Procalcitonin as a predictor of severity and mortality in a cohort of patients hospitalised with COVID-19

INTRODUCTION

To evaluate the association of Procalcitonin (PCT) with severity in Coronavirus disease 2019 (COVID-19), hospitalised patients and to test the hypothesis that it is an independent predictor of mortality.

MATERIALS AND METHODS

This study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine and Department of Medicine, Aga Khan University (AKU), Karachi Pakistan. Electronic medical records of all in-patients including both genders and all age groups with documented COVID-19 from March to August 2020 were reviewed and recorded on a pre-structured performa. The subjects were divided into two categories severe and non-severe COVID-19; and survivors and non-survivors. Between-group differences were tested using the Chi-square and Mann-Whitney's U-test. The receiver operating characteristic curve was plotted for serum PCT with severity and mortality. A binary logistic regression was used to identify variables independently associated with mortality. The data was analysed using SPSS.

RESULTS

336 patients were reviewed as declared COVID-19 positive during the study duration, and 136 were included in the final analysis including 101 males and 35 females. A statistically significant difference in PCT was found between severe and non-severe COVID-19 (p value=0.01); and survivors and nonsurvivors (p value<0.0001). PCT, older age and increased duration of hospital stay were revealed as variables independently associated with mortality. On ROC analysis, an AUC of 0.76 for mortality prediction was generated for PCT.

CONCLUSION

Baseline serum PCT concentration is a promising predictor of mortality and severity in COVID-19 cases when considered in combination with clinical details and other laboratory tests.

The association of malnutrition with mortality and amputation outcomes in critical limb ischemia: a systematic review

Introduction

Critical limb ischemia (CLI) is a severe stage of peripheral arterial disease with high mortality. Malnutrition has been recognized as a potentially modifiable risk factor that may be prognostic of mortality and amputation outcomes in CLI. Great variability exists in the measurement of malnutrition including surrogate markers such as albumin level and body mass index (BMI) but also validated tools including geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT).

Purpose

To conduct a systematic review examining the association of malnutrition with mortality and amputation outcomes in patients with CLI.

Methods

A systematic literature search of AMED, CINAHL, Cochrane Library, Medline, Embase, Pubmed, Scopus, Web of Science, and Google Scholar was conducted through September 12, 2020. The review protocol was registered in PROSPERO. Only CLI patients were included. It was limited by adult human studies and those after 1982, when CLI was first defined. Eligible studies were randomized controlled trials, cohort studies, and case-control studies while case series, case reports, editorials, conference abstracts, and non-English studies were excluded. Malnutrition measured by albumin, BMI, or a validated malnutrition assessment tool was included. Outcomes of interest were mortality, any amputation, amputation free survival (AFS), major adverse limb events (MALE), major adverse cardiovascular events (MACE), or a composite of these. Two reviewers independently performed screening, data extraction, and quality assessment with a third independent reviewer resolving disagreements.

Results

3290 initial studies were found. The final 33 eligible studies were from 7 countries published between 2002 to 2020. Of these 30 were retrospective cohort studies, three were prospective cohort studies, and none were randomized controlled trials. No studies were at serious or critical risk of bias by evaluation with ROBINS-I quality tool. The average sample size was 553 patients (range N=21–5110). The median age was 72 years and 67.1% were male. The prognostic association of malnutrition and outcomes varied by malnutrition tool used. Malnutrition as measured by the validated tools of GNRI and CONUT was associated with all mortality outcomes, except for GNRI and cardiovascular mortality. The malnutrition surrogate markers of albumin and BMI were only associated with mortality outcomes in 62.5–75% of results. The validated nutrition tools were also consistently prognostic of amputation outcomes in all results, whereas surrogate markers only in 62.5–67%. Overall malnutrition by validated tools was prognostic in 14/15 (93.3%) of results while surrogate markers in 29/42 (69%) of results. See table 1.

Conclusion

Malnutrition is prognostically associated with mortality and amputation outcomes in CLI. This association is most consistent when malnutrition is assessed by a validated tool.

Funding Acknowledgement

Type of funding sources: None.

Thoracic endometriosis: an unusual cause of hemothorax

In this report we describe the clinical presentation, diagnosis, treatment and outcome of a 45-year-old woman with thoracic endometriosis. Four clinical presentations have been described. The majority have presented with catamenial pneumothorax, followed by hemothorax, hemoptysis and lung nodules. Our patient presented with right-sided hemothorax and lung nodules. Video-assisted thoracoscopic aurgery confirmed the presence of endometrial tissue embedded in the diaphragmatic pleura. Talc pleurodesis alongwith atotal abdominal hysterectomy and bilateral salpingo-oophorectomy led to a clinical and radiological resolution.