Abstract 14403: Troponin as a Powerful Predictor of Mortality in Critically Ill Covid-19 Patientsmulticenter Analysis in 159 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zulfiqar Qutrio Baloch ◽  
Abbas Ali ◽  
Abdullah Alabcha ◽  
manel boumegouas ◽  
Steven Do ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cardiac Involvement ◽  
Demographic Data ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Biomarkers ◽  
Serial Determination ◽  
Patient Status ◽  
Multicenter Analysis

Introduction: Certain cardiac biomarkers have been shown to predict survival in patients infected with COVID-19. However. The use of Troponins, CPK and LDH in predicting the outcome in patients who are critically ill and require advanced respiratory support is less clear. Methods: We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) were recorded. Cardiac biomarkers (CPK, Troponins, BNP, LDH) were analyzed. Patient status was classified either alive or deceased at the end of follow up period. Results: Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariate logistic regression analysis identified 2 factors (Age >62 HR 2.4, 95% CI 1.21-4.676, p<0.01 and elevated Troponin >0.5 HR 3.45, 95% CI 1.01-11.8, p 0.048) has significant and independent contributions to the likelihood of survival (Fig 1 and Fig 2). Fig 1 KM curve of different strata of Troponin levels Fig 2 KM curve of 2 strata of Age Conclusion: Elevated Troponins level are common in critically ill COVID-19 patients. The highly predictive value of Troponins in survival may indicate possible cardiac involvement of COVID-19 infection as a determinant of mortality. Early and serial determination of Troponin values can provide risk stratification for these patients and timely aggressive intervention may decrease mortality.

Abstract 13274: Predictors of Mortality in Critically Ill Covid-19 Patients - A Multicenter Prospective Analysis of 159 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Randy Ip ◽  
Zulfiqar Qutrio Baloch ◽  
manel boumegouas ◽  
Abdullah Al abcha ◽  
Steven Do ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Demographic Data ◽  
Prior History ◽  
Multivariable Logistic Regression Analysis ◽  
Elevated Troponin ◽  
Ischemic Disease ◽  
Patient Status ◽  
History Of

Introduction: Certain patient demographics and biomarkers have been shown to predict survival in patients infected with COVID-19. However, predictors of outcome in patients who are critically ill and require advanced respiratory support are unclear. Methods: We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) and past medical history (hypertension, diabetes, COPD, CKD, history of cardiac ischemic disease, atrial fibrillation and heart failure) were recorded. Laboratory values (troponin, CPK, pro-BNP, ferