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Jose J, Al-Dorzi HM, Al-Omari A, Mandourah Y, Al-Hameed F, Sadat M, Al Qasim E, Alraddadi B, Al Harthy A, Al Mekhlafi GA, Almotairi A, Al Khatib K, Abdulmomen A, Qushmaq I, Sindi AA, Mady A, Solaiman O, Al-Raddadi R, Maghrabi K, Ragab A, Kharaba A, Shalhoub S, Al-Aithan AM, Vishwakarma GK, Bhattacharjee A, Arabi YM. Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study. BMC Infect Dis 2021; 21:84. [PMID: 33468070 PMCID: PMC7814976 DOI: 10.1186/s12879-021-05771-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS). METHODS This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality. RESULTS Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72). CONCLUSIONS Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
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Affiliation(s)
- Jesna Jose
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Mathematics & Computing, Indian Institute of Technology (ISM), Dhanbad, Jharkhand 826004 India
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Awad Al-Omari
- Department of Intensive Care, College of Medicine, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fahad Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Musharaf Sadat
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basem Alraddadi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Ghaleb A. Al Mekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Almotairi
- Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kasim Al Khatib
- Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ahmed Abdulmomen
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ismael Qushmaq
- Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Anees A. Sindi
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Tanta University Hospitals, Tanta, Egypt
| | - Othman Solaiman
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rajaa Al-Raddadi
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Maghrabi
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Ragab
- Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah, Saudi Arabia
| | - Sarah Shalhoub
- Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada
- King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulsalam M. Al-Aithan
- Department of Medicine, Critical Care Division, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia
| | - Gajendra K. Vishwakarma
- Department of Mathematics & Computing, Indian Institute of Technology (ISM), Dhanbad, Jharkhand 826004 India
| | - Atanu Bhattacharjee
- Homi Bhaba National Institute, Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
| | - Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - The Saudi Critical Care Trials Group
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Mathematics & Computing, Indian Institute of Technology (ISM), Dhanbad, Jharkhand 826004 India
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Intensive Care, College of Medicine, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia
- Military Medical Services, Ministry of Defense, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
- Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
- Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Tanta University Hospitals, Tanta, Egypt
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia
- Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah, Saudi Arabia
- Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada
- King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- Department of Medicine, Critical Care Division, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia
- Homi Bhaba National Institute, Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
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Arabi YM, Shalhoub S, Mandourah Y, Al-Hameed F, Al-Omari A, Al Qasim E, Jose J, Alraddadi B, Almotairi A, Al Khatib K, Abdulmomen A, Qushmaq I, Sindi AA, Mady A, Solaiman O, Al-Raddadi R, Maghrabi K, Ragab A, Al Mekhlafi GA, Balkhy HH, Al Harthy A, Kharaba A, Gramish JA, Al-Aithan AM, Al-Dawood A, Merson L, Hayden FG, Fowler R. Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study. Clin Infect Dis 2020; 70:1837-1844. [PMID: 31925415 PMCID: PMC7108209 DOI: 10.1093/cid/ciz544] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. METHODS This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. RESULTS Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a; none received rIFN-β1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73-1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30-1.44]; P = .29). CONCLUSIONS In this observational study, RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sarah Shalhoub
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.,King Fahad Armed Forces Hospital, Jeddah
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, Prince Sultan Military Medical City, Riyadh
| | - Fahad Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah
| | - Awad Al-Omari
- Department of Intensive Care, College of Medicine, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh
| | - Eman Al Qasim
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jesna Jose
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Basem Alraddadi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah.,Department of Medicine, University of Jeddah
| | | | - Kasim Al Khatib
- Intensive Care Department, Al-Noor Specialist Hospital, Makkah
| | - Ahmed Abdulmomen
- Department of Critical Care Medicine, King Saud University, Riyadh
| | - Ismael Qushmaq
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah
| | - Anees A Sindi
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia.,Tanta University Hospitals, Egypt
| | - Othman Solaiman
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh
| | - Rajaa Al-Raddadi
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University
| | - Khalid Maghrabi
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh
| | - Ahmed Ragab
- Intensive Care Department, King Fahd Hospital, Jeddah
| | | | - Hanan H Balkhy
- Department of Infection Prevention and Control, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh
| | | | - Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah
| | - Jawaher A Gramish
