The Effect of CRP/Albumin, Platelet/Lymphocyte, SOFA, and APACHE II in Predicting Mortality in Covid-19 Patients in Intensive Care Unit

Objectives: It is important to predict the prognosis during hospital admission of Covid-19 patients. The purpose of this study was to see how CRP/ Albumin (CAR) and Platelet/Lymphocyte (PLR) ratios, obtained from patients in the intensive care unit (ICU) within the first 24 hours of their hospitalization with a Covid-19 diagnosis, predictmortality and how they correlated with acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA). Method(s): Using hospital records, records of 83 patients hospitalized in the ICU with a diagnosis of Covid-19 between 11.03.2020 and 01.01.2021 were retrospectively analyzed . Patients were divided into two groups discharged (Group I) and exits (ex) group (Group II). CAR and PLR were recorded during the first 24 hours of ICU admission, and APACHE II and SOFA scores were computed. The calculated CAR and PLR were correlated with APACHE II and SOFA scores and their association with mortality was investigated. Result(s): SOFA, APACHE II, PLO, and age were higher, and albumin was lower in patients in the mortal course (p<0.05). ROC analysis revealed that APACHE II and SOFA scores could be employed to estimate mortality. Conclusion(s): We believe that APACHE II and SOFA scores can be used to predict mortality in patients admitted to the ICU due to Covid-19, whereas CRP/Albumin and Platelet/Lymphocyte ratios cannot. Copyright © 2023 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Predictors of Mortality in Sepsis Patients Resulting from Severe and Critical COVID-19

Patients with severe and critical COVID-19 may exhibit sepsis and mortality resulting from multi-organ failure. Neutrophil-lymphocyte-ratio (NLR) values, C-reactive protein (CRP) levels, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE-II) scores were used to assess the risk of mortality in sepsis patients resulting from severe COVID-19 infection. The adequacy of NLR, CRP, SOFA, and APACHE-II scores were evaluated as predictors of mortality in septic COVID-19 patients at Dr. Kariadi Hospital Semarang, Indonesia, between August 2021 and July 2022. The subjects included severe and critical COVID-19 patients who fulfilled the WHO interim guidelines and Sepsis-3 criteria. A total of 211 patients were included, which were divided into survivor (n = 116) and non-survivor (n = 95) groups. NLR values, CRP levels, SOFA, and APACHE-II scores were measured within 24 hours of patient admission. Univariate and multivariate logistic regression analyses were used to identify the risk factors for COVID-19 mortality. Receiver operating characteristic curve analysis was used to predict the mortality of severe COVID-19 patients. The results indicated that the APACHE-II score was an independent predictor of mortality in sepsis patients resulting from severe and critical COVID-19. © 2023 by SPC (Sami Publishing Company).

Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital.

HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.

Results from the first audit of an intensive care unit in Botswana.

Background: Botswana is an economically stable middle-income country with a developing health system and a large HIV and infectious disease burden. Princess Marina Hospital (PMH) is the largest referral and teaching hospital with a mixed eight-bed intensive care unit (ICU). Objectives: To conduct an audit of PMH ICU in order to investigate major admission categories and quantify morbidity and mortality figures using a validated scoring system for quality improvement, education and planning purposes. Methods: PMH medical records and laboratory data were accessed to record demographics, referral patterns, diagnoses, HIV status, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores and mortality rates. Results: A total of 182 patients >14 years of age were enrolled over a 12-month period from April 2017 - March 2018. Patient's mean age was 42.9 years, males represented 56.6% of the study population and surgical conditions accounted for 46% of diagnostic categories. Sixty percent of the patients were HIV-negative and 12% had no HIV status recorded. The mean APACHE II score was 25 and the mean length of stay in ICU was 10.3 days. Higher APACHE II scores were associated with higher mortality regardless of HIV status. The overall mortality was 42.8% and there was no difference in mortality rates in ICU or at 30 days between HIV-positive and HIV-negative ICU patient groups. Conclusion: The PMH ICU population is young with a high mean APACHE II score, significant surgical and HIV burdens and a high mortality rate. PMH ICU has significant logistical challenges making comparison with international ICUs challenging, and further research is warranted. Contributions of the study: This study is the first published audit for an intensive care unit in Botswana. The findings are especially relevant for the development of critical care capacity in the country during the current COVID-19 pandemic. We advocate for the establishment of an ICU registry in the country to allow ongoing accurate research in the field of critical care medicine and to improve healthcare for all critically ill patients in Botswana.

Prognostic value of intensive care scores concerning the prediction of 30-day mortality in COVID-19

Objective: The goal of our study was to determine the prognostic value of CURB-65, Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA, and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission in patients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off value for death regarding these parameters. Methods: This observational retrospective study was performed in COVID-19 triage in Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI, MuLBSTA, and CURB-65, data were collected from patients who were selected by available sampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality was assessed as the primary outcome. ROC analysis was conducted using the STATA software to evaluate the prognostic value of the scoring systems. DeLong test was utilized to compare AUC of scores using a web based tool. Results: Ninety-two patients were included in this study with the mean age of 51.02 ± 17.81 years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P = 0.130), but other indices had statistically significant values of AUC. Based on the comparison of the AUCs, SOFA was the worst scoring system in COVID-19 as it had significantly lower AUC than PSI and APACHE II (P < 0.05);while its comparison with MULBSTA and CURB65 was not statistically significant (P > 0.05). Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our study with no statistical difference compared together (P > 0.05). The sensitivity of APACHE II and PSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off point was 13 and 50 for APACHE II and PSI, respectively. © 2023 The Author(s).

Deciding When to Intubate a COVID-19 Patient.

Background: The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes. Methods: This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission. Results: Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival. Conclusions: There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.

A Comparison of ICU Mortality Scoring Systems Applied to COVID-19.

Background Over the past three years, COVID-19 has been a major source of mortality in intensive care units around the world. Many scoring systems have been developed to estimate mortality in critically ill patients. Our intent with this study was to compare the efficacy of these systems when applied to COVID-19. Methods The was a multicenter, retrospective cohort study of critically ill patients with COVID-19 admitted to 16 hospitals in Texas from February 2020 to March 2022. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, and 4C Mortality scores were calculated on the initial day of ICU admission. Primary endpoints were all-cause mortality, ICU length of stay, and hospital length of stay. Results Initially, 62,881 patient encounters were assessed, and the cohort of 292 was selected based on the inclusion of the requisite values for each of the scoring systems. The median age was 56 +/- 14.93 years and 61% of patients were male. Mortality was defined as patients who expired or were discharged to hospice and was 78%. The different scoring systems were compared using logistic regression, receiver operating characteristic (ROC) curve, and area under the ROC curve (AUC) analysis to compare the accuracy of prediction of the mortality and length of stay. The multivariate analysis showed that SOFA, APACHE II, SAPS II, and 4C scores were all significant predictors of mortality. The SOFA score had the highest AUC, though the confidence intervals for all of the models overlap therefore one model could not be considered superior to any of the others. Linear regression was performed to evaluate the models' ability to predict ICU and hospital length of stay, and none of the tested systems were found to be significant predictors of length of stay. Conclusion The SOFA, APACHE II, ISARIC 4-C, and SAPS II scores all accurately predicted mortality in critically ill patients with COVID-19. The SOFA score trended to perform the best.

Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II Score in COVID-19 Patients Admitted to the Intensive Care Unit in Times of Resource Scarcity.

Introduction During the coronavirus disease 2019 (COVID-19) pandemic, a high number of patients needed to be admitted to the intensive care units (ICUs). Such a high demand led to periods where resources were insufficient and the triage of patients was needed. This study aims to evaluate the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II as a predictor of mortality in periods where triage protocols were implemented. Methods A single-center, longitudinal, retrospective cohort study was performed on patients admitted to the ICU between January 2020 and December 2021. Patients were divided into two periods: Period 1 (where patients needing ICU admission outnumbered the available resources) and Period 2 (where resources were adequate). The discriminative power of the APACHE II was checked using the receiver operating characteristic (ROC) curves. Calibration was accessed, and survival analysis was performed. Results Data from 428 patients were analyzed (229 in Period 1 and 199 in Period 2). The area under the ROC curve (AUROC) was 0.763 for Period 1 and 0.761 for Period 2, reflecting a good discriminative power. Logistic regression showed the APACHE II to be a significant predictor of mortality. The Hosmer-Lemeshow test demonstrated good calibration. The Youden index was determined, and a log-rank test showed a significantly lower survival for patients with higher APACHE II scores in both periods. Conclusions The APACHE II score is an effective tool in predicting mortality in patients with COVID-19 admitted to the ICU in a period where resource allocation and triage of patients are needed, paving a way for the future development of better and improved triage systems.

Association of APACHE-II Scores With 30-Day Mortality After Tracheostomy: A Retrospective Study.

OBJECTIVE: The objective of this study was to assess whether the Acute Physiology, Age, Chronic Health Evaluation II (APACHE-II) score is a reliable predictor of 30-day mortality in the setting of adult patients with ventilator-dependent respiratory failure (VDRF) who undergo tracheostomy. METHODS: This is a retrospective, single-institution study. Potential subjects were identified using the current procedural terminology codes for the tracheostomy procedure and International Classification of Diseases, 10th Revision, codes for VDRF. APACHE-II scores were retrospectively calculated. Tracheostomies were performed in our population over an 18-month period (November 2018 through April 2020). Our study population did not include patients with novel coronavirus. The primary outcome was mortality at 30 days after tracheostomy. RESULTS: A total of 238 patients with VDRF who had a tracheostomy were included in this study. Twenty-eight (11.8%) patients died within 30 days of tracheostomy. The mean (standard deviation) APACHE-II score was 22.5 (10.2) for patients who died within 30 days of tracheostomy and 19.8 (7.4) for patients living within 30 days of tracheostomy (p = 0.30). Patients with APACHE-II scores greater than or equal to 30 showed higher odds of death within 30 days of tracheostomy (odds ratio, 3.0; 95% CI, 1.14-7.89, p = 0.03). CONCLUSION: An APACHE-II score of 30 and above is associated with mortality within 30 days of tracheostomy in patients with VDRF. APACHE-II scores may be a promising tool for assessing risk of mortality in patients with VDRF after tracheostomy. LEVEL OF EVIDENCE: 3 Laryngoscope, 2022.

Cytokine Levels and Severity of Illness Scoring Systems to Predict Mortality in COVID-19 Infection.

