients had one or more comorbidities. Twenty one (25.9%) patients were transplanted less than 1 year ago. Forty four (54.3% ) patients had mild disease only while 23(28.4%) patients had severe COVID-19 disease. Of the 81 patients 14 patients died and overall mortality was 17.3. CONCLUSION Uncomplicated liver transplant recipients without comorbidities who acquire SARS-CoV-2 do not have poor outcome.
Collapse
Key Words
- ARDS, Acute respiratory distress syndrome
- CAD, Coronary artery disease
- CKD, Chronic kidney disease
- CNIs, Calcineurin inhibitors
- COVID-19
- COVID-19, corona virus disease 2019
- LDLT, live donor liver transplants
- LT, Liver transplant
- NAAT, nucleic acid amplification test
- NAFLD, Nonalcoholic fatty liver disease
- NASH, Nonalcoholic steatohepatitis
- OPD, Outpatients department
- SARS-CoV-2, severe acute respiratory syndrome corona virus-2
- liver transplant
Collapse
Affiliation(s)
- Shekhar S. Jadaun
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Shweta A. Singh
- Center for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, 110017, India,Address for correspondence. Dr.Shweta A Singh, MD Anesthesiology, Director & Head Anesthesiology & Critical care, Center for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, 110017, India. Tel.: +919810625177.
| | - Kaushal Madan
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Subhash Gupta
- Center for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| |
Collapse
|
6
|
Anand A, Panghal R, Kaler P, Saigal S, Panda R, Kodamanchili S, Bhardwaj K, Gowthaman TB. Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India. Indian J Crit Care Med 2021; 25:1211. [PMID: 34916762 PMCID: PMC8645815 DOI: 10.5005/jp-journals-10071-23982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Anand A, Panghal R, Kaler P, Saigal S, Panda R, Kodamanchili S, et al. Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India. Indian J Crit Care Med 2021; 25(10):1211.
Collapse
Affiliation(s)
- Abhijeet Anand
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Reecha Panghal
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paridhi Kaler
- Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Saurabh Saigal
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajesh Panda
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saiteja Kodamanchili
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Krishnkant Bhardwaj
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - T B Gowthaman
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|
7
|
Wang Y, Xu J, Wang Y, Hou H, Shi L, Yang H. Prevalence of comorbid tuberculosis amongst COVID-19 patients: A rapid review and meta-analysis. Int J Clin Pract 2021; 75:e14867. [PMID: 34670351 PMCID: PMC8646527 DOI: 10.1111/ijcp.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yadong Wang
- Department of ToxicologyHenan Center for Disease Control and PreventionZhengzhouChina
| | - Jie Xu
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Ying Wang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Hongjie Hou
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Li Shi
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Haiyan Yang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| |
Collapse
|
8
|
Abstract
How to cite this article: Kumar A. COVID-19: Epidemiology, Case Fatalities and the Adversaries within. Indian J Crit Care Med 2021;25(6):603-605.
Collapse
Affiliation(s)
- Arun Kumar
- Department of Intensive Care, Medical Intensive Care Unit, Fortis Healthcare Ltd, Mohali, Punjab, India
| |
Collapse
|