More attention should be paid to Omicron-associated sepsis: a multicenter retrospective study in south China.

Background: The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible but causes less severe disease compared to other variants. However, its association with sepsis incidence and outcomes is unclear. This study aimed to investigate the incidence of Omicron-associated sepsis, as per the Sepsis 3.0 definition, in hospitalized patients, and to explore its relationship with clinical characteristics and prognosis. Methods: This multicenter retrospective study included adults hospitalized with confirmed SARS-CoV-2 infection across six tertiary hospitals in Guangzhou, China from November 2022 to January 2023. The Sequential Organ Failure Assessment (SOFA) score and its components were calculated at hospital admission to identify sepsis. Outcomes assessed were need for intensive care unit (ICU) transfer and mortality. Receiver operating characteristic curves evaluated the predictive value of sepsis versus other biomarkers for outcomes. Results: A total of 299 patients (mean age: 70.1±14.4 years, 42.14% female) with SOFA score were enrolled. Among them, 152 were categorized as non-serious cases while the others were assigned as the serious group. The proportion of male patients, unvaccinated patients, patients with comorbidity such as diabetes, chronic cardiovascular disease, and chronic lung disease was significantly higher in the serious than non-serious group. The median SOFA score of all enrolled patients was 1 (interquartile range, 0-18). In our study, 147 patients (64.19%) were identified as having sepsis upon hospital admission, with the majority of these septic patients (113, representing 76.87%) being in the serious group, the respiratory, coagulation, cardiovascular, central nervous, and renal organ SOFA scores were all significantly higher in the serious compared to the non-serious group. Among septic patients, 20 out of 49 (40.81%) had septic shock as indicated by lactate measurement within 24 hours of admission, and the majority of septic patients were in the serious group (17/20, 76.87%). Sepsis was present in 118 out of 269 (43.9%) patients in the general ward, and among those with sepsis, 34 out of 118 (28.8%) later required ICU care during hospitalization. By contrast, none of the patients without sepsis required ICU care. Moreover, the mortality rate was significantly higher in patients with than without sepsis. Conclusions: A considerable proportion of patients infected with Omicron present with sepsis upon hospital admission, which is associated with a poorer prognosis. Therefore, early recognition of viral sepsis by evaluation of the SOFA score in hospitalized coronavirus disease 2019 patients is crucial.

Development and validation of a clinical risk model to predict the hospital mortality in ventilated patients with acute respiratory distress syndrome: a population-based study.

BACKGROUND: Large variability in mortality exists in patients of acute respiratory distress syndrome (ARDS), especially those with invasive ventilation. The aim of this study was to develop a model to predict risk of in-hospital death in ventilated ARDS patients. METHODS: Ventilated patients with ARDS from two public databases (MIMIC-III and eICU-CRD) were randomly divided as training cohort and internal validation cohort. Least absolute shrinkage and selection operator (LASSO) and then Logistic regression was used to construct a predictive model with demographic, clinical, laboratory, comorbidities and ventilation variables ascertained at first 24 h of ICU admission and invasive ventilation. Our model was externally validated using data from another database (MIMIC-IV). RESULTS: A total of 1075 adult patients from MIMIC-III and eICU were randomly divided into training cohort (70%, n = 752) and internal validation cohort (30%, n = 323). 521 patients were included from MIMIC-IV. From 176 potential predictors, 9 independent predictive factors were included in the final model. Five variables were ascertained within the first 24 h of ICU admission, including age (OR, 1.02; 95% CI: 1.01-1.03), mean of respiratory rate (OR, 1.04; 95% CI: 1.01-1.08), the maximum of INR (OR, 1.14; 95% CI: 1.03-1.31) and alveolo-arterial oxygen difference (OR, 1.002; 95% CI: 1.001-1.003) and the minimum of RDW (OR, 1.17; 95% CI: 1.09-1.27). And four variables were collected within the first 24 h of invasive ventilation: mean of temperature (OR, 0.70; 95% CI: 0.57-0.86), the maximum of lactate (OR, 1.15; 95% CI: 1.09-1.22), the minimum of blood urea nitrogen (OR, 1.02; 95% CI: 1.01-1.03) and white blood cell counts (OR, 1.03; 95% CI: 1.01-1.06). Our model achieved good discrimination (AUC: 0.77, 95% CI: 0.73-0.80) in training cohort but the performance declined in internal (AUC: 0.75, 95% CI: 0.69-0.80) and external validation cohort (0.70, 95% CI: 0.65-0.74) and showed modest calibration. CONCLUSIONS: A risk score based on routinely collected variables at the start of admission to ICU and invasive ventilation can predict mortality of ventilated ARDS patients, with a moderate performance.

