Predicting Intensive Care Unit Admissions for COVID-19 Patients in the Emergency Department

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.283 ◽

2021 ◽

pp. 1-5

Author(s):

Suphi Bahadirli ◽

Erdem Kurt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Chest Ct ◽

C Reactive Protein ◽

Diffuse Infiltration ◽

Reactive Protein ◽

Binary Regression Analysis ◽

D Dimer

Abstract Objective: Determining the parameters that can predict the requirement of intensive care unit (ICU) admissions among the coronavirus disease 2019 (COVID-19) patients presented to the emergency departments (EDs). Methods: In adult consecutive patients admitted (March 15 - April 15, 2020) to the ED of a state hospital for COVID-19, we retrospectively analyzed demographic data, symptoms, laboratory tests, and chest computed tomography (CT) on arrival. Results: We included 458 patients [213 (46.5%) females, median age 48 y]. Body temperature, respiration rate, C-reactive protein (CRP), D-dimer, ferritin values, and the number of comorbidities were significantly higher in patients admitted to the ICU than others. Also, diffuse infiltration in chest CT is more common in patients who need ICU follow-up. As a result of the binary regression analysis, a statistically significant correlation was found between the presence of dyspnea (odds ratio [OR]: 12.55), tachypnea (relative risk [RR] ≥ 18) (OR: 14.54), multiple comorbidities (≥2) (OR: 23.39), diffuse infiltration in CT (OR: 14.52), and CRP (≥45 mg/L) (OR: 4.71); and the need for ICU admission. Conclusion: It has been concluded that the presence of dyspnea and tachypnea, elevated CRP, presence of multiple comorbidities, and diffuse infiltration in CT may predict the need for ICU admissions of the patients, who presented to the EDs.

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

10.22514/sv.2021.068 ◽

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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Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study

JMIR Public Health and Surveillance ◽

10.2196/22471 ◽

2020 ◽

Vol 6 (4) ◽

pp. e22471

Author(s):

Rahila Bhatti ◽

Amar Hassan Khamis ◽

Samara Khatib ◽

Seemin Shiraz ◽

Glenn Matfin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Characteristics ◽

Laboratory Data ◽

Length Of Hospital Stay ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Patients With Diabetes ◽

D Dimer

Background Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). Objective This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. Methods This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. Results Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. Conclusions Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

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Synthetic metrics of early predictive value in patients with COVID-19 pneumonia

Hirurg (Surgeon) ◽

10.33920/med-15-2102-05 ◽

2021 ◽

pp. 36-43

Author(s):

Denis Stanislavovich Baranovsky ◽

Delara Rafaelovna Baranovskaya ◽

Natalya Vadimovna Polekhina ◽

Leonid Aleksandrovich Laberko ◽

Grigory Vladimirovich Rodoman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Disease Onset ◽

Severe Pneumonia ◽

C Reactive Protein ◽

Laboratory Assessment ◽

Reactive Protein ◽

Synthetic Indicators ◽

Thrombotic Complications ◽

D Dimer

Clinical observations have shown that COVID-19-associated pneumonia is often accompanied by coagulopathy, an increase in C-reactive protein and D-dimer. Early laboratory assessment may represent a promising approach for predicting the development of thrombotic complications and the severity of COVID-19. Thrombotic complications often cause a rapid deterioration in the patient’s condition, the development of ARDS and a negative outcome of the disease. In this study, the authors sought to identify synthetic indicators that may be associated with the development of acute respiratory distress syndrome (ARDS) requiring treatment in an intensive care unit in patients with viral pneumonia caused by COVID-19. Differences in D-dimer levels and the ratios of D-dimer and C-reactive protein (CRP) levels to the number of days (Days) elapsed from disease onset to hospitalization were investigated between COVID-19 patients who were transferred to the intensive care unit, within two weeks after admission to the hospital (n = 78), and patients with COVID-19 with a stable course of the disease (n = 70). Multiple comparisons showed statistically significantly higher values of CRP / Days at admission in patients with COVID-19 transferred to the ICU (median 22,57) compared with stable patients (median 7,19), p < 0,0001. D-dimer levels on admission did not have statistically significant differences in these groups, while comparison of D-dimer / days ratios in patients transferred to the ICU and in stable patients revealed statistically significant differences: median 44,57 and 41,27, respectively (p = 0,0048). The authors suggest that these synthetic indicators, which are easily determined in patients with COVID-19 upon admission to the hospital, can be used as early predictive markers of severe pneumonia and a high risk of ARDS, requiring transfer to the intensive care unit.

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Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study (Preprint)

10.2196/preprints.22471 ◽

2020 ◽

Author(s):

Rahila Bhatti ◽

Amar Hassan Khamis ◽

Samara Khatib ◽

Seemin Shiraz ◽

Glenn Matfin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Characteristics ◽

Laboratory Data ◽

Length Of Hospital Stay ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Patients With Diabetes ◽

D Dimer

BACKGROUND Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). OBJECTIVE This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. METHODS This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. RESULTS Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1<sub>c</sub> level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (<i>P</i><.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. CONCLUSIONS Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

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Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

JAI (Jurnal Anestesiologi Indonesia) ◽

10.14710/jai.v12i3.32905 ◽

2020 ◽

Vol 12 (3) ◽

pp. 17-33

Author(s):

Rohmantuah Trada Purba ◽

Mahendratama Purnama Adhi ◽

Erna Kusumawardhani ◽

Rapto Hardian ◽

Andri Lumban Tobing

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lactate Dehydrogenase ◽

Interleukin 6 ◽

Virus Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Corona Virus ◽

D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

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C-reactive protein to predict intensive care unit readmission?

Journal of Critical Care ◽

10.1016/j.jcrc.2006.03.007 ◽

2006 ◽

Vol 21 (3) ◽

pp. 265-266 ◽

Cited By ~ 2

Author(s):

Suzana M.A. Lobo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Intensive Care Unit Readmission

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Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

Acta Médica Portuguesa ◽

10.20344/amp.12143 ◽

2019 ◽

Vol 32 (12) ◽

pp. 737

Author(s):

Marta Ayres Pereira ◽

Ana Lídia Rouxinol-Dias ◽

Tatiana Vieira ◽

José Artur Paiva

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Critically Ill ◽

Fast Response ◽

C Reactive Protein ◽

Protein Kinetics ◽

Reactive Protein ◽

Prognostic Assessment ◽

One Year

Introduction: The ideal biomarker to assess response and prognostic assessment in the infected critically ill patient is still not available. The aims of our study were to analyze the association between early C-reactive protein kinetics and duration and appropriateness of antibiotic therapy and its usefulness in predicting mortality in infected critically ill patients.Material and Methods: We have carried out an observational retrospective study in a cohort of 60 patients with community-acquired pneumonia, aspiration pneumonia and bacteremia at an intensive care unit. We have collected C-reactive protein consecutive serum levels for eight days as well as duration and appropriateness of initial antibiotic therapy. C-reactive protein kinetic groups were defined based on the levels at days 0, 4 and 7. With a follow-up of one year, we have evaluated mortality at different time-points.Results: We have obtained three different C-reactive protein kinetic groups from the sample: fast response, delayed but fast response and delayed and slow response. We did not find statistically significant associations between C-reactive protein kinetics and early (intensive care unit, hospital and 28-days) or late (six months and one year) mortality and antibiotic therapy duration (p > 0.05). Although there were no statistically significant differences between the appropriateness of antibiotic therapy and the defined groups (p = 0.265), no patient with inappropriate antibiotic therapy presented a fast response pattern.Discussion: Several studies suggest the importance of this protein in infection.Conclusion: Early C-reactive protein kinetics is not associated with response and prognostic assessment in infected critically ill patients. Nevertheless, a fast response pattern tends to exclude initial inappropriate antibiotic therapy.

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Neonatal COVID-19 Pneumonia: Report of the First Case in a Preterm Neonate in Mayotte, an Overseas Department of France

Children ◽

10.3390/children7080087 ◽

2020 ◽

Vol 7 (8) ◽

pp. 87

Author(s):

Soumeth Abasse ◽

Laila Essabar ◽

Tereza Costin ◽

Voninavoko Mahisatra ◽

Mohamed Kaci ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Respiratory Distress ◽

Neonatal Intensive Care ◽

Preterm Neonate ◽

Chest Ct ◽

First Case ◽

Chest Ct Scan

We report the first case of COVID-19 pneumonia in a preterm neonate in Mayotte, an overseas department of France. The newborn developed an acute respiratory distress by 14 days of life with bilateral ground glass opacities on a chest CT scan and a 6-week-long stay in the neonatal intensive care unit (NICU). This case report emphasizes the need for a cautious and close follow-up period for asymptomatic neonates born to mothers with COVID-19 infection. Vertical transmission cannot be excluded in this case.

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