Prognostic Factors Associated With Mortality of Patients With COVID-19 Requiring Ventilator Management: A Retrospective Cohort Study.

Aim There are few reports on the prognostic factors associated with mortality in coronavirus disease (COVID-19) patients with critical disease. This study assessed prognostic factors associated with mortality of patients with critical COVID-19 who required ventilator management. Methods This single-center, retrospective cohort study used medical record data of COVID-19 patients admitted to an emergency ICU at a hospital in Japan between March 1, 2020 and September 30, 2021, and provided with ventilator management. Multivariable logistic regression was used to identify factors associated with mortality. Results Seventy patients were included, of whom 29 (41.4%) died. The patients who died were significantly older (median: 69 years) (interquartile range [IQR]: 47-82 years) than the patients who survived (62 years [38-84 years], p<0.007). In addition, patients who died were significantly less likely to have received steroid therapy than patients who survived (25 [86.2%] vs. 41 [100%], p=0.026). In the multivariable analysis, age was identified as a significant prognostic factor for mortality and the risk of death increased by 6% for every one-year increase in age (OR: 1.06; 95% CI: 1.00-1.13; p=0.048). Medical history was not a risk factor for death. Conclusion Age was a predictor of mortality in critically ill patients with COVID-19. Therefore, the indications for critical care in older patients with COVID-19 should be carefully considered.

Diagnosis and long-term management of hydrolyzed wheat protein wheat-dependent exercise-induced anaphylaxis.

Case: A 37-year-old woman was admitted to the emergency room with bilateral periorbital edema, hypotension, and expiratory stridor that developed 30 min after starting to hang out washing following consumption of a jam bun. Despite no food allergies or similar episodes, she had recently developed facial wheals after bathing. Outcome: She was immediately and repeatedly administered adrenalin and succinic acid hydrocortisone sodium for wheat-dependent exercise-induced anaphylaxis. On the third hospital day, radioallergosorbent testing reactions to wheat, gluten, and omega-5 gliadin were mildly positive; skin-prick tests for hydrolyzed wheat protein and a face-wash challenge were positive. Therefore, we diagnosed hydrolyzed wheat protein wheat-dependent exercise-induced anaphylaxis. Despite advising her about hyposensitization, the episode recurred and an adrenalin auto-injector was prescribed. Conclusion: Differentiating hydrolyzed wheat protein wheat-dependent exercise-induced anaphylaxis from conventional wheat-dependent exercise-induced anaphylaxis is important owing to their severity and similarities. Each requires long-term management of patients' etiological conditions by advising them about hyposensitization and prescribing adrenalin auto-injectors.

Plasma nitrotyrosine concentration relates to prognosis in human septic shock.

Interrelation of plasma nitrotyrosine (NT) concentrations in patients of septic shock and their prognosis was examined. Blood samples were obtained from 12 patients during the first episode of septic shock at hospitalization, and their plasma NT concentrations were measured. Five patients died within five days after hospitalization, but seven patients recovered. Plasma NT concentrations (means +/- SE) of the non-survivors and survivors were 0.68 +/- 0.13 nmol/mL (n = 7), and 0.21 +/- 0.05 nmol/mL (n = 5), respectively, the former being significantly higher than the latter. The present results suggest that plasma concentration of NT relates to prognosis in human septic shock, although further studies with a larger patient population are necessary for confirmation of the suggestion.