The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

A novel predictor in endovascular treatment patients for cerebral perfusion and prognosis: CHA2DS2-VASC.

OBJECTIVE: Thrombolysis in Cerebral Infarction(TICI) score is used to objectively evaluate cerebral perfusion after intervention in acute stroke with mechanical thrombectomy. In our study, we aimed to compare the results of patients with successful TICI perfusion score (TICI ≥ 2c) with the results of patients with poor TICI perfusion score (TICI < 2c) and to investigate the relationship of the CHA2DS2-VASc scoring system with the final TICI perfusion score and other endpoints. METHODS: For this retrospective, single-center, cross-sectional study, 278 patients who underwent endovascular thrombectomy were screened consecutively by the interventional neurology department of hospital. The primary endpoint of the study was in-hospital and 1-year all-cause death. All patients underwent cranial imaging to evaluate hemorrhagic transformation after the procedure. RESULTS: It was observed that CHA2DS2-VASc score was significantly higher in the poor cerebral perfusion group than in the succesful cerebral perfusion group (3.19 ± 1.8 vs 2.72 ± 1.73, p = 0.046). According to Kaplan Meier's analysis, a significant difference was observed in the group with a CHA2DS2-VASc score > 2.5 in terms of all-cause mortality at follow-up compared to the group with a low CHA2DS2-VASc score (p = 0.002). According to Kaplan Meier's analysis, a significant difference was observed in the group with a poor TICI score compared to the group with a succesful one in terms of all-cause mortality at follow-up (p < 0.001). Cox regression model showed that poor TICI score group, Age ≥ 75 years, lower glomerular filtariton rate (GFR), higher high-sensitiveC-reactiveprotein (Hs-CRP), and higher admission NIHSS score were independent predictors of 1-year all-cause mortality. CONCLUSION: High CHA2DS2-VASc score has been shown to be a predictor of unsuccessful cerebral perfusion score and 1-year mortality after mechanical thrombectomy in stroke patients. As a result of our research, it has been shown that complete or nearly complete reperfusion has more positive results than partial reperfusion.

Association of 25-Hydroxyvitamin D Level with COVID-19-Related in-Hospital Mortality: A Retrospective Cohort Study.

BACKGROUND: The primary aim of this study was to compare the 25(OH)D level between patients with COVID-19 and the reference population. The secondary aim was to determine the association of 25(OH)D level with COVID-19-related in-hospital mortality. METHODS: The COVID-19-positive group comprised 520 hospitalized patients and the reference population comprised 15,789 COVID-19-negative patients. The 25(OH)D level was categorized as vitamin D deficiency (25[OH]D < 20 ng/mL) and severe vitamin D deficiency (25[OH]D < 12 ng/mL). RESULTS: While the incidence of vitamin D deficiency was similar in both groups, the incidence of severe vitamin D deficiency was higher in patients with COVID-19 than in the reference population (68.3% [n = 355] vs. 55.1% [n = 8,692], p < 0.001). Severe vitamin D deficiency in patients with COVID-19 was higher in the intensive care unit (ICU) group than in the non-ICU group (75.3% [n = 183] vs. 62% [n = 172], p = 0.001). The incidence of severe vitamin D deficiency was 65.4% (n = 280) in survivors and 81.5% (n = 75) in nonsurvivors (p = 0.003). However, multivariable Cox proportional hazard regression analysis showed no relationship between 25(OH)D level and in-hospital mortality. The median survival times of patients with and without severe vitamin D deficiency were not different, as shown by Kaplan-Meier survival analysis. CONCLUSION: Severe vitamin D deficiency is more common in patients with COVID-19 and may play a significant role in worsening the prognosis of these patients. However, the 25(OH)D level was not observed to effect COVID-19-related in-hospital mortality.

Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study

ABSTRACT BACKGROUND: Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN AND SETTING: Prospective study developed in a pandemic hospital in the city of Şırnak, Turkey. METHODS: We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. RESULTS: The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 μg/dl versus 16.47 μg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 μg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 μg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 μg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.

The effect of high-dose parenteral vitamin D3 on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study.

BACKGROUND: In many studies, vitamin D has been found to be low in COVID-19 patients. In this study, we aimed to investigate the relationship between clinical course and inhospital mortality with parenteral administration of high-dose vitamin D3 within the first 24 h of admission to patients who were hospitalized in the intensive care unit (ICU) because of COVID-19 with vitamin D deficiency. METHODS: This study included 175 COVID-19 patients with vitamin D deficiency [25(OH) D <12 ng/mL] who were hospitalized in the ICU. Vitamin D3 group (n = 113) included patients who received a single dose of 300,000 IU vitamin D3 intramuscularly. Vitamin D3 was not administered to the control group (n = 62). RESULTS: Median C-reactive protein level was 10.8 mg/dL in the vitamin D3 group and 10.6 mg/dL in the control group (p = 0.465). Thirty-nine percent (n = 44) of the patients in the vitamin D3 group were intubated endotracheally, and 50% (n = 31) of the patients in the control group were intubated endotracheally (p = 0.157). Parenteral vitamin D3 administration was not associated with inhospital mortality by multivariate logistic regression analysis. According to Kaplan-Meier survival analysis, the median survival time was 16 d in the vitamin D3 group and 17 d in the control group (log-rank test, p = 0.459). CONCLUSION: In this study, which was performed for the first time in the literature, it was observed that high-dose parenteral vitamin D3 administration in critical COVID-19 patients with vitamin D deficiency during admission to the ICU did not reduce the need for intubation, length of hospital stay, and inhospital mortality.

Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study.

BACKGROUND: Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN AND SETTING: Prospective study developed in a pandemic hospital in the city of Sirnak, Turkey. METHODS: We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. RESULTS: The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 µg/dl versus 16.47 µg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 µg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 µg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 µg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.

The prognostic impact of thyroid disorders on the clinical severity of COVID-19: Results of single-centre pandemic hospital.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause thyroid hormonal disorders. In addition, tracheal compression by thyroid nodules can aggravate hypoxia in critically ill patients. No studies have investigated the effect of thyroid nodules on the prognosis of patients with COVID-19. In this study, we investigated the effect of thyroid hormonal disorders and thyroid nodules on the prognosis of patients with COVID-19. MATERIALS AND METHODS: This prospective study was conducted at the Sirnak State Hospital (Pandemic hospital in Turkey) between 15 March and 15 August 2020. We evaluated thyroid hormonal disorder and thyroid nodules in 125 patients who were admitted to the non-intensive care unit (non-ICU) due to mild COVID-19 pneumonia (group 1) and 125 critically ill patients who were admitted to the ICU (group 2). RESULTS: Thyroid-stimulating hormone levels (TSH) were not significantly different between groups 1 and 2; however, group 2 patients had significantly lower levels of free thyroxine (FT4) and free triiodothyronine (FT3) as compared to group 1 (P = .005, P < .0001, respectively). FT3 level showed a negative correlation with length of hospital stay and C-reactive protein level (rho: -0.216, p: 0.001; rho: -0.383, P < .0001). Overt thyroid disorder was observed in 13 patients [2 patients in group 1 (both with overt thyrotoxicosis) and 11 patients in group 2 (3 overt hypothyroidism, 8 overt thyrotoxicosis) (P = .01)]. Thyroid nodules sized ≥1 cm were found in 9 patients (7%) in group 1 and 32 patients (26%) in group 2 (P < .0001). CONCLUSION: Overt thyroid hormonal disorders were more common in critically ill COVID-19 patients. FT3 level at hospital admission is a potential prognostic marker of COVID-19 patients. Thyroid nodules may be associated with severe COVID-19 disease.

Patient Decision Making Prior to Radical Prostatectomy: What Is and Is Not Involved.

The current study assessed the decision-making process before surgery in prostate cancer patients. A structured telephone interview was conducted by an independent third party in 162 consecutive patients who underwent surgery for prostate cancer. Responders revealed that details regarding diagnosis and treatment alternatives were withheld from a significant number of patients. Radiation and active surveillance were presented as alternative options to surgery in 57 (39%) and 20 (14%) of responders, respectively. Twenty-six (18%) patients reported not being informed regarding potential surgical side effects. Patients were not active participants in critical aspects of decision making in 61 (42%) of the cases. Being inadequately informed and more frequent visits to the urologist appeared to make decisions more difficult. Treatment regret was reported by 23 (16%) of the patients who underwent surgery and was more common when the patient was not involved in the decision or was inadequately informed. As such, shared decision making should replace paternalism when managing patients with localized prostate cancer in urologic practice.