The Comparison of scoring systems: SOFA, APACHE-II, LODS, MODS, and SAPS-II in critically ill elderly sepsis patients.

INTRODUCTION: The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients. METHODOLOGY: In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between "survivor" and "non-survivor" groups. RESULTS: 202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001). CONCLUSIONS: This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality.

IS LYMPHOPENIA A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19?

In this study, we evaluated the relation between the presence of lymphopenia and the need of intensive care unit (ICU) or mortality. A total of 1670 COVID-19 patients were divided according to the severity of lymphopenia developing at the time of COVID-19 infection. According to the symptoms and need of ICU, the infection was classified as mild or severe. The rates of severe infection, ICU admission, and mortality were evaluated between the groups. Among 1670 patients, 576 (34.4%) patients had severe disease and 1094 (65.6%) patients had a mild form of the disease; 213 (12.7%) patients with severe COVID-19 died. The severe form of COVID-19 was more common in patients with low lymphocyte levels (<500) than in those with normal lymphocytes count (64.7% vs. 5.2%; p<0.001). The odds ratio of lymphopenic patients was 2.4 (1.8-3.0; p=0.001). The risk of severe COVID-19 infection and mortality was 8.9 and 12.4 times higher in patients with low lymphocyte count compared to patients with normal lymphocyte count subsequently. ROC analysis showed that lymphocyte counts lower than 615 lym/mcL had 96.4% sensitivity for severe disease (AUC:0.89 (0.842-0.938); p<0.001). There was a significant negative correlation between lymphocyte count and mortality rate and severe COVID-19 disease (for severe COVID-19 r=-0.590; p<0.001and for mortality r=-0.511; p=0.001). In conclusion, we found a strong correlation between lymphopenia and COVID-19 outcomes. Lymphopenia in patients with COVID-19 was a prognostic factor in the course of the disease. Lymphopenia is an easy and inexpensive prognostic factor that can be used in the management of COVID-19 patients.

Analysis of COVID-19 infection in hemodialysis and kidney transplant patients in a pandemic hospital.

INTRODUCTION: The mortality rate for any infection is often higher in patients with a kidney transplant (KT) and hemodialysis (HD), which may also be the case in novel coronavirus disease 2019 (COVID-19). METHODOLOGY: In this study, the demographic, clinic, laboratory, and radiologic signs of KT and HD patients diagnosed with COVID-19 infection between 11th March 2020 and 11th March 2021 were evaluated prospectively. RESULTS: In the present study, 72 HD (median age, 57.5 Q1-Q3:43-65; female: 36/50%) and 58 KT patients (median age, 44.5 Q1-Q3:28.75-55.25; female: 21/36.2%) with COVID-19 infection were enrolled. Fifteen patients with HD (20.8%) died. Age, diabetes mellitus (DM), abnormal hemoglobin levels, albumin, C-reactive protein (CRP), ferritin, D-dimer, and procalcitonin were significant in the univariate analysis of survival in patients with HD. However, only age was significant in the Cox-regression analysis [Hazard ratio (HR) (95% CI 1.070 (19.016-1.126)]. Nine (15.5%) KT patients died. The median time from symptoms onset to admission was three days (2-5). This rate was two (2-3) and five (4-5.75) days, respectively, for patients followed up in our center and the external centers (p < 0.001). Although age, DM, shortness of breath, bilateral involvement in CT images, abnormal levels of CRP, urea, leukocyte count, ferritin, and follow-ups of patients from the external center were significant in the univariate analysis of survival in patients with KT, no variables were significant in the cox-regression analysis. CONCLUSIONS: Increased mortality is expected in both HD and KT patients. Early diagnosis of COVID-19 in those patients with COVID-19 infection can be life-saving.

Successful Treatment of COVID-19-Related Immune- Complex Glomerulonephritis, Case Report.

Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment.  DOI: 10.52547/ijkd.6527.

Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital.

BACKGROUND: Knowing the risk factors for patients in intensive care units (ICUs) facilitates patient's management. The goal of this study was to determine the risk agents that influence our medical ICU mortality. PATIENTS AND METHODS: This 11-month retrospective trial was managed in the medical ICU. In this study, 340 patients who were followed up for at least 24 hours in ICUs were accepted. The clinical data on patients were recorded retrospectively, and the mortality-related factors were analyzed. A regression analysis was also performed to determine the independent risk factors for ICU mortality. RESULTS: The median age was 73 (53-82) years. The death rate was 23.8%. Length of stay (LOS) in ICU was 3 (2-5) days, and APACHE-II (acute physiologic and chronic health evaluation) score was 19 (13-25). The prevalence of chronic diseases was not dissimilar except acute and chronic renal failures among survivors and deceased patients (p >0.05). Acute and chronic renal failures were higher in deceased patients than in survivors and were statistically important [107 (41.3%) vs 47 (58%), p = 0.008] and 38 (14.7%) vs 22 (27.2%), p = 0.01], respectively. In the binary logistic regression analysis, age, APACHE II score, need for invasive mechanical ventilation (IMV), decreased serum albumin levels, and increased creatinine levels were established to be independent risk factors for death [(OR (odds ratio): 1.045 (1.009-1.081), p = 0.013, OR: 1.076 (21.008-1.150), p = 0.029, OR: 19.655 (6.337-60.963), p = 0.001), OR: 2.673 (1.191-6.024), p = 0.017, OR: 1.422 (1.106-1.831), p = 0.006)], respectively. CONCLUSION: The most significant risk agents of death were determined through high APACHE II score, decreased serum albumin levels, and increased creatinine levels. HOW TO CITE THIS ARTICLE: Kalin BS, Özçaylak S, Solmaz I, Kiliç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022;26(1):49-52.

Risk factors affecting ICU admission in COVID-19 patients; Could air temperature be an effective factor?

AIM: As the COVID-19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID-19 infection and to reveal whether the seasonal change has an effect on the disease course. METHODS: Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID-19 disease between March 16 and July 15. RESULTS: As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels. CONCLUSIONS: It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease.