scholarly journals Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality

2021 ◽  
Author(s):  
Francesco Violi ◽  
Giancarlo Ceccarelli ◽  
Roberto Cangemi ◽  
Francesco Cipollone ◽  
Damiano D’Ardes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Cox Regression ◽  
Thrombotic Event ◽  
White Blood Cells ◽  
Intensive Care Unit Treatment ◽  
Cox Regression Analysis ◽  
D Dimer

Abstract Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

scholarly journals Preadmission Statin Use and 90-day Mortality in the Critically Ill

2019 ◽  
Vol 131 (2) ◽  
pp. 315-327 ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song ◽  
Jae Ho Lee ◽  
Cheong Lim ◽  
Young-Tae Jeon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Critically Ill ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Cox Regression Analysis ◽  
Statin Dose ◽  
Mortality Hazard Ratio ◽  
Statin Use

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality. Methods This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality. Results A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P &lt; 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P &lt; 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P &lt; 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P &lt; 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use. Conclusions Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.

scholarly journals Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 26 ◽  
pp. 107602962096708
Author(s):  
Belayneh Kefale ◽  
Gobezie T. Tegegne ◽  
Amsalu Degu ◽  
Melaku Tadege ◽  
Desalegn Tesfa
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
English Language ◽  
Meta Analysis ◽  
Thrombotic Event ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
D Dimer

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jae Heon Kim ◽  
Hankyu Jeon ◽  
Sang Soo Lee ◽  
Hee Jin Kim ◽  
Ra Ri Cha ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Cox Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Hepatic Disease ◽  
Cox Regression Analysis ◽  
Entire Cohort ◽  
Factors Associated ◽  
The Impact

Abstract Background: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality in intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia in intensive care unit patients and evaluate the factors related to 90-day mortality. Methods: Between February 2016 and February 2020, 972 cases in 948 intensive care unit patients without hepatic disease were retrospectively enrolled and classified as hyperammonemia grades 0 (≤80 µg/dL; n=585 (60.2%)), 1 (≤160 µg/dL; n=291 (29.9%)), 2 (≤240 µg/dL; n=55 (5.7%)), and 3 (>240 µg/dL; n=41 (4.2%)). Factors associated with hyperammonemia and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for 90-day mortality were constructed.Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984 per year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272 per unit), and albumin (0.694 per g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of 90-day mortality in intensive care unit patients. Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with 90-day mortality in intensive care unit patients. Therefore, clinicians must examine serum ammonia levels in patients before admission to intensive care unit.

scholarly journals Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Bin Liu ◽  
Kun Xiao ◽  
Peng Yan ◽  
Tianyu Sun ◽  
Jiang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Cox Regression Analysis ◽  
Increased Risk

Background. Critical illness in the intensive care unit (ICU) has been a global health priority. Systemic nutritional status has turned out to be related to the prognosis of critically ill patients. The albumin-globulin ratio (AGR) has been reported to be a novel prognostic factor of many diseases. This study is aimed at investigating whether the AGR could predict the mortality risk in critically ill patients. Methods. We enrolled 582 adult patients admitted to the respiratory intensive care unit (RICU). We collected the clinical and laboratory data. X-tile software was used to determine the optimal cut-off values for the AGR. Patients were divided into three groups according to the AGR (low AGR group with AGR < 0.8 , medium AGR group with AGR ranging from 0.8 to 1.1, and high AGR group with AGR > 1.1 ). Kaplan-Meier analysis was used for survival analysis. A Cox proportional hazard model was applied to the univariate and multivariate analyses for the potential predictors associated with survival. Results. Our present study showed that the AGR was related to the 28-day survival of critically ill patients in the RICU. The rate of pneumonia in the low AGR group was significantly higher than that in the other groups. Patients with a lower AGR present an increased risk of 28-day mortality compared to patients with a higher AGR. Cox regression analysis showed that the AGR might be an independent predictor of prognosis to 28-day survival in critically ill patients in the RICU. Medium and high AGR values remained independently associated with better 28-day survival than low AGR values (HR: 0.484 (0.263-0.892) ( p = 0.02 ); HR: 0.332 (0.166-0.665) ( p = 0.002 )). Conclusion. The AGR might be an independent predictor of prognosis in critically ill patients.

scholarly journals Prognostic Value of Chromogranin A at Admission in Critically Ill Patients: A Cohort Study in a Medical Intensive Care Unit

2008 ◽  
Vol 54 (9) ◽  
pp. 1497-1503 ◽  
Author(s):  
Dan Zhang ◽  
Thomas Lavaux ◽  
Anne-Claire Voegeli ◽  
Thierry Lavigne ◽  
Vincent Castelain ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Critically Ill ◽  
Chromogranin A ◽  
Prognostic Value ◽  
Cox Regression ◽  
Linear Regression Analysis ◽  
Cox Regression Analysis ◽  
Saps Ii

Abstract Background: Risk assessments of patients should be based on objective variables, such as biological markers that can be measured routinely. The acute response to stress causes the release of catecholamines from the adrenal medulla accompanied by chromogranin A (CGA). To date, no study has evaluated the prognostic value of CGA in critically ill intensive care unit patients. Methods: We conducted a prospective study of intensive care unit patients by measuring serum procalcitonin (PCT), C-reactive protein (CRP), and CGA at the time of admission. Univariate and multivariate analyses were performed to evaluate the ability of these biomarkers to predict mortality. Results: In 120 consecutive patients, we found positive correlations between CGA and the following: CRP (r2 = 0.216; P = 0.02), PCT (r2 = 0.396; P &lt; 0.001), Simplified Acute Physiologic Score II (SAPS II) (r2 = 0.438; P &lt; 0.001), and the Logistic Organ Dysfunction System (LODS) score (r2 = 0.374; P &lt; 0.001). Nonsurvivors had significantly higher CGA and PCT concentrations than survivors [median (interquartile range): 293.0 μg/L (163.5–699.5 μg/L) vs 86.0 μg/L (53.8–175.3 μg/L) for CGA, and 6.78 μg/L (2.39–22.92 μg/L) vs 0.54 μg/L (0.16–6.28 μg/L) for PCT; P &lt; 0.001 for both comparisons]. In a multivariable linear regression analysis, creatinine (P &lt; 0.001), age (P &lt; 0.001), and SAPS II (P = 0.002) were the only significant independent variables predicting CGA concentration (r2 = 0.352). A multivariate Cox regression analysis identified 3 independent factors predicting death: log-normalized CGA concentration [hazard ratio (HR), 7.248; 95% confidence interval (CI), 3.004–17.487], SAPS II (HR, 1.046; 95% CI, 1.026–1.067), and cardiogenic shock (HR, 3.920; 95% CI, 1.731–8.880). Conclusions: CGA is a strong and independent indicator of prognosis in critically ill nonsurgical patients.

scholarly journals RISK FACTORS FOR FAILURE TO REACH TOTAL ENERGY VALUE IN AN INTENSIVE CARE UNIT

2018 ◽  
Vol 11 (2) ◽  
pp. 337
Author(s):  
Louise Carnevali Furtado de Medeiros ◽  
Cláudia Sena de Pádua ◽  
Irla Maiara Silva Medeiros ◽  
Monica Silvina Maia Nascimento ◽  
Thatiana Lameira Maciel Amaral ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Total Energy ◽  
Cox Regression ◽  
Nutrition Therapy ◽  
Cox Regression Analysis ◽  
Energy Value ◽  
Exclusive Enteral Nutrition ◽  
Number Of Patients

The objective was identify the risk factors associated with the failure to total energy value. A prospective cohort study was conducted in an intensive care unit with 87 patients receiving exclusive enteral nutrition therapy. The Kaplan-Meier and Cox regression analysis were used to evaluate the results. Regarding the patients, 35.6% were aged between 31 and 50 years, and 58.6% were males. At the end of the third day, 70.8% reached the total recommended energy value. Postoperative patients (HR: 7.09; 95% CI: 2.02-24.81), hemodynamically unstable patients (HR: 5.97; 95% CI: 1.11-31.99) and those who were fasting for the performance of tests (HR: 4.95; 95% CI: 1.01-24.61) presented a greater risk of not reaching the recommended value. The number of patients who achieved the total energy value was adequate, but can be optimized by the evaluation of these identified factors.

