scholarly journals “Urban Tertiary Care Centre Experience of Characteristics of Severe COVID-19 Pneumonia”

Author(s):  
Nehal M Shah ◽  
Janakkumar R Khambholja ◽  
Nilay Suthar ◽  
Hemant Tiwari ◽  
Vandit Desai ◽  
...  

AbstractIntroductionThe global pandemic of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019, and has since spread worldwide.[1] This study attempts to summarize current evidence regarding major inflammatory markers, severity predictors and its impact on outcome, which provide current clinical experience and treatment guidance for this novel coronavirus.MethodsThis is a retrospective observational study done at an urban teaching covid-19 designated hospital. Hospital data were analysed with aim of studying inflammatory markers, predictors and outcome. Patients were classified in Mild, Moderate, Severe & Critical categories of COVID cases. Their clinical parameters, laboratory investigations, radiological findings & Outcome measures were studied. Strength of association & correlation of those parameters with severity and in-hospital mortality were studied.ResultsA total 204 (N) patients were clinically classified into different severity groups, as per MOHFW and qCSI(quick Covid Severity Index) guidelines, as Mild (34), Moderate (56), Severe (39) and Critical (75). The mean(SD) age of the cohort was 55.1+13.2 years; 74.02% were male. Severe COVID-19 illness is seen more in patients more than 50 years of age. COVID-19 patients having IHD develop worse disease with excess early in-hospital mortality. Respiratory rate & Heart Rate on admission are correlated with severe and stormy disease. Among Inflammatory markers, on admission LDH, D-Dimer and CRP are related with severity and excess in-hospital death rate.ConclusionAdvanced age, male gender, IHD, Respiratory Rate & Heart Rate on admission were associated with severe covid-19 illness. S. Lactate Dehydrogenase & D-dimer was associated with severe covid-19 illness and early in-hospital death.

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
Jose Morais ◽  
Diana Dima

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.


CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 270-278
Author(s):  
Qamar Amin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell ◽  
Subhra Mohapatra ◽  
Abdulaziz Alsadoon ◽  
...  

AbstractObjectiveDiagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism.MethodsThis was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism.ResultsWe enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0).ConclusionIn summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules.


2021 ◽  
Vol 59 (235) ◽  
Author(s):  
Prabin Khatri ◽  
Krishna Kumar Agrawal ◽  
Dipesh Sharma ◽  
Pradip Chhetri ◽  
Aryan Neupane ◽  
...  

Introduction: D-dimer is currently the best available marker for COVID-19 associated hemostatic abnormalities. This study aims to find out the prevelance of elevated D-dimer levels in confirmed COVID-19 cases in intensive care unit of a tertiary care hospital of western Nepal. Methods: This descriptive cross-sectional study was conducted among 95 patients admitted to COVID Intensive Care Unit of a teriary care centre from August 2020 to January 2021 after taking ethical clearence from Institutional Review Committee in order to determine the D-dimer levels in confirmed COVID-19 cases. D-dimer value was measured at the admission and the highest D-dimer value was recorded during the course of hospital stay with the risk of mortality in confirmed COVID-19 cases. The normal range of D-dimer was taken as <0.35 mg/dl as per our hospital laboratory standards. Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 25.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 95 cases of COVID-19 included in this study, 25 (89.3%) patients with age ≥65 years and 42 (62.69%) patients aged <65 years had elevated D-dimer on admission. Data showed that 29 (67.4%) patients having elevated D-dimer at admission had mortality. Conclusions: Elevated D-dimer levels was frequently seen in patients admitted in Intensive Care Unit with COVID-19. Our study suggested that measurement of D-dimer may guide in clinical decision making.


2021 ◽  
Vol 9 (06) ◽  
pp. 773-777
Author(s):  
Archana Jadhav ◽  
◽  
Rashmi Bengali ◽  

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Selcuk ◽  
T Cinar ◽  
N Gunay ◽  
M Keskin ◽  
V Cicek ◽  
...  

Abstract Objective The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p&lt;0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p&lt;0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1


2020 ◽  
Author(s):  
Siegbert Rieg ◽  
Maja von Cube ◽  
Johannes Kalbhenn ◽  
Stefan Utzolino ◽  
Katharina Pernice ◽  
...  

