scholarly journals Characteristics and Clinical Course of Adult in Patients with SARS-CoV-2 Pneumonia at High Altitude

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Javier Leonardo Galindo ◽  
Juan Ricardo Lutz ◽  
María Alejandra Izquierdo ◽  
Katherine Parra ◽  
Lina María Prieto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
High Altitude ◽  
Invasive Mechanical Ventilation ◽  
Underlying Disease ◽  
Icu Admission ◽  
Arterial Ph ◽  
Hospital Patients ◽  
Critical Care Admission

Background. SARS-CoV-2 has spread worldwide with different dynamics in each region. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission, and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in a high-altitude population living in Bogotá, Colombia. Methods. We conducted a concurrent cohort study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and outcomes at 28 days of follow-up. Results. 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Nonsurvivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]; p ≤ 0.001 ) and more likely male (28 [32.9%] vs. 57 [67.1%]; p = 0.029 ). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]), and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29–26.01; p ≤ 0.001 ), ICU admission (OR 12.37, 95% CI 6.08–25.18; p ≤ 0.001 ), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08–0.74; p = 0.01 ) were independently associated with in-hospital mortality. Conclusions. In this study of in-hospital patients with SARS-CoV-2 pneumonia living at high altitude, frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation were high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.

scholarly journals Characteristics and Clinical Course of Adult in-Patients With SARS-CoV-2 Pneumonia in Bogotá, Colombia.

2021 ◽  
Author(s):  
Javier Leonardo Galindo ◽  
Juan Ricardo Lutz ◽  
María Alejandra Izquierdo ◽  
Katherine Parra ◽  
Lina María Prieto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Invasive Mechanical Ventilation ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Icu Admission ◽  
Arterial Ph ◽  
Critical Care Admission

Abstract Background: SARS-CoV-2 virus has spread worldwide causing a crisis in healthcare systems. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in Bogotá, Colombia.Methods: We conducted a cross-sectional study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and clinical outcomes at 28 days of follow-up.Results: Between March 20 and June 30, 2020, 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Non-survivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]) and more likely male (28 [32.9%] vs. 57 [67.1%]). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]) and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01; p=0.00), ICU admission (OR 12.37, 95% CI 6.08-25.18; p=0.00), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74; p=0.01) were independently associated with in-hospital mortality.Conclusions: In this study of in-hospital patients with SARS-CoV-2 pneumonia frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation was high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.

scholarly journals Characteristics and Clinical Course of Adult in-Patients With SARS-CoV-2 Pneumonia in Bogotá, Colombia.

2021 ◽  
Author(s):  
Javier Leonardo Galindo ◽  
Juan Ricardo Lutz ◽  
María Alejandra Izquierdo ◽  
Katherine Parra ◽  
Lina María Prieto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Invasive Mechanical Ventilation ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Icu Admission ◽  
Arterial Ph ◽  
Critical Care Admission

Abstract Background: SARS-CoV-2 virus has spread worldwide causing a crisis in healthcare systems. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in Bogotá, Colombia.Methods: We conducted a cross-sectional study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic and clinical data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and clinical outcomes at 28 days of follow-up.Results: Between March 20 and June 30, 2020, 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Non-survivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]) and more likely male (28 [32.9%] vs. 57 [67.1%]). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]) and obesity (114 [30.2%]). Critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01; p=0.00), ICU admission (OR 12.37, 95% CI 6.08-25.18; p=0.00), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74; p=0.01) were associated with in-hospital mortality.Conclusions: In this study of in-hospital patients with SARS-CoV-2 pneumonia frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation was high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.

scholarly journals Comparison of Hospital- and Community-Acquired Septic Shock in Children: A Single-Center, Cohort, Retrospective Study

2021 ◽  
Author(s):  
Guoyun Su ◽  
Chaonan Fan ◽  
Boliang Fang ◽  
Zhengde Xie ◽  
Suyun Qian
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Hematological Tumor

Abstract Background To explore differences between hospital- (HASS) and community-acquired septic shock (CASS) in patient characteristics, pathogens, complications, outcomes, and risk factors in pediatric intensive care unit (PICU) children. Methods This retrospective study enrolled septic shock children from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into HASS and CASS groups. After comparison, logistic regression analyses were used to identify risk factors for mortality. Results A total of 298 children were enrolled. 65.9% of HASS patients (N = 91) had hematological/tumor diseases and were mainly bloodstream infections of Gram-negative bacteria (47.3%). 67.7% of CASS (N = 207) had no obvious underlying disease and were mostly infected with Gram-positive bacteria (30.9%) of the respiratory or central nervous system. 28-day mortality was 62.6% and 32.7% in HASS and CASS groups, respectively (p < 0.001). The factor associated with 28-day mortality of HASS and CASS was MODS (OR:11.524; 95% CI: 2.140-62.051) and needed invasive mechanical ventilation therapy (OR:6.884; 95% CI: 1.499–31.624), respectively. Conclusions The underlying diseases, pathogens, complications, prognosis and mortality varied widely. 28-day mortality is associated with MODS and need for invasive mechanical ventilation therapy in HASS and CASS patients.

