Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia

This study aims to examine the clinical characteristics and mortality-related factors of obstetric patients, who were taken to the intensive care unit due to Coronavirus Disease 2019 (COVID-19). This study included 31 patients in the peripartum period with COVID-19 pneumonia, followed up in the intensive care unit (ICU) from March 2020 to December 2020. Symptoms, laboratory values, intensive care unit duration of stay, complications, the requirement of non-invasive and invasive mechanical ventilation, and mortality were recorded. The mean age was 30.7 ± 6.2 years and the mean gestational age was 31.1 ± 6.4 weeks. Among the patients, 25.8% had a fever, 87.1% had a cough, 96.8% had dyspnoea and 77.4% had tachypnoea. Seventeen patients (54.8%) had mild, 6 (19.4%) had moderate and 8 (25.8%) had severe pulmonary involvement on computed tomography. Sixteen (51.6%) patients required high-frequency oscillatory ventilation, 6 (19.3%) patients required continuous positive airway pressure, and 5 (16.1%) patients required invasive mechanical ventilation. Sepsis complicated by septic shock and multiorgan failure occurred in 4 patients and all of them died. The ICU duration of stay was 4.9 ± 4.3 days. We have found that older maternal age, obesity, high LDH, AST, ALT, ferritin, leukocyte, CRP, and procalcitonin values, and severe lung involvement were mortality-related factors.Impact statementWhat is already known on this subject? Pregnant women are in the high-risk group for Covid-19 disease and its complications. Although most pregnant women are asymptomatic, severe infection-related hypoxia can cause serious foetal and maternal problems.What do the results of this study add? When we examined the literature, we found that the number of studies on pregnant women with severe Covid-19 infection was limited. For this reason, with our study results, we aim to contribute to the literature by determining the biochemical parameters and patient-related factors associated with severe infection and mortality in pregnant patients with severe Covid-19 infection.What are the implications of these findings for clinical practice and/or further research? With our study results, predisposing factors for the development of severe Covid-19 infection in the pregnant patient population and biochemical parameters that are early indicators of severe infection were determined. In this way, pregnant women in the high-risk group can be followed closely and the necessary treatments can be started quickly so disease-related complications and mortality can be reduced.

One Year Survival of Extrahepatic Cholangiocarcinoma Patients Who Did Not Undergo Curative Resection and Paliative Chemotherapy and Its Associated Factors

BACKGROUND

Extrahepatic cholangiocarcinoma is rare but fatal. Patients who come are usually already in the advanced stage that can not undergo curative resection and chemotherapy also seems to be very rarely done. The survival rate and its associated factors in Indonesia are unknown. This study aimed to identify 1-year survival of patients with extrahepatic cholangiocarcinoma without curative resection and palliative chemotherapy and its associated factors.

METHODS

This is a cross-sectional study using medical records of extrahepatic cholangiocarcinoma (perihilar and distal) inpatient and outpatient patients at Cipto Mangunkusumo Hospital, Jakarta from January 2015 to March 2020, reviewed retrospectively. The following factors were analyzed in terms of mortality: metastasis, sepsis, hypoalbuminemia, serum bilirubin level, serum CA 19-9 level, billiary drainage, neutrophyl lympocyte ratio (NLR) and comorbid factors.

RESULTS

115 out of 144 patients were enrolled in this study with male proportion of 50.4%, and proportion of patients aged 65 years or above was 71.3%. 1 year survival rate was 10 % and median survival was 3 months (CI 95% 2.388-3.612)Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and total bilirubin >19.8 mg/dl were independent predictors of mortality.

CONCLUSION

1 year survival of extrahepatic cholangiocarcinoma without curative resection and paliative chemotherapy was 10 %.Sepsis, unsuccessful or no prior bilirary drainage, and total biirubin >19.8 mg/dl  are factors significantly associated with shortened survival in malignant obstructive jaundice patients.

Six-month Survival of Patients with Malignant Distal Biliary Stricture Following Endoscopic Biliary Stent Procedure and Its Associated Factors

BACKGROUND

unresectable malignant distal biliary stricture patients require endoscopic biliary stent placement procedure. The survival rate and its associated factors in Indonesia are unknown.

OBJECTIVES

To identify 6-month survival of patients with malignant distal biliary stricture following endoscopic biliary stent procedure and its associated factors.

METHODS

a retrospective cohort study was conducted using medical records of patients with unresectable malignant distal biliary stricture, which involved caput of pancreas, ampulla of Vater or distal cholangiocarcinoma following endoscopic biliary stent procedure between June 2015 and August 2017 at Cipto Mangunkusumo National Central General Hospital. The cumulative survival was defined by using the Kaplan-Meier curve. Bivariate and multivariate analyses were performed using Cox regression of some factors including failure of biliary stent insertion, bleeding, sepsis, comorbidities, malnutrition, and serum albumin levels.

RESULTS

out of total 120 subjects, 85 subjects died within 6 months following the stent procedure with a proportion of 180-day survival of 24% and a median survival of 81 days (CI 95%: 56-106 days). In bivariate analysis, factors of comorbidities, sepsis, malnutrition and albumin levels ≤ 3.0 g/dL had p values of < 0.25; while the subsequent multivariate analysis showed that albumin level of ≤ 3.0 g/dL had HR of 2.73 (CI 95%: 1.48 - 5.05; p = 0.001).

CONCLUSION

the 6-month survival following endoscopic biliary stent procedure is 24% with a median survival of 81 days. Albumin level of ≤ 3.0 g/dL has a 2.73 times greater risk for 6-month mortality rate.