The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

Background

The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia.

Methods

Single-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for invasive mechanical ventilation and hospital length of stay. Cox regression models were used to test the association between potential independent predictors and all-cause mortality.

Results

Two hundred thirty-five patients, 197 survivors and 38 nonsurvivors, were studied. The median Ichikado CT score for nonsurvivors was significantly higher than survivors (P < 0.001). An Ichikado CT score of more than 172 enabled prediction of mortality, with a sensitivity of 84.2% and a specificity of 79.7%. Multivariate analysis identified Ichikado CT score (HR, 7.772; 95% CI, 3.164–19.095; P < 0.001), together with age (HR, 1.030; 95% CI, 1.030–1.060; P = 0.043), as independent predictors of all-cause in-hospital mortality.

Conclusions

Ichikado CT score is an independent predictor of both requiring invasive mechanical ventilation and all-cause mortality in patients hospitalized with COVID-19 pneumonia. Further prospective evaluation is necessary to confirm these findings.

Trial registration: The WCG institutional review board approved this retrospective study and patient consent was waived due to its non-interventional nature (Identifier: 20210799).

Aeromedical Transport of Critically Ill Patients: A Literature Review

The aeromedical transport of critically ill patients has become an integral part of practicing medicine on a global scale. The development of reliable portable medical equipment allows physicians, emergency medical technicians, and nurses to transport wounded and diseased patients under constant critical care attention. Air transportation involves utilizing a fixed-wing (airplane) or rotor-wing (helicopter) aircraft to accomplish different types of transports ranging from scene responses to international transfers. The proper preparation and management of patients undergoing aeromedical transport require a basic understanding of the physiological changes and unique challenges encountered within the aircraft environment at 8,000 ft above sea level. The purpose of this paper is to review the literature and provide guidelines for approaching the aeromedical transportation of critically ill patients.

Pulmonary Infection Caused by Mycobacterium terrae: A Case Report and Literature Review

Mycobacterium terrae infection can cause progressive debilitating disease. A case of a 63-year-old man with localized pulmonary infection characterized by extensive, thick-walled cavitary lesions is presented. A pneumonectomy was considered as definitive treatment, but the patient would not have tolerated the procedure given his severe deconditioning. Instead, he was placed on lifelong antibiotic treatment, but he continued to deteriorate and passed away. The slow-growing microorganism, Mycobacterium terrae, was isolated from bronchoalveolar lavage cultures seven weeks after specimen collection, five and a half weeks after the patient's death. Clinical, microbiological and therapeutic data from this case and 16 other pulmonary cases from the literature are reviewed. Increased awareness of this microorganism will allow clinicians to consider Mycobacterium terrae in their differential diagnosis when dealing with nontuberculous mycobacteria infections.

Gene expression, serum amino acid levels, and growth performance of pigs fed dietary leucine and lysine at different ratios

We examined 96 pigs (28.1 ± 0.83 kg) to analyze the effect of Leu:Lys ratios on expression of the cationic amino acid transporters b(0,+) and CAT-1 in the jejunum and liver as well as myosin expression in 2 muscles to estimate the optimum standardized ileal digestible (SID) Leu:Lys ratio for growth rate and efficiency. A wheat-and wheat bran-based diets were formulated to meet the requirements of SID amino acids other than Leu (0.70%) and Lys (0.80%). L-Leu was added to the basal diet in 5 SID Leu:Lys ratios (88, 100, 120, 140, and 160% in diets 1-5). Tissue samples were collected from 8 pigs with ratios of 88, 120, and 160%. Relative expression of b(0,+), CAT-1, and myosin was analyzed. b(0,+) expression in the jejunum was higher but lower in the liver of pigs with the 120% ratio compared to those with the 88 or 160% ratio; myosin expression in longissimus dorsi was also higher in pigs with the 120% ratio (P < 0.05). CAT-1 was lower in the jejunum and longissimus dorsi of pigs with 120 or 160% ratios than in pigs with 88%. Serum concentration of nearly all amino acids decreased with excess dietary Leu (P < 0.05). The SID Leu:Lys of 104 and 109% optimized average daily gain and feed conversion ratio, respectively. Thus, the dietary Leu:Lys ratio affects the expression of genes coding for amino acid transporters and myosin, the availability of Lys, and the growth rate and efficiency in pigs.

Effect of L-valine supplementation to a wheat-based diet with leucine excess on performance, gene expression, and serum concentration of amino acids

Excess Leu in the diet reduces the expression of the cationic AA transporter b(0,+), absorption of Lys and Arg, feed intake, and ADG of pigs. Because Val competes with Leu for absorption, surplus Val may correct some of these effects. An experiment was conducted to analyze the effect of surplus Val in a basal wheat (Triticum aestivum) diet fortified with free Lys, Thr, and Met and containing excess Leu and Ile on performance, expression of genes encoding b(0,+), and serum concentrations of AA. Sixteen pigs (30.3 ± 2.1 kg BW) were used. Treatments were wheat based with excess Leu and Ile (T1) and T1 plus 0.44% L-Val (T2). At the end of the 21-d study, 12 pigs were euthanized; jugular blood was collected to analyze serum AA and jejunal mucosa to measure expression of b(0,+). Surplus Val increased (P < 0.05) ADG and G:F and serum Val, Lys, and Arg but did not affect (P > 0.10) b(0,+) expression. Although analyzed Val content in the basal diet was lower than calculated, the increased serum Lys and improved pig performance may suggest that excess Leu limits Val availability and that surplus Val could correct some of the negative effects of excess Leu.