Various scoring systems and cytokines have been cited as predicting disease severity in COVID-19 infection. This study analyzed the link between mortality rate, levels of cytokines, and scoring systems such as the Glasgow Coma Scale (GCS), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index in patients infected with COVID-19. Adult patients infected with COVID-19 were followed up in the intensive care unit (ICU) and analyzed prospectively. We measured serum cytokine levels (Interleukin-10 (IL-10), Interleukin-8 (IL-8), Interleukin-6 (IL-6), Interleukin-1ß (IL-1ß), tumor necrosis factor-alpha (TNF-α) and High mobility group box 1 (HMGB-1)) and recorded GCS, APACHE II, SOFA, and Charlson comorbidity index scores on admission to the ICU. Receiver operating curve (ROC) analysis was performed to predict mortality from IL-1ß, IL-6 IL-10, IL-8, TNF-α, and HMGB-1 values. Study participants were grouped as follows: Group A, survivors, and Group B, deceased, during the 28-day follow-up. The mean age was 65.69 (±13.56) in Group A (n = 36) and 70.85 (±10.06) in Group B (n = 27). The female/male ratio was 23/40. Age, sex, body mass index (BMI), comorbid illnesses, GCS, APACHE II, SOFA, and Charlson scores, duration of hospitalization or ICU admission, therapeutic choices, and lymphocyte, PMNL, NLR, platelet, D-dimer, fibrinogen, GGT, CRP, procalcitonin, and lactate levels were similar between the groups. The frequency of acute kidney injury (AKI) was higher in Group B (p = 0.005). Serum IL-10, IL-8, IL-6, IL-1ß, TNF-α, HMGB-1, ferritin, and LDH values were higher, and PaO2/FiO2 was lower in Group B than in Group A. ROC analysis showed that there was an association between serum IL-1ß (>1015.7), serum IL-6 (>116.7), serum IL-8 (>258.4), serum IL-10 (>247.5), serum TNF-α (>280.7), and serum HMGB-1 (>23.5) and mortality. AKI gave rise to a greater risk of mortality (odds ratio: 7.081, p = 0.014). Mortality was associated with serum IL-10, IL-8, IL-6, IL-1ß, TNF-α, and HMGB-1 but not with GCS, APACHE II, SOFA, or Charlson comorbidity index scores. AKI increased the risk of mortality by seven times. Our findings suggest that cytokine levels (serum IL-10, IL-8, IL-6, IL-1ß, TNF-α, and HMGB-1) were predictors of mortality in COVID-19 infection. In addition, our results might give an opinion about the course of COVID-19 infection.

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era.

BACKGROUND: We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. METHODS: Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. RESULTS: Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. CONCLUSION: An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

Low muscle strength and low phase angle predicts greater risk to mortality than severity scales (APACHE, SOFA, and CURB-65) in adults hospitalized for SARS-CoV-2 pneumonia.

Introduction: The acute physiology and chronic health evaluation (APACHE), sepsis-related organ failure assessment (SOFA), score for pneumonia severity (CURB-65) scales, a low phase angle (PA) and low muscle strength (MS) have demonstrated their prognostic risk for mortality in hospitalized adults. However, no study has compared the prognostic risk between these scales and changes in body composition in a single study in adults with SARS-CoV-2 pneumonia. The great inflammation and complications that this disease presents promotes immobility and altered nutritional status, therefore a low PA and low MS could have a higher prognostic risk for mortality than the scales. The aim of the present study was to evaluate the prognostic risk for mortality of PA, MS, APACHE, SOFA, and CURB-65 in adults hospitalized with SARS-CoV-2 pneumonia. Methodology: This was a longitudinal study that included n = 104 SARS-CoV-2-positive adults hospitalized at General Hospital Penjamo, Guanajuato, Mexico, the PA was assessed using bioelectrical impedance and MS was measured with manual dynamometry. The following disease severity scales were applied as well: CURB-65, APACHE, and SOFA. Other variables analyzed were: sex, age, CO-RADS index, fat mass index, body mass index (BMI), and appendicular muscle mass index. A descriptive analysis of the study variables and a comparison between the group that did not survive and survived were performed, as well as a Cox regression to assess the predictive risk to mortality. Results: Mean age was 62.79 ± 15.02 years (31-96). Comparative results showed a mean PA of 5.43 ± 1.53 in the group that survived vs. 4.81 ± 1.72 in the group that died, p = 0.030. The mean MS was 16.61 ± 10.39 kg vs. 9.33 ± 9.82 in the group that died, p = 0.001. The cut-off points for low PA was determined at 3.66° and ≤ 5.0 kg/force for low grip strength. In the Cox multiple regression, a low PA [heart rate (HR) = 2.571 0.726, 95% CI = 1.217-5.430] and a low MS (HR = 4.519, 95% CI = 1.992-10.252) were associated with mortality. Conclusion: Phase angle and MS were higher risk predictors of mortality than APACHE, SOFA, and CURB-65 in patients hospitalized for COVID-19. It is important to include the assessment of these indicators in patients positive for SARS-CoV-2 and to be able to implement interventions to improve them.

Comparison Between Physiological Scores SIPF, CURB-65, and APACHE II as Predictors of Prognosis and Mortality in Hospitalized Patients with COVID-19 Pneumonia: A Multicenter Study, Saudi Arabia.

Background: A coronavirus pandemic (COVID-19) is associated with catastrophic effects on the world with high morbidity and mortality. We aimed to evaluate the accuracy of physiological shock index (SIPF) (shock index and hypoxemia), CURB -65, acute physiology, and chronic health assessment II (APACHE II) as predictors of prognosis and in-hospital mortality in patients with COVID-19 pneumonia. Methods: In Saudi Arabia, a multicenter retrospective study was conducted on hospitalized adult patients confirmed to have COVID-19 pneumonia. Information needed to calculate SIPF, CURB-65, and APACHE II scores were obtained from medical records within 24 hours of admission. Results: The study included 1131 COVID-19 patients who met the inclusion criteria. They were divided into two groups: (A) the ICU group (n=340; 30.1%) and (B) the ward group (n=791; 69.9%). The most common concomitant diseases of patients at initial ICU admission were hypertension (71.5%) and diabetes (62.4%), and most of them were men (63.8%). The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001). The SIPF score showed a significantly higher ability to predict both ICU admission and mortality in patients with COVID-19 pneumonia compared with APACHE II and CURB -65; (AUC 0.89 vs 0.87; p < 0.001) and (AUC 0.89 vs 0.84; p < 0.001) for ICU admission and (AUC 0.90 vs 0.65; p < 0.001) and (AUC 0.90 vs 0.80; p < 0.001) for mortality, respectively. Conclusion: The ability of the SIPF score to predict ICU admission and mortality in COVID-19 pneumonia is higher than that of APACHE II and CURB-65. The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001).

Prognostic predictors for mortality of patients with COVID-19 in an intensive care unit.

INTRODUCTION: Fatality due to COVID-19 continues to be a challenge. Timely identification of critical COVID-19 patients is crucial for their close clinical follow-up and treatment. We aimed to identify the mortality predictors of critical COVID-19 patients. METHODOLOGY: We analyzed medical records of 232 out of 300 patients with COVID-19 hospitalized in the intensive care unit (ICU) whose medical records were available in the hospital database. Non-survivors and survivors were compared for parameters. Medical records of demographics, comorbidities, radiological signs, respiratory support, and laboratory tests on the first day of ICU admission were included. The durations of ICU stay and hospitalization were also evaluated. RESULTS: The patients with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score above 28.5 and the patients with blood urea nitrogen (BUN) above 45.5 mg/dL were significantly more mortal (95% CI: 0.701, p = 0.0001; 95% CI: 0.599, p = 0.022; respectively). Partial oxygen pressure/fraction of inspired oxygen (P/F) ratio below 110.5 mmHg was a predictor for mortality (95% CI: 0.397, p = 0.018). Older age, smoking, crazy paving pattern on computed tomography (CT), and short duration of hospitalization were also predictors of mortality. The patients requiring invasive mechanical ventilation were significantly more mortal whereas the patients requiring high flow oxygen and non-invasive ventilation were significantly more likely to survive. CONCLUSIONS: We recommend evaluating APACHE-II score, BUN value, P/F ratio, age, smoking status, radiological signs on CT, length of hospitalization and modality of respiratory support upon ICU admission to identify critical patients with poor prognoses.

