688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (<18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2<90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2<90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

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Which Clinical Scoring Systems Are Most Useful in Showing Severity in COVID-19 Patients?

10.21203/rs.3.rs-362665/v1 ◽

2021 ◽

Author(s):

Ishak San ◽

Emin Gemcioglu ◽

Salih Baser ◽

Nuray Yilmaz Cakmak ◽

Abdulsamet Erden ◽

...

Keyword(s):

High Risk ◽

Clinical Outcomes ◽

Predictive Value ◽

Independent Predictor ◽

Severe Disease ◽

Scoring Systems ◽

High Risk Group ◽

World Health ◽

Severe Group ◽

Clinical Scoring

Abstract IntroductionIn this study, we compare the predictive value of clinical scoring systems that are already in use in patients with COVID-19, including the BCRSS, qSOFA, SOFA, MuLBSTA and HScore, for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians.Materials and MethodsWe classified the patients into two groups according to the stage of the disease (severe and non-severe) by using the slightly modified and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 hours.ResultsOf the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR: 6.1, 95% CI: 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR: 4.757, 95% CI: 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively.ConclusionCalculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. With early identification of the high-risk group using BRCSS and qSOFA, early interventions for high-risk patients can improve clinical outcomes in COVID-19.

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Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database

BMC Infectious Diseases ◽

10.1186/s12879-021-07004-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vaishali Gupte ◽

Rashmi Hegde ◽

Sandesh Sawant ◽

Kabil Kalathingal ◽

Sonali Jadhav ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Oxygen Therapy ◽

High Flow ◽

Low Flow ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

High Flow Oxygen

Abstract Background Real-world data on safety and clinical outcomes of remdesivir in COVID-19 management is scant. We present findings of data analysis conducted for assessing the safety and clinical outcomes of remdesivir treatment for COVID-19 in India. Methods This retrospective analysis used data from an active surveillance programme database of hospitalised patients with COVID-19 who were receiving remdesivir. Results Of the 2329 patients included, 67.40% were men. Diabetes (29.69%) and hypertension (20.33%) were the most common comorbidities. At remdesivir initiation, 2272 (97.55%) patients were receiving oxygen therapy. Remdesivir was administered for 5 days in 65.38% of patients. Antibiotics (64.90%) and steroids (47.90%) were the most common concomitant medications. Remdesivir was overall well tolerated, and total 119 adverse events were reported; most common were nausea and vomiting in 45.40% and increased liver enzymes in 14.28% patients. 84% of patients were cured/improved, 6.77% died and 9.16% showed no improvement in their clinical status at data collection. Subgroup analyses showed that the mortality rate was significantly lower in patients < 60 years old than in those > 60 years old. Amongst patients on oxygen therapy, the cure/improvement rate was significantly higher in those receiving standard low-flow oxygen than in those receiving mechanical ventilation, non-invasive ventilation, or high-flow oxygen. Factors that were associated with higher mortality were age > 60 years, cardiac disease, diabetes high flow oxygen, non-invasive ventilation and mechanical ventilation. Conclusion Our analysis showed that remdesivir is well tolerated and has an acceptable safety profile. The clinical outcome of cure/improvement was 84%, with a higher improvement in patients < 60 years old and on standard low-flow oxygen.

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Prevention of suicide following psychiatric hospitalization

Oxford Textbook of Suicidology and Suicide Prevention ◽

10.1093/med/9780198834441.003.0061 ◽

2021 ◽

pp. 511-520

Author(s):

Natalie B. Riblet ◽

Brian Shiner

Keyword(s):

High Risk ◽

Clinical Outcome ◽

Suicide Attempts ◽

Psychiatric Hospitalization ◽

World Health ◽

Effective Strategies ◽

Risk Period ◽

The World ◽

Cognitive Therapies ◽

Health Organization

The period following a psychiatric hospitalization is a high-risk period for suicide and several factors may contribute such as problems with patient engagement. It is vital that researchers identify effective strategies to prevent suicide in the period following hospitalization. Yet, researchers face many challenges in conducting suicide research. Importantly, because the clinical outcome of greatest interest, death by suicide, is rare, researchers must rely heavily on proxy measures of suicide. Furthermore, while there have been over 30 trials of various strategies to mitigate suicide risk following hospital or emergency room discharge, there is mixed evidence regarding the efficacy of these interventions. While some studies have shown significant reduction in suicide attempts, other studies have found no difference. Few studies have demonstrated a significant effect on death by suicide. The most promising interventions include cognitive therapies for suicide prevention, the World Health Organization Brief Intervention and Contact programme.