Risk factors of chronic cough in China: a systematic review and meta-analysis.

INTRODUCTION: Risk factors of chronic cough in China have not been systematically analyzed and we hypothesized that risk factors of chronic cough might have distinct characteristics in China. Hence, we performed this meta-analysis focusing on the potential risk factors of chronic cough in China. AREAS COVERED: This systematic review was performed to explore the risk factors of chronic cough in accordance with the PRISMA checklist. Seven databases were searched for published articles using predefined inclusion criteria. A total of 33 eligible articles were identified and included in this systematic review, and 28 studies were included in the meta-analysis. EXPERT COMMENTARY: The study indicated that allergy, nasal/sinusitis diseases, family history of allergy, family history of chronic respiratory diseases, exposure to pollutants, passive smoking, and exposure to pets were risk factors for chronic cough in China. Although several potential risk factors (e.g.: sex and BMI) were not explore for the limited information in the included articles, this paper provides useful epidemiological information for managing chronic cough not only in China but around the world.

Prevalence of chronic cough in China: a systematic review and meta-analysis.

BACKGROUND: Individual studies have indicated variable prevalence for chronic cough, but thus far, there has been no systematic report on the prevalence of this condition. METHODS: In this study, we performed a systematic review and meta-analysis by searching databases including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese biomedical literature service system, Wanfang Database, and VIP database, for studies on chronic cough in China published before December 28, 2020. A random effects model was used to calculate pooled prevalence estimates with 95% confidence interval [95%CI], weighted by study size. RESULTS: Fifteen studies with 141,114 community-based adults were included in the study, showing a prevalence of 6.22% (95% CI 5.03-7.41%). And 21 studies with 164,280 community-based children were included, presenting a prevalence of 7.67% (95% CI 6.24-9.11%). In subgroup meta-analyses, the prevalence in adults was 4.38% (95% CI 2.74-6.02%) in southern China and 8.70% (95% CI 6.52-10.88%) in northern China. In the children population, the prevalence in northern China was also higher than in southern China (northern vs. southern: 7.45% with a 95% CI of 5.50-9.41%, vs. 7.86% with a 95% CI of 5.56-10.16%). CONCLUSIONS: Our population-based study provides relatively reliable data on the prevalence of chronic cough in China and may help the development of global strategies for chronic cough management.

The association between neutrophil-to-lymphocyte count ratio and mortality in septic patients: a retrospective analysis of the MIMIC-III database.

BACKGROUND: Neutrophil-to-lymphocyte count ratio (NLCR) has been shown as a feasible parameter associated with outcomes of tumor patients and an accessible predictor of bacteremia. However, only a handful of research shed the light on the association between NLCR and outcomes of septic patients. This study is aimed to evaluate the association between NLCR and all-cause mortality in a population of adult septic patients. METHODS: We extracted clinical data from Medical Information Mart for Intensive Care (MIMIC)-III V1.4, a free, large-scale, single-center database. NLCR was computed individually. Patients were categorized by quartiles of NLCR. The associations between NLCR quartiles and 28-day all-cause mortality in septic patients were assessed using Cox proportional hazards models and subgroup analyzes. To evaluate the accuracy of NLCR in predicting 28-day mortality of sepsis, receiver operator characteristic curves (ROC), areas under the curve (AUC), and the Youden's J Index were calculated. Other outcomes included 7-day all-cause mortality, mortality in the intensive care units (ICU), in-hospital mortality and length of ICU stay. RESULTS: A total of 3,043 eligible patients were included in the study, of which, 760, 759, 766 and 758 patients were fallen in the first quartile (≤5.89), the second quartile (>5.89, ≤10.69), the third quartile (>10.69, ≤20.25) and the fourth quartile (>20.25) of NLCR, respectively. The 7-day mortality (13.4%, 9.9%, 13.6% and 14.2%; P=0.064) showed no difference in the four quartiles. In multivariate analysis, after adjusting for confounding factors, the highest NLCR quartile (>20.25) was associated with increased 28-day all-cause mortality [hazard ratio (HR) 1.22, 95% Cl: 1.01-1.49; P=0.046]. The areas under the receiver operating characteristic curves (AUROCs) for NLCR was 0.553 (95% CI: 0.529-0.576) for 28-day mortality. CONCLUSIONS: High NLCR (>20.25) is independently related to increased 28-day all-cause mortality in adult septic patients of a limited sensibility and specificity. Further large multi-center prospective studies are needed to confirm such relationship and to validate whose clinical significance.