COVID-19 presentation as acute pancreatitis: A case report

Rationale: The gastrointestinal manifestations of COVID-19 include anorexia, nausea, vomiting, abdominal pain, and diarrhea. However, pancreatitis as the presentation of COVID-19 is rarely reported. Patient's Concern: A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d. Diagnosis: Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction. Interventions: The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness. The patient was started on enteral feeding, analgesics, antibiotics, dexamethasone, low molecular weight heparin, and supportive therapy. Outcomes: The patient developed severe acute respiratory distress syndrome and died 6 days after admission. Lessons: Management of COVID-19 in the presence of pancreatitis is challenging. Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed. Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir. Dexamethasone, even though it has shown a beneficial effect in treating COVID-19, can have an additive effect in causing hyperglycemia in these cases. Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies, keeping in mind the considerations for both diseases.

Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis.

Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment. Aim and objective: To investigate patient characteristics and specific biomarkers as possible early predictors of disease severity of SARS-COV-2 infection. Materials and methods: Retrospective single-centric observational study conducted at 70-bedded intensive care unit of tertiary care hospital at Haryana, India. 100 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, acute physiology and chronic health evaluation II (Apache-II) score, and Inflammatory markers were compared with respect to oxygenation defect (PaO2/FiO2 ratio: <300 or ≥300 mm Hg), need of invasive ventilation, ICU length of stay and 28-day mortality. Findings: Mean age was significantly more in lower PF ratio group (58.01 ± 15.33 vs 50.97 ± 13.78, p = 0.023) whereas sex ratio was comparable among patients in two groups. Significantly, higher APACHE-II score (p ≤0.001) and presence of hypertension (43.54% vs 23.68%; p = 0·045) in low PF ratio group along with higher C-reactive protein (171.78 ± 124.45 vs 101.52 ± 88.70), IL-6 (173.51 vs 53.18) and ferritin (1677.60 ± 2271.13 vs 643.54 ± 718.68) levels. Procalcitonin, lactate dehydrogenase, and creatine phosphokinase (CPK) levels were not significant. Interpretation: Age and APACHE II score and among laboratory parameters CRP, ferritin, and IL-6 levels were significantly higher in low PF ratio group, patients requiring invasive ventilation and in mortality group. Use of this triad (CRP, ferritin, and IL-6 levels) at admission may predict the disease severity early in the course. Addition of APACHE-II may further improve the accuracy of the score. How to cite this article: Gupta D, Jain A, Chauhan M, Dewan S. Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis. Indian J Crit Care Med 2022;26(4):482-486.

Yoğun Bakımda Takip Edilen COVID-19 Tanılı Hastaların Retrospektif Íncelenmesi

Amaç: Koronavirüs hastalığı-19 (COVID-19), akut solunum sıkıntısı sendromu (ARDS), sepsis, septik şok, miyokardit, aritmi, kardiyojenik şok veya çoklu organ yetmezliği tablolarına sebep olan multisistemik bir hastalıktır. Bu çalışmada yoğun bakımda takip edilen hastaları retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: Retrospektif olarak planladığımız bu çalışmamızda 200 hasta incelendi. Hastalar yaşayan ve ölen olmak üzere gruplara ayrıldı. Gruplar arasındaki farklar ki-kare ve Mann-Whitney U testi ile değerlendirildi. Bulgular: Çalışma grubunda 124 erkek, 76 kadın vardı. Ölenler grubu 143 yaşayanlar grubunda 57 kişi vardı. Ölenler grubundaki hastaların yaş ortalaması (70,5±14,02) yaşayanlara göre daha yüksekti (64,3±16,25) (p=0,15). Yoğun bakıma kabulde APACHE II skoru ölenler grubunda 17 (min: 5 - maks: 37) iken yaşayanlar grubunda 14 (min: 5 - maks: 27, p=0,001) idi. SOFA skoru ölenler grubunda 5 (min: 2 - maks: 17) iken yaşayanlar grubunda 3 (min: 0 - maks: 14, p<0,001) idi.Hastaların yoğun bakıma kabulde laktat değerleri ölenler grubunda 2,3 (min: 0,8 - maks: 18) iken yaşayanlar grubunda 2 (min: 0,6 - maks: 10,5, p=0,012) ve geliş satürasyon değerleri ölenler grubunda 85 (min: 35 - maks: 97) yaşayanlar grubunda ise 89 (min: 70 - maks: 100, p=0,029) idi. Ölenler grubunda lenfosit değerinin yoğun bakıma kabuldeki değere göre 14. günde yüzde değişimi %27 azalma şeklinde iken yaşayanlar grubunda %15 artış şeklindeydi (p=0,006). Prokalsitonin değerinin 14. gün yüzde değişimi ölenler grubunda %56 artış iken yaşayanlar grubunda %62 azalma şeklindeydi (p<0,001).Troponin değerinin 14. gün yüzde değişimi ölenler grubunda %64 artış iken yaşayanlar grubunda %71 azalma şeklindeydi (p=0,014). PaO2 /FiO2 oranının 14. gün yüzde değişimi ölenler grubunda %29 artış yaşayanlar grubunda ise %115 artış şeklindeydi (p=0,033). D-dimer değerinin 7. gün yüzde değişimi ölenler grubunda %84 artış, yaşayanlar grubunda ise %4 artış şeklindeydi (p=0,022). Yoğun bakıma kabulde LDH değeri ölenler grubunda 630 (min: 37 - maks: 6.517) iken yaşayanlar grubunda 511 (min: 216 -maks: 1.434, p=0,004) idi. LDH değerinin 7. gün yüzde değişimi ölenler grubunda %6 artış iken yaşayanlar grubunda %16 azalma şeklindeydi (p=0,008). Sonuç: Çalışmamızda daha yüksek yaş ortalaması, APACHE II ve SOFA skorları, daha yüksek giriş laktat ve LDH değerleri, daha düşük saturasyon değerleri mortalite ile ilişkiliydi. Lenfosit, prokalsitonin, PaO2 /FiO2, troponin, D-dimer ve LDH değerlerindeki değişimler mortalite ile ilişkiliydi. Kısıtlı hasta sayısı ve gruplar arası dağılımın homojen olmamaması nedeniyle ileri klinik çalışmalara ihtiyaç vardır. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Risk factors associated with mortality in intensive care COVID-19 patients: the importance of chest CT score and intubation timing as risk factors

Background/aim: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the predictors of mortality in critically ill patients admitted to the intensive care unit (ICU) are not yet well understood. In this study, we aimed to investigate the risk factors associated with ICU mortality in our hospital. Materials and methods: In this single-centered retrospective study, we enrolled 86 critically ill adult patients with COVID-19 admitted to ICU of Dokuz Eylül University Hospital (Izmir, Turkey) between 18 March 2020 and 31 October 2020. Data on demographic information, preexisting comorbidities, treatments, the laboratory findings at ICU admission, and clinical outcomes were collected. The chest computerized tomography (CT) of the patients were evaluated specifically for COVID-19 and CT score was calculated. Data of the survivors and nonsurvivors were compared with survival analysis to identify risk factors of mortality in the ICU. Results: The mean age of the patients was 71.1 ± 14.1 years. The patients were predominantly male. The most common comorbidity in patients was hypertension. ICU mortality was 62.8%. Being over 60 years old, CT score > 15, acute physiology and chronic health evaluation (APACHE) II score ≥ 15, having dementia, treatment without favipiravir, base excess in blood gas analysis ≤ ­2.0, WBC > 10,000/mm3, D-dimer > 1.6 µg/mL, troponin > 24 ng/L, Na ≥ 145 mmol/L were considered to link with ICU mortality according to Kaplan­Meier curves (log-rank test, p < 0.05). The APACHE II score (HR: 1.055, 95% CI: 1.021­1.090) and chest CT score (HR: 2.411, 95% CI:1.193­4.875) were associated with ICU mortality in the cox proportional-hazard regression model adjusted for age, dementia, favipiravir treatment and troponin. Howewer, no difference was found between survivors and nonsurvivors in terms of intubation timing. Conclusions: COVID-19 patients have a high ICU admission and mortality rate. Studies in the ICU are also crucial in this respect. In our study, we investigated the ICU mortality risk factors of COVID-19 patients. We determined a predictive mortality model consisting of APACHE II score and chest CT score. It was thought that this feasible and practical model would assist in making clinical decisions.

Impact of the COVID-19 Epidemic on the Routine Emergency Services in a Tertiary Hospital, China: A Retrospective Cohort Study.

BACKGROUND: The sudden outbreak of the COVID-19 pandemic has caused tremendous challenges to the medical system. The government and hospitals have taken robust measures to curb the spread of the deadly virus. Its impact on routine medical services is gradually being taken seriously. OBJECTIVE: To identify the impact of the novel Coronavirus pandemic on emergency department (ED) patient flow and the performance of the routine ED service. METHODS: This retrospective cohort study was undertaken in a tertiary public teaching hospital ED in Chengdu, China. ED data of patients were routinely collected to compare demographic, clinical characteristics and outcomes during an 8-week period from January 1, 2019 to February 25, 2020. Data were analyzed with the chi-square statistical test. RESULTS: Over the study periods, there were 31855 and 25244 patients presented to the ED in 2019 and 2020 respectively. During the pandemic period in 2020, the daily number of average ED visits was lower than that in 2019 (430 ± 134.9 versus 572 ± 38.6, P = 0.00), with fewer triage 1&2 cases (145 ± 33.3 versus 178 ± 15.0, P = 0.00). Nevertheless, the mortality increased remarkably during the pandemic period in 2020 (0.2% versus 0.1%, P = 0.009), with higher APACHE II scores (28 versus 19, P = 0.022) and shorter ED elapsed time (0.2 versus 1.4 days, P = 0.016) among these death cases. CONCLUSIONS: The COVID-19 pandemic had an evident impact on the patient's behavioral patterns and routine emergency services, which caused higher ED mortality.

Severity of illness scores at presentation predict ICU admission and mortality in COVID-19.

BACKGROUND: The COVID-19 pandemic has overwhelmed hospital systems in multiple countries and necessitated caring for patients in atypical healthcare settings. The goal of this study was to ascertain if the conventional critical care severity scores qSOFA, SOFA, APACHE-II, and SAPS-II could predict which patients admitted to the hospital from an emergency department would eventually require intensive care. METHODS: This single-center, retrospective cohort study enrolled patients admitted to Vanderbilt University Hospital from the emergency room with symptomatic, confirmed COVID-19 infection between March 8, 2020 through May 15, 2020. Clinical phenotyping was performed by chart abstraction, and the correlation of the qSOFA, SOFA, APACHE-II, and SAPS-II scores for the primary endpoint of ICU admission and secondary endpoint of in-hospital mortality was evaluated. RESULTS: During the study period, 128 patients were admitted to Vanderbilt University Hospital from the emergency room with COVID-19. Of these, 39 patients eventually required intensive care; the remaining 89 were discharged from the medical ward. All severity of illness scores demonstrated at least moderate ability to identify patients who would die or require ICU admission. Of the three severity of illness scores assessed, the APACHE-II score performed best with an AUC of 0.851 (95% CI: 0.786 to 0.917) for identifying patient that would require ICU admission. No patient with an APACHE-II score at the time of presentation less than 8 or qSOFA of 0 required intensive care unit (ICU) admission. All patients with an APACHE-II score less than 10 or qSOFA score of 0 survived to hospital discharge. CONCLUSIONS: The APACHE-II score accurately predicts the eventual need for ICU admission. This may allow for risk-stratification of patients safe to treat in alternative health care settings and prognostic enrichment to accelerate clinical trials of COVID-19 therapies.