scholarly journals SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 890
Author(s):  
Michel Drancourt ◽  
Sébastien Cortaredona ◽  
Cléa Melenotte ◽  
Sophie Amrane ◽  
Carole Eldin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Rare Event ◽  
Viral Shedding ◽  
Qrt Pcr ◽  
Viral Culture ◽  
D Dimer

SARS-CoV-2 nasopharyngeal shedding contributes to the spread of the COVID-19 epidemic. Among 3271 COVID-19 patients treated at the Hospital University Institute Méditerranée Infection, Marseille, France from 3 March to 27 April 2020, tested at least twice by qRT-PCR, the median SARS-CoV-2 nasopharyngeal shedding duration was 6 days (range 2–54 days). Compared with short shedders (qRT-PCR positivity < 10 days), 34 (1.04%) persistent shedders (qRT-PCR positivity ≥ 17 days; mean ± SD: 23.3 ± 3.8 days) were significantly older, with associated comorbidities, exhibiting lymphopenia, eosinopenia, increased D-dimer and increased troponin (p < 0.05), and were hospitalized in intensive care unit in 17.7% vs. 1.1% of cases (p < 0.0001). Viral culture was positive in six persistent shedders after day 10, including in one patient after day 17, and no viral co-pathogen was detected in 33 tested patients. Persistent shedders received azithromycin plus hydroxychloroquine ≥ 3 days in 26/34 (76.5%) patients, a figure significantly lower than in short shedders (86.6%) (p = 0.042). Accordingly, mortality was 14.7% vs. 0.5% (p < 0.0001). Persistent shedding was significantly associated with persistent dyspnea and anosmia/ageusia (p < 0.05). In the context of COVID-19 treatment, including treatment with azithromycin plus hydroxychloroquine, the persistence of SARS-CoV-2 nasopharyngeal shedding was a rare event, most frequently encountered in elderly patients with comorbidities and lacking azithromycin plus hydroxychloroquine treatment.

scholarly journals Effect of Aprotinin and Avifavir® Combination Therapy for Moderate COVID-19 Patients

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1253
Author(s):  
Andrey A. Ivashchenko ◽  
Valeria N. Azarova ◽  
Alina N. Egorova ◽  
Ruben N. Karapetian ◽  
Dmitry V. Kravchenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Body Temperature ◽  
Combination Therapy ◽  
Serine Proteases ◽  
Clinical Status ◽  
Single Center ◽  
Single Center Study ◽  
D Dimer ◽  
Center Study

COVID-19 is a contagious multisystem inflammatory disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied the efficacy of Aprotinin (nonspecific serine proteases inhibitor) in combination with Avifavir® or Hydroxychloroquine (HCQ) drugs, which are recommended by the Russian Ministry of Health for the treatment therapy of moderate COVID-19 patients. This prospective single-center study included participants with moderate COVID-19-related pneumonia, laboratory-confirmed SARS-CoV-2, and admitted to the hospitals. Patients received combinations of intravenous (IV) Aprotinin (1,000,000 KIU daily, 3 days) and HCQ (cohort 1), inhalation (inh) treatment with Aprotinin (625 KIU four times per day, 5 days) and HCQ (cohort 2) or IV Aprotinin (1,000,000 KIU daily for 5 days) and Avifavir (cohort 3). In cohorts 1–3, the combination therapy showed 100% efficacy in preventing the transfer of patients (n = 30) to the intensive care unit (ICU). The effect of the combination therapy in cohort 3 was the most prominent, and the median time to SARS-CoV-2 elimination was 3.5 days (IQR 3.0–4.0), normalization of the CRP concentration was 3.5 days (IQR 3–5), of the D-dimer concentration was 5 days (IQR 4 to 5); body temperature was 1 day (IQR 1–3), improvement in clinical status or discharge from the hospital was 5 days (IQR 5–5), and improvement in lung lesions of patients on 14 day was 100%.

The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group 2 ◽  
D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

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