ABSTRACT
Background and objectives: Major adverse cardiac events (MACE) are frequent in coronavirus disease-2019 (COVID-19). Remdesivir is used worldwide for treatment in COVID-19. In this retrospective observational study, our primary objective was to assess the impact of remdesivir administration on the incidence of MACE and associated 28 day survival in critically ill patients admitted for moderate to severe COVID-19 pneumonia. Patients and methods: We analyzed the data of 437 patients admitted in intensive care unit (ICU) and divided them into two groups: R group (received remdesivir at ICU admission) and NR group (nonremdesivir) or based on the occurrence of MACE in ICU. We followed the data until discharge, death, or 28 days postadmission. Our primary objective was to investigate the log-odds of survival with remdesivir administration and a correlation/regression analysis of MACE with remdesivir administration in all included patients. Results: The incidence of MACE was 72 among 437 patients, with 17 (9.3%) patients in R group vs 55 (21.8%) in NR group (p <0.001). On performing correlation analysis between MACE and remdesivir administration, significant correlation coefficient of -0.168 (p = 0.004) was obtained. On regression analysis, the odds ratio for occurrence of MACE with remdesivir administration was 0.362 (regression coefficient: -1.014, p <0.001). It indicates a 64% decrease in the log-odds of MACE and a 16% increase in the log-odds of survival with remdesivir administration. All 72 patients with MACE had expired, suggesting a high mortality risk with cardiac complications. The odds ratio for mortality due to MACE with remdesivir administration was 0.216 (regression coefficient: -1.530, p -<0.001). It indicates a 79% decrease in the log-odds of death due to MACE with remdesivir administration. Conclusion: Our study showed significant reduction in MACE and mortality benefit in patients who received remdesivir in comparison to standard treatment. How to cite this article: Panda R, Singh P, Jain G, Saigal S, Karna ST, Anand A, et al. Effect of Remdesivir Administration on Occurrence of Major Adverse Cardiac Events in Critically Ill COVID-19 Pneumonia: A Retrospective Observational Study. Indian J Crit Care Med 2022;26(9):993-999.
ABSTRACT
BACKGROUND: Coronavirus disease-2019 (COVID-19) commonly presents with respiratory symptoms. However, symptoms involving the digestive system may be present, significance of which is not well studied in the Indian scenario. METHODS: This prospective observational cohort study included consecutive patients with severe COVID-19 admitted to intensive care unit of our tertiary care hospital from September 9, 2020, to March 14, 2021. We evaluated the frequency of preadmission digestive symptoms and compared the demographic, clinical, laboratory parameters, and organ failure at admission and during intensive care along with mortality between those with and without digestive symptoms. In the digestive group, we sought to find predictors of mortality. RESULTS: Digestive symptoms were present in 76/234 (32.4%) with severe COVID-19 infection. In comparison to nondigestive group, digestive patients had higher need for noninvasive ventilation (p 0.028), invasive lines (68%, p 0.003), vasopressors (64%, p 0.01), blood product transfusion (21.1%, p <0.001), and heart failure (55.4%, p 0.041). Confounding factors of alcohol abuse, smoking, sedentary lifestyle as a causative agent for heart failure could not be ruled out. Proportional mortality rate is higher in the digestive group (65.8%, p = 0.015). Mortality is multifactorial with preadmission abdominal pathologies (HR 4.3) or central nervous system (CNS)-related comorbidities (HR 2.829), presentation with multiple digestive symptoms (HR 6.9), higher sequential organ failure assessment score (SOFA) score at admission (HR 1.258) and discharge (HR 1.162), and presence of acute kidney injury (AKI) Grade 3 (HR 2.95) as predictors of mortality. After adjusting for all confounders, need for vasopressor was observed to be associated with 11.58 times higher risk of mortality. CONCLUSION: Preadmission digestive symptoms may be associated with a turbulent illness with invasive interventions, heart failure, and greater proportional mortality in severe COVID-19. AKI Grade 3 is identified as a preventable risk factor predicting mortality. CTRI/2021/03/032325. HOW TO CITE THIS ARTICLE: Karna ST, Singh P, Revadi G, Khurana A, Shivhare A, Saigal S, et al. Frequency and Impact of Preadmission Digestive Symptoms on Outcome in Severe COVID-19: A Prospective Observational Cohort Study. Indian J Crit Care Med 2021;25(11):1247-1257.
ABSTRACT
BACKGROUND: Preoperative fasting may lead to intravascular volume depletion and this volume depletion may be a cause of perioperative stress. This study intends to compare the levels of stress markers in patients undergoing long and short duration fasting before an elective laparoscopic surgery. METHOD: This was a single blind, observational study. Based on the duration of fasting, 70 ASA I and II category patients undergoing elective laparoscopic cholecystectomy(LC) were divided into two groups of 35 patients each. If the surgeon had prescribed a fasting since midnight then patient was considered for inclusion in Long fasting (LF) group; if surgeon had allowed clear fluids till 2 h before surgery then the patient was considered for inclusion in the short fasting(SF) group. The extent of intravascular volume depletion was measured using inferior vena cava collapsibility index (IVCCI). Levels of relevant stress markers i.e. cortisol, Tetraiodothyronine (FT4), C-peptide, C-reactive protein(CRP) and blood glucose (BGL) were measured at 8 PM in the night before surgery, at 7 AM on the day of surgery, 2 h after the surgery and 24 h after the surgery. RESULT: IVCCI was significantly more in the LF group; 27.66 ± 3.34% vs17.83 ± 2.22%, 95% CI 8.47-11.18, P-value <0.001). IVCCI had a significant correlation with the duration of fasting, Pearson's correlation r = 0.69,P-value <0.001. Repeated measures ANCOVA revealed that CRP, Free T4 and C-peptide levels got significantly elevated over the study duration, P-values <0.001,<0.001 and 0.03 respectively but with IVCCI, Age and Gender as the covariates, the increase in the levels of CRP, Free T4 and C-peptide were similar in both the groups. CONCLUSION: Stress markers levels show significant elevation in the perioperative period, maximum over the study duration, but this change is similar in both the groups. CLINICAL TRIAL NO: CTRI/2021/02/031456.