scholarly journals Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Lorenzo Gamberini ◽  
◽  
Tommaso Tonetti ◽  
Savino Spadaro ◽  
Gianluca Zani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Observational Study ◽  
Competing Risks ◽  
Sofa Score ◽  
Late Onset ◽  
Invasive Mechanical Ventilation ◽  
Cardiovascular Complications ◽  
Icu Mortality ◽  
Icu Admission

Abstract Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

BMJ Open ◽  
2016 ◽  
Vol 6 (6) ◽  
pp. e011474 ◽  
Author(s):  
Damian J Mole ◽  
Usha Gungabissoon ◽  
Philip Johnston ◽  
Lynda Cochrane ◽  
Leanne Hopkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Critical Care ◽  
Linkage Analysis ◽  
Record Linkage ◽  
Critical Care Admission

scholarly journals MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tarek Abdellatif ◽  
Abdullah Hamad ◽  
Mohamad Alkadi ◽  
Essa Abuhelaiqa ◽  
Muftah Othman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Mortality Rate ◽  
General Population ◽  
Hospital Stay ◽  
Laboratory Tests ◽  
Length Of Hospital Stay ◽  
Dialysis Patients ◽  
Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p&lt;0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

scholarly journals Risk factors associated with the mortality of Acinetobacter baumannii

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Diaa Alrahmany ◽  
Sirous Golchinheydari ◽  
Islam M. Ghazi
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Acinetobacter Baumannii ◽  
Regression Tree ◽  
Antimicrobial Treatment ◽  
Classification And Regression Tree ◽  
Cart Analysis ◽  
Critical Care Admission ◽  
General Wards

Background: Acinetobacter baumannii (AB) was declared an antibiotic-resistant “Priority 1 pathogen” by WHO. We sought to investigate the predisposing risk factors to this pathogen. Methods: In a retrospective study, adults who were admitted to Sohar hospital during 2016-2017 and had a positive laboratory-confirmed culture of AB were studied.We classified patients into 2 groups based on 30-day, all-cause mortality and compared the characteristics. Exploratory classification and regression tree (CART) analysis was performed to explore risk factors for mortality to include to a logistic regression model. Results: A total of 321 patients were included, age was (Mean±SD) 57.42±20.22, male gender was 180(56.07%), mortality was 140(44%). Survivors vs deceased had; length of stay 38.25±88.74 vs 51.31±79.19 (p=0.002),multi-drug resistantisolates 134(51.34%) vs 127(48.66%) p=<0.001, critical care admission 35(38.04%) vs 57(61.96%) p=<0.001, comorbidities 114(47.50%) vs 126(52.50%) p=<0.001 and history of invasive procedures 82(59.85%) vs 55(40.15%) p=0.27. Logistic regression revealed that the odds of dying increase by a factor of 1.044 for every additional year of age, 1.844 times higher for male compared to female, 4.412 times higher for patients admitted into critical care units compared to general wards, 3.138 times higher for patients admitted with a diagnosis of infection, 2.356 times higher for patients with hospital-acquired AB infection compared to community-acquired. Conclusion: Both modifiable and non-modifiable risk factors are associated with mortality and overall health status may contribute to infection outcome. Stabilization of comorbidities and effective antimicrobial treatment could be the mainstay of successful prevention.

scholarly journals Interim Analysis of Risk Factors for Severe Outcomes among a Cohort of Hospitalized Adults Identified through the U.S. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

2020 ◽  
Author(s):  
Lindsay Kim ◽  
Shikha Garg ◽  
Alissa O'Halloran ◽  
Michael Whitaker ◽  
Huong Pham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
The United States ◽  
Surveillance Network ◽  
Adjusted Risk ◽  
Factors Associated ◽  
Icu Admission ◽  
Male Sex ◽  
Race Ethnicity

Background: As of May 15, 2020, the United States has reported the greatest number of coronavirus disease 2019 (COVID-19) cases and deaths globally. Objective: To describe risk factors for severe outcomes among adults hospitalized with COVID-19. Design: Cohort study of patients identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network. Setting: 154 acute care hospitals in 74 counties in 13 states. Patients: 2491 patients hospitalized with laboratory-confirmed COVID-19 during March 1-May 2, 2020. Measurements: Age, sex, race/ethnicity, and underlying medical conditions. Results: Ninety-two percent of patients had at least 1 underlying condition; 32% required intensive care unit (ICU) admission; 19% invasive mechanical ventilation; 15% vasopressors; and 17% died during hospitalization. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male sex (aRR 1.34); obesity (aRR 1.31); immunosuppression (aRR 1.29); and diabetes (aRR 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease (aRR 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR 1.28); neurologic disorders (aRR 1.25); and diabetes (aRR 1.19). Race/ethnicity was not associated with either ICU admission or death. Limitation: Data were limited to patients who were discharged or died in-hospital and had complete chart abstractions; patients who were still hospitalized or did not have accessible medical records were excluded. Conclusion: In-hospital mortality for COVID-19 increased markedly with increasing age. These data help to characterize persons at highest risk for severe COVID-19-associated outcomes and define target groups for prevention and treatment strategies.

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