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Early mannitol administration improves clinical outcomes of pediatric patients with brain edema

Medical Journal of Indonesia ◽

10.13181/mji.v27i4.2377 ◽

2018 ◽

Vol 27 (4) ◽

pp. 244-9 ◽

Cited By ~ 1

Author(s):

Putu A. Sekarningrum ◽

Dyah K. Wati ◽

IGN Made Suwarba ◽

I Nyoman B. Hartawan ◽

Dewi S. Mahalini ◽

...

Keyword(s):

Multivariate Analysis ◽

Clinical Outcome ◽

Brain Edema ◽

Clinical Outcomes ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Outcome Variable ◽

Chi Square ◽

Primary Outcome Variable ◽

Chi Square Test

Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU).Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25.Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01).Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.

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COVID-19 Inmate Risk Appraisal (CIRA): Development and validation of a screening tool to assess COVID-19 vulnerability in prisons

10.21203/rs.3.rs-40225/v1 ◽

2020 ◽

Author(s):

Leonel C. Gonçalves ◽

Stéphanie Baggio ◽

Michael Weber ◽

Laurent Gétaz ◽

Hans Wolff ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Medical Staff ◽

Screening Tool ◽

Control Sample ◽

Case Control ◽

Elevated Risk ◽

World Health ◽

Validation Sample ◽

Risk Appraisal

Abstract Objectives. To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). Design. Cross-sectional study with a representative sample (development) and a case-control sample (validation).Setting. The two largest Swiss prisons.Participants. (1) Development sample: all male persons detained in Pöschwies, Zurich (n=365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n=192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors).Main outcome measures. The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as prognosis of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency, and cancer. Results. Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7), and high (>5.7) risk. In the validation sample, the CIRA identified all individuals considered vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximized sensitivity (1) and specificity (.97). The CIRA had even higher capacity in discriminating vulnerable individuals according to clinical evaluation (a four-level risk categorization based on a consensus of medical staff). The category “elevated risk” maximized sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity=.89, specificity=.97). Conclusions. The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritize actions using a standardized valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA should be considered preliminary. Underlying data will be updated regularly on the website www.prison-research.com, where the CIRA algorithm is freely available.

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Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization

Journal of Clinical Medicine ◽

10.3390/jcm9082379 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2379

Author(s):

Marcel Niemann ◽

Frank Graef ◽

Serafeim Tsitsilonis ◽

Ulrich Stöckle ◽

Sven Märdian

Keyword(s):

Clinical Outcome ◽

Treatment Duration ◽

Flail Chest ◽

Case Control ◽

Hospital Treatment ◽

Invasive Ventilation ◽

Total Hospital ◽

Ventilation Duration ◽

Morphine Equivalent ◽

Oral Analgesia

Background: In polytrauma (PT) patients, osseous thoracic injuries are commonly observed. One of the most severe injuries is the flail chest where the rib cage is broken in such a way that leads to a partial functional detachment of the thoracic wall. Especially in PT patients, the integrity of the respiratory system and especially, of the respiratory muscles is essential to prevent respiratory failure. Besides conservative treatment options, flail chest injuries may be surgically stabilized. However, this treatment option is rarely carried out and evidence on the outcome of surgically treated flail chest patients is rare. Objective: This study intends to investigate the clinical outcome of PT patients with the diagnosis of a flail chest who received an osteosynthetic stabilization for that compared to the same group of patients without an operative treatment. The between-groups outcome was compared regarding the duration of the total hospital and the intensive care unit (ICU) stay, the total of the invasive ventilation days, the incidence of pneumonia, and the dosage of the pain medication at the hospital discharge. Methods: A retrospective analysis was conducted including all PT patients who received an osteosynthetic stabilization of a flail chest. Furthermore, another cohort of PT patients and the diagnosis of a flail chest but without operative treatment was determined. Both groups were case-control matched for the Injury Severity Score (ISS) and age. Further statistical analysis was performed using the Wilcoxon signed-rank test and the McNemar’s test. Results: Out of eleven operatively and 59 conservatively treated patients, eleven patients per group were matched. Further analysis revealed no significant differences in the normal ward treatment duration (5.64 ± 6.62 and 6.20 ± 5.85 days), the invasive ventilation duration (was 6.25 ± 7.17 and 7.10 ± 6.14 days), the morphine equivalent dosage of the oral analgesia (61.36 ± 67.23 mg and 39.67 ± 65.65 mg), and the pneumonia incidence (36.4 and 54.5%) when conservatively and operatively treated patients were compared, respectively. However, surgically treated patients had a longer ICU (25.18 ± 14.48 and 15.27 ± 12.10 days, Z = −2.308, p = 0.021) and a longer total hospital treatment duration (30.10 ± 13.01 and 20.91 ± 10.34 days, Z = −2.807, p = 0.005) when compared to conservatively treated patients. Conclusion: In the present study cohort, there was no outcome difference between conservatively and operatively treated patients with the diagnosis of a flail chest regarding the normal ward treatment duration, the invasive ventilation duration, the morphine equivalent dosage of the oral analgesia, and the pneumonia incidence while ICU treatment duration and hospital treatment duration was longer in operatively treated patients.

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Sars-Cov-2 Induced Endotheliopathy and the Impact on Clinical Outcomes in Critically Ill Pediatric Patients

Blood ◽

10.1182/blood-2021-153084 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3145-3145

Author(s):

Shreya Agarwal ◽

Mark Zobeck ◽

Clay T Cohen ◽

Sarah E Sartain

Keyword(s):

Mechanical Ventilation ◽

Statistical Analysis ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Patients ◽

Endothelial Injury ◽

Negative Regulator ◽

Plasma Samples ◽

Positive Correlation

Abstract Background: Coronavirus disease-19 (COVID-19) is an acute respiratory illness caused by the SARS-COV-2 virus. Patients with COVID-19 infection can present with thrombosis in the setting of inflammation (thromboinflammation), presumably from endothelial dysfunction, or "endotheliopathy". Yu et al demonstrated in vitro that the spike protein subunit of SARS-COV2 acts as a potent activator of the alternative complement pathway (AP), one of three complement pathways within the innate immune system. Satyam et alreported the deposition of complement components on lung tissue of patients who succumbed to COVID-19, consistent with activation of classical and alternate pathways. These studies suggest complement dysregulation potentially causing endotheliopathy in COVID-19 patients. Thrombomodulin (TM) is an endothelial glycoprotein that plays two crucial roles in maintaining a healthy endothelium - as a natural anticoagulant and a negative regulator of complement. TM shed into the circulation due to endothelial injury can be measured in the plasma as soluble TM (sTM). Goshua et al showed elevated sTM in an adult cohort of patients with COVID-19. However, it is yet to be demonstrated if there is any correlation between endothelial injury and AP activation in COVID-19, or if either play a role in clinical outcome in the pediatric population. Objective: To 1) assess endothelial injury and AP activation in a cohort of critically ill pediatric patients with COVID-19 by measuring sTM and Ba (an AP activation product); 2) determine the correlation between endothelial injury and AP activation; and 3) analyze the utility of sTM and Ba in predicting pediatric clinical outcomes. Methods: We collected plasma samples of patients admitted to the Pediatric Intensive Care Unit and found to be positive for SARS-CoV-2 between Dec 2, 2020 and Jan 22, 2021 at Texas Children's Hospital. For controls, we collected plasma samples from pediatric patients undergoing preoperative clearance, all at their baseline state of health. sTM levels and Ba levels were measured in plasma samples using commercially available TM and Ba ELISA kits. sTM greater than 7.6 ng/ml (based on the assay range in adults) and Ba greater than 1080 ng/ml (based on data from adult healthy controls) were considered elevated. Data regarding demographics, length of ICU stay, clinical indicators of end organ damage- mechanical ventilation, dialysis, use of vasopressors, ECMO, mortality were obtained retrospectively via chart review. Inclusion criteria included all patients with a positive SARS-COV2 PCR admitted to the ICU. Exclusion criteria was age greater than 21 years, pregnant female, patients with known inflammatory or complement-mediated disorders. Statistical analysis: For sTM and Ba levels between control and COVID-19 patients, mean +/- standard deviation was calculated and significance determined with an unpaired t-test. Fischer exact test, Wilcoxon rank sum and Pearson product-moment correlation tests were used for statistical analysis of clinical outcomes as appropriate. A p-value <0.05 was considered statistically significant. Results: A total of 38 control patients and 33 COVID-19 patients were enrolled. Ba and sTM levels were both significantly higher in the COVID-19 pediatric patients compared to the controls (Fig. 1). Within the COVID-19 patient cohort, 61% (n=20) had elevated sTM and 42% (n=14) had elevated Ba levels. There was a moderately positive correlation between sTM and plasma Ba levels in the COVID-19 cohort (Fig. 2). Within the COVID-19 patients' cohort, though higher Ba levels were not associated with an increased rate of intubation, they were associated with an increased duration of mechanical ventilation (p=.039) for those intubated (Table 1). Elevated sTM was associated with increased vasopressor use (p=.011). Although other clinical outcome variables did not reach statistical significance likely owing to small numbers, overall trend indicated worse outcomes in patients with elevated sTM. Conclusions: Our findings are consistent with the hypothesis that SARS-COV-2 activates AP and causes endothelial injury in children. The positive correlation between sTM and Ba suggest interplay between inflammation, coagulation and endotheliopathy supporting thromboinflammation in COVID-19. Higher sTM and Ba levels indicated worse clinical outcomes in children, but larger studies are needed to confirm our findings. Figure 1 Figure 1. Disclosures Sartain: Alexon Pharamaceuticals: Membership on an entity's Board of Directors or advisory committees.

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Effect of the Neutralizing SARS-CoV-2 Antibody Sotrovimab in Preventing Progression of COVID-19: A Randomized Clinical Trial

10.1101/2021.11.03.21265533 ◽

2021 ◽

Author(s):

Anil Gupta ◽

Yaneicy Gonzalez-Rojas ◽

Erick Juarez ◽

Manuel Crespo ◽

Jaynier Moya ◽

...

Keyword(s):

High Risk ◽

Emergency Room ◽

Severe Disease ◽

Neutralizing Antibody ◽

Supplemental Oxygen ◽

Secondary Outcome ◽

Effective Treatment Option ◽

Double Blind ◽

Increased Risk ◽

High Flow Oxygen

Importance: Older patients and those with underlying comorbidities infected with SARS-CoV-2 may be at increased risk of hospitalization and death from COVID-19. Sotrovimab is a neutralizing antibody designed for treatment of high-risk patients to prevent COVID-19 progression. Objective: To evaluate the efficacy and safety of sotrovimab in preventing progression of mild to moderate COVID-19 to severe disease. Design: Randomized, double-blind, multicenter, placebo-controlled, phase 3 study. Setting: 57 centers in 5 countries. Participants: Nonhospitalized patients with symptomatic, mild to moderate COVID-19 and at least 1 risk factor for disease progression. Intervention: Patients were randomized (1:1) to an intravenous infusion of sotrovimab 500 mg or placebo. Main Outcomes and Measures: The primary efficacy outcome was the proportion of patients with COVID-19 progression, defined as all-cause hospitalization longer than 24 hours for acute illness management or death through day 29. Key secondary outcomes included the proportion of patients with COVID-19 progression, defined as emergency room visit, hospitalization of any duration, or death, and proportion of patients developing severe/critical respiratory COVID-19 requiring supplemental oxygen. Results: Among 1057 patients randomized (sotrovimab, 528; placebo, 529), all-cause hospitalization longer than 24 hours or death was significantly reduced with sotrovimab (6/528 [1%]) vs placebo (30/529 [6%]) by 79% (95% CI, 50% to 91%; P<.001). Secondary outcome results further demonstrated the effect of sotrovimab in reducing emergency room visits, hospitalization of any duration, or death, which was reduced by 66% (95% CI, 37% to 81%; P<.001), and severe/critical respiratory COVID-19, which was reduced by 74% (95% CI, 41% to 88%; P=.002). No patients receiving sotrovimab required high-flow oxygen, oxygen via nonrebreather mask, or mechanical ventilation compared with 14 patients receiving placebo. The proportion of patients reporting adverse events was similar between treatment groups; sotrovimab was well tolerated, and no safety concerns were identified. Conclusions and Relevance: Among nonhospitalized patients with mild to moderate COVID-19, a single 500-mg intravenous dose of sotrovimab prevented progression of COVID-19, with a reduction in hospitalization and need for supplemental oxygen. Sotrovimab is a well-tolerated, effective treatment option for patients at high risk for severe morbidity and mortality from COVID-19.

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Brescia-COVID Respiratory Severity Scale (BRCSS) and Quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients

Scientific Reports ◽

10.1038/s41598-021-01181-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ishak San ◽

Emin Gemcioglu ◽

Salih Baser ◽

Nuray Yilmaz Cakmak ◽

Abdulsamet Erden ◽

...

Keyword(s):

High Risk ◽

Clinical Outcomes ◽

Predictive Value ◽

Scoring System ◽

Independent Predictor ◽

Severe Disease ◽

World Health ◽

Smoking History ◽

Severity Scale ◽

Severe Group

AbstractIn this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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