Abstract BackgroundReported mortality of hospitalised COVID-19 patients varies substantially, particularly in critically ill patients. So far COVID-19 in-hospital mortality and modes of death under optimised care conditions have not been systematically studied.MethodsThis retrospective observational monocenter cohort study was performed after implementation of a non-restricted, dynamic tertiary care model at the University Medical Center Freiburg, an experienced ARDS and ECMO referral center. All hospitalised patients with PCR-confirmed SARS-CoV-2 infection were included. The primary endpoint was in-hospital mortality, secondary endpoints included major complications and modes of death. A multistate analysis and a Cox regression analysis for competing risk models were performed. Modes of death were determined by two independent reviewers.ResultsBetween February 25, and May 8, 213 patients were included in the analysis. The median age was 65 years, 129 patients (61%) were male. 70 patients (33%) were admitted to the intensive care unit (ICU), of which 57 patients (81%) received mechanical ventilation and 23 patients (33%) extracorporeal membrane-oxygenation (ECMO) support. According to the multistate model the probability to die within 90 days after COVID-19 onset was 24% in the whole cohort. If the levels of care at time of study entry were accounted for, the probabilities to die were 16% if the patient was initially on a regular ward, 47% if in the ICU and 57% if mechanical ventilation was required at study entry. Age ≥ 65 years and male sex were predictors for in-hospital death. Predominant complications – as judged by two independent reviewers – determining modes of death were multi-organ failure, septic shock and thromboembolic and hemorrhagic complications.ConclusionIn a dynamic care model COVID-19-related in-hospital mortality remained substantial. In the absence of potent antiviral agents, strategies to alleviate or prevent the identified complications should be investigated. In this context, multistate analyses enable comparison of models-of-care and treatment strategies and allow estimation and allocation of health care resources.RegistrationGerman Clinical Trials Register (identifier DRKS00021775), retrospectively registered June 10, 2020.


Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 26-35
Author(s):  
I. V. Kovtyukh ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
A. M. Baymukanov ◽  
A. E. Nikitin ◽  
...  

Background     Heart damage is one of complications of the novel coronavirus infection. Searching for available predictors for in-hospital death and survival that determine the tactic of managing patients with COVID-19, is a challenge of the present time.Aim      To determine the role echocardiographic (EchoCG) parameters in evaluation of the in-hospital prognosis for patients with the novel coronavirus infection, COVID-19.Material and methods  The study included 158 patients admitted for COVID-19. EchoCG was performed for all patients. The role of left ventricular (LV) ejection fraction (EF) was analyzed in various age groups. EchoCG data were compared with the clinical picture, including the severity of respiratory failure (RF), blood oxygen saturation (SрО2), data of computed tomography (CT) of the lungs, and blood concentration of troponin. Comorbidity was analyzed, and the highest significance of individual pathologies was determined.Results LV EF ≤40 % determined the worst prognosis of patients with COVID-19 (p<0.0001), including the age group older than 70 years (р=0.013). LV EF did not correlate with the degree of lung tissue damage determined by CT upon admission (р=0.54) and over time (р=0.23). The indexes that determined an adverse in-hospital prognosis to a considerable degree were pericardial effusion (p<0.0001) and pulmonary hypertension (p<0.0001). RV end-diastolic dimension and LV end-diastolic volume did not determine the in-hospital mortality and survival. Blood serum concentration of troponin I higher than 165.13 µg/l was an important predictor for in-hospital death with a high degree of significance (р<0.0001). Th degree of RF considerably influenced the in-hospital mortality (р<0.0001). RF severity was associated with LV EF (р=0.024). The SpO2 value determined an adverse immediate prognosis with a high degree of significance (р=0.0009). This parameter weakly correlated with LV EF (r=0.26; p=0.0009). Patients who required artificial ventilation (AV) constituted a group with the worst survival rate (р<0.0001). LV EF was associated with a need for AV with a high degree of significance (р=0.0006). Comorbidities, such as chronic kidney disease, postinfarction cardiosclerosis and oncologic diseases, to the greatest extent determined the risk of fatal outcome.Conclusion      EchoCG can be recommended for patients with COVID-19 at the hospital stage to determine the tactics of management and for the in-hospital prognosis.