- Pharmaceutical Care Department, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh
| | - Abdulsalam M Al-Aithan
- Department of Medicine, Critical Care Division, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Laura Merson
- International Severe Acute Respiratory and Emerging Infection Consortium, Infectious Diseases Data Observatory, Oxford University, United Kingdom
| | - Frederick G Hayden
- International Severe Acute Respiratory and Emerging Infection Consortium, Infectious Diseases Data Observatory, Oxford University, United Kingdom.,Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Robert Fowler
- Institute of Health Policy Management and Evaluation, University of Toronto, Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Ontario, Canada
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Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA, Hussein MA, Jose J, Pinto R, Al-Omari A, Kharaba A, Almotairi A, Al Khatib K, Alraddadi B, Shalhoub S, Abdulmomen A, Qushmaq I, Mady A, Solaiman O, Al-Aithan AM, Al-Raddadi R, Ragab A, Balkhy HH, Al Harthy A, Deeb AM, Al Mutairi H, Al-Dawood A, Merson L, Hayden FG, Fowler RA. Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med 2019; 197:757-767. [PMID: 29161116 DOI: 10.1164/rccm.201706-1172oc] [Citation(s) in RCA: 762] [Impact Index Per Article: 152.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Corticosteroid therapy is commonly used among critically ill patients with Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation. OBJECTIVES To investigate the association of corticosteroid therapy on mortality and on MERS coronavirus RNA clearance in critically ill patients with MERS. METHODS ICU patients with MERs were included from 14 Saudi Arabian centers between September 2012 and October 2015. We performed marginal structural modeling to account for baseline and time-varying confounders. MEASUREMENTS AND MAIN RESULTS Of 309 patients, 151 received corticosteroids. Corticosteroids were initiated at a median of 3.0 days (quartile 1 [Q1]-Q3, 1.0-7.0) from ICU admission. Patients who received corticosteroids were more likely to receive invasive ventilation (141 of 151 [93.4%] vs. 121 of 158 [76.6%]; P < 0.0001) and had higher 90-day crude mortality (112 of 151 [74.2%] vs. 91 of 158 [57.6%]; P = 0.002). Using marginal structural modeling, corticosteroid therapy was not significantly associated with 90-day mortality (adjusted odds ratio, 0.75; 95% confidence interval, 0.52-1.07; P = 0.12) but was associated with delay in MERS coronavirus RNA clearance (adjusted hazard ratio, 0.35; 95% CI, 0.17-0.72; P = 0.005). CONCLUSIONS Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.
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Affiliation(s)
| | - Yasser Mandourah
- 3 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fahad Al-Hameed
- 4 Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Anees A Sindi
- 5 Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghaleb A Almekhlafi
- 3 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Jesna Jose
- 6 Department of Biostatistics and Bioinformatics, and
| | - Ruxandra Pinto
- 7 Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Awad Al-Omari
- 8 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,9 Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- 10 Department of Critical Care, King Fahad Hospital, Al-Madinah Al-Monawarah, Saudi Arabia.,11 Department of Critical Care, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia
| | - Abdullah Almotairi
- 12 Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kasim Al Khatib
- 13 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Basem Alraddadi
- 8 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,14 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Sarah Shalhoub
- 15 Division of Infectious Diseases, Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ahmed Abdulmomen
- 16 Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ismael Qushmaq
- 14 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Mady
- 17 Department of Anesthesiology and Intensive Care, Tanta University Hospitals, Tanta, Egypt.,18 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Othman Solaiman
- 19 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Rajaa Al-Raddadi
- 21 Department of Research, Ministry of Health, Jeddah, Saudi Arabia
| | - Ahmed Ragab
- 22 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Hanan H Balkhy
- 1 College of Medicine.,23 Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Al Harthy
- 17 Department of Anesthesiology and Intensive Care, Tanta University Hospitals, Tanta, Egypt
| | - Ahmad M Deeb
- 24 Research Office, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hanan Al Mutairi
- 24 Research Office, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Laura Merson
- 25 International Severe Acute Respiratory and Emerging Infection Consortium, Infectious Diseases Data Observatory, Oxford University, Oxford, United Kingdom
| | - Frederick G Hayden
- 25 International Severe Acute Respiratory and Emerging Infection Consortium, Infectious Diseases Data Observatory, Oxford University, Oxford, United Kingdom.,26 Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert A Fowler
- 27 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; and.,28 Department of Critical Care Medicine and.,29 Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
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Alraddadi BM, Qushmaq I, Al-Hameed FM, Mandourah Y, Almekhlafi GA, Jose J, Al-Omari A, Kharaba A, Almotairi A, Al Khatib K, Shalhoub S, Abdulmomen A, Mady A, Solaiman O, Al-Aithan AM, Al-Raddadi R, Ragab A, Balkhy HH, Al Harthy A, Sadat M, Tlayjeh H, Merson L, Hayden FG, Fowler RA, Arabi YM. Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome. Influenza Other Respir Viruses 2019; 13:382-390. [PMID: 30884185 PMCID: PMC6586182 DOI: 10.1111/irv.12635] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied. Methods Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV). Results Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90‐day mortality (propensity score‐adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27). Conclusions In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.
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Affiliation(s)
- Basem M Alraddadi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Fahad M Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Yasser Mandourah
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Ghaleb A Almekhlafi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Jesna Jose
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Awad Al-Omari
- Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- Department of Critical Care, Ohoud Hospitals, King Fahad Hospital, Al-Madinah Al-Monawarah, Saudi Arabia
| | | | - Kasim Al Khatib
- Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Sarah Shalhoub
- Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada.,Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Ahmed Mady
- Department of Anesthesiology, Intensive Care, Tanta University Hospitals, Tanta, Egypt.,Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Othman Solaiman
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Rajaa Al-Raddadi
- Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Ahmed Ragab
- Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Hanan H Balkhy
- Infection Prevention and Control Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Musharaf Sadat
- Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Laura Merson
- Infectious Diseases Data Observatory, Churchill Hospital, Oxford University, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Headington, UK
| | - Frederick G Hayden
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Charlottesville, Virginia
| | - Robert A Fowler
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yaseen M Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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5
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Shalhoub S, Al-Hameed F, Mandourah Y, Balkhy HH, Al-Omari A, Al Mekhlafi GA, Kharaba A, Alraddadi B, Almotairi A, Al Khatib K, Abdulmomen A, Qushmaq I, Mady A, Solaiman O, Al-Aithan AM, Al-Raddadi R, Ragab A, Al Harthy A, Al Qasim E, Jose J, Al-Ghamdi G, Merson L, Fowler R, Hayden FG, Arabi YM. Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study. PLoS One 2018; 13:e0206831. [PMID: 30439974 PMCID: PMC6237307 DOI: 10.1371/journal.pone.0206831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022] Open
Abstract
Background Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes. Aim We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS. Methods Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012–9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale. Findings Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days. Conclusion Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.
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Affiliation(s)
- Sarah Shalhoub
- Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada, Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fahad Al-Hameed
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Yasser Mandourah
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hanan H. Balkhy
- Department of Infection Prevention and Control, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Awad Al-Omari
- Department of Intensive Care, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia
| | - Ghaleb. A. Al Mekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia
| | - Basem Alraddadi
- Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah Almotairi
- Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kasim Al Khatib
- Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ahmed Abdulmomen
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Othman Solaiman
- Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Rajaa Al-Raddadi
- Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Ahmed Ragab
- Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia
| | | | - Eman Al Qasim
- Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jesna Jose
- Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ghassan Al-Ghamdi
- Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Laura Merson
- Infectious Diseases Data Observatory, Oxford University, Headiington, United Kingdom
| | - Robert Fowler
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Frederick G. Hayden
- Department of Medicine, Division of Infectious Diseases and International Health University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Yaseen M. Arabi
- Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- * E-mail:
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Arabi YM, Alsolamy S, Al-Dawood A, Al-Omari A, Al-Hameed F, Burns KEA, Almaani M, Lababidi H, Al Bshabshe A, Mehta S, Al-Aithan AM, Mandourah Y, Almekhlafi G, Finfer S, Abdukahil SAI, Afesh LY, Dbsawy M, Sadat M. Thromboprophylaxis using combined intermittent pneumatic compression and pharmacologic prophylaxis versus pharmacologic prophylaxis alone in critically ill patients: study protocol for a randomized controlled trial. Trials 2016; 17:390. [PMID: 27488380 PMCID: PMC4972959 DOI: 10.1186/s13063-016-1520-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/22/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) remains a common problem in critically ill patients. Pharmacologic prophylaxis is currently the standard of care based on high-level evidence from randomized controlled trials. However, limited evidence exists regarding the effectiveness of intermittent pneumatic compression (IPC) devices. The Pneumatic compREssion for preventing VENous Thromboembolism (PREVENT trial) aims to determine whether the adjunct use of IPC with pharmacologic prophylaxis compared to pharmacologic prophylaxis alone in critically ill patients reduces the risk of VTE. METHODS/DESIGN The PREVENT trial is a multicenter randomized controlled trial, which will recruit 2000 critically ill patients from over 20 hospitals in three countries. The primary outcome is the incidence of proximal lower extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the scans are blinded to intervention allocation, whereas the patients and caregivers are unblinded. The trial has 80 % power to detect a 3 % absolute risk reduction in proximal DVT from 7 to 4 %. DISCUSSION The first patient was enrolled in July 2014. As of May 2015, a total of 650 patients have been enrolled from 13 centers in Saudi Arabia, Canada and Australia. The first interim analysis is anticipated in July 2016. We expect to complete recruitment by 2018. TRIAL REGISTRATION Clinicaltrials.gov: NCT02040103 (registered on 3 November 2013). Current controlled trials: ISRCTN44653506 (registered on 30 October 2013).
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
| | - Sami Alsolamy
- Emergency Medicine and Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia
| | - Awad Al-Omari
- Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Fahad Al-Hameed
- Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Mohammed Almaani
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, ᅟRiyadh, ᅟSaudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hani Lababidi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, ᅟRiyadh, ᅟSaudi Arabia
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Assir Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Sangeeta Mehta
- Medical/Surgical ICU, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Yasser Mandourah
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.,International Extended Care Centers, ᅟJeddah, ᅟSaudi Arabia
| | - Ghaleb Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Simon Finfer
- Intensive Care Royal North Shore Hospital of Sydney and Sydney Adventist Hospital, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Lara Y Afesh
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Maamoun Dbsawy
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Musharaf Sadat
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Iqbal M, Al-Aithan AM, Rehmani R, Eledrisi M. Initial experience with an intensive care hyperglycemia protocol in a Saudi Arabian intensive care unit. Saudi Med J 2006; 27:492-6. [PMID: 16598326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE To study the efficacy of nurse-driven intensive glucose management protocol in an intensive care setting. METHODS This cohort study took place at King Abdul-Aziz National Guard Hospital, Al-Hasa, Saudi Arabia from April 2005 through June 2005. We modified a validated nurse-driven glycemic protocol when glucose level was >11.1 mmol/L. Protocol was applied to 103 consecutive patients. Three months after implementing the protocol, we analyzed the glucose control and relevant patient variables. To check the efficacy, glucose values were compared with patients admitted consecutively 2 months prior to the implementation of the protocol. Duration and mean insulin infusion rates were also recorded. A brief nursing survey was also conducted. RESULTS The median blood glucose upon ICU admission was 8.7 mmol/L (interquartile range 6.9-12.05). Our cohort included 45 patients with history of diabetes while the remaining 58 were non-diabetics. Mean blood glucose decreased from 10 +/- 4.4 mmol/L on admission to 8.2 +/- 1.8 mmol/L for the duration of ICU stay. Protocol was effective in both diabetics and non-diabetics. Insulin infusion was employed in 33 patients. Median insulin infusion rate required throughout the ICU length of stay was 4.3 units/hour. Duration and rate of insulin infusion were not statistically significant between diabetics and non-diabetics. The glucose control was significantly better when compared with the prior practices of glucose control. CONCLUSION Our study demonstrates that nurse-driven hyperglycemia protocol were manageable to used in critically ill patients. Moreover, the protocol is equally effective in both diabetic and non-diabetic patients.
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Affiliation(s)
- Mobeen Iqbal
- Department of Medicine, King Abdul-Aziz National Guard Hospital, Al-Hasa, Kingdom of Saudi Arabia
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