2021 ◽  
Vol 8 (28) ◽  
pp. 2520-2525
Author(s):  
Sunil Baragi ◽  
Pavani Mallikarjun Dyavannavar

BACKGROUND A novel coronavirus was identified as being responsible for a cluster of pneumonia cases worldwide. With an upward trajectory of (corona virus disease-19) COVID-19 cases and its numerous presentations, there is an urgent requirement of identifying initial signs of decline of quality and an adequate response in order to shift a patient to specialized intensive care units (ICU) for those who progress morbidly to severe or critical categories. It has been reported that various acute phase reactants like erythrocyte sedimentation rate (ESR), ferritin, C-reactive protein (CRP), lactate dehydrogenase (LDH) and D-dimer are raised much more in severe and critical patients than in the mild cases. These markers might have a role to predict mortality. The present study was done to assess the relationship of serum ferritin, and CRP levels at admission with in-hospital mortality among patients with COVID-19 infection and to determine cut-off values of the best prediction of mortality. METHODS A cross-sectional study of 109 reverse transcription polymerase chain reaction (RTPCR) confirmed COVID-19 patients admitted in our hospital was done. The outcome of cases was categorized into mild, moderate and severe grades. RESULTS Out of 109, 80(73.4 %) were males and 29 (26.6 %) were females. Majority patients of both genders were having severe disease with 30 males and females 10 (P - value = 0.066). Among 109 patients, mild cases (33), moderate case (36), severe case (40). Serum ferritin value severe group (n = 49) 422.45 ng/mL, moderate group (n = 33) 563.64 ng/mL, mild group (n = 27) 529.63 ng/mL. Mean ESR value in severe group 98.37, moderate group 100, mild group 100. Mean CRP in severe group 242.86 mg/L, moderate group 248.48 mg/L, mild group 307.41 mg/L. Mean d-dimer in severe group 971.43 ng/mL, moderate group 803.03 ng/mL, mild group 811.11 ng/mL. CONCLUSIONS Our study showed higher levels of markers like ferritin, D-dimer, CRP and ESR in severe patients as compared to mild and helped in forecasting the advancement of mild cases to severe. Also, the blood levels of CRP and ferritin and the duration to complete symptomatic relief all demonstrated a substantial statistical link thus aiding for monitoring of patients at home and in hospitals. KEYWORDS Covid-19, Inflammatory Markers


2021 ◽  
pp. 3-5
Author(s):  
Santosh Kumar ◽  
Priyanka Prasad ◽  
Ajay Kumar Sinha

Objectives: The outbreak of 2019 Novel coronavirus disease (COVID-19) has caused global attention. Due to its rapid spread worldwide, COVID-19 was declared as a public health emergency by the World Health Organization. Although most patients have mild symptoms and good prognosis, severe COVID-19 cases may present with acute respiratory distress syndrome (ARDS) and systemic inammation. Thus, it is to evaluate the disease severity and investigate possible biomarkers so as to make fast and correct clinical decisions. Methods: This is a single center, prospective study conducted at Nalanda Medical College and Hospital Patna. We enrolled 100 OPD and inhospital patients with COVID- 19 admitted to the Nalanda Medical College and Hoapital and analyzed infection biomarkers in covid patients who had been tested for ferritin, PCT, CRP, IL-6 and procalcitonin. Results:Average level of Ferritin in Covid-19 patients is 18746.34 ng/ml whereas in control patients it is around 226.29 ng/ml. Around 97 percent of patients affected with COVID-19 having Ferritin level very high from the referred range. Average level of D-dimer in Covid patients is 2807.16 ng/ml and in non COVID patients 276.04 ng/ml. All the covid patients have D-dimer level very high than the referred range. Average level of Procalcitonin in Covid and control patients is 0.93 and 0.53 ng/ml respectively. Around three fourth of covid patients and one third of control patients have this level higher than the referred range. CRPlevel of COVID patients are very high (on an average 483.48 mg/l) in comparison to non covid patients (on an average 6.29 mg/l). All the covid patients have IL-6 level much higher than the referred range. Conclusion: Our ndings suggest that level of Ferritin, D-dimer, PCT, CRP and IL-6 can be used to predict the result of COVID-19 test. They can help in detection of COVID-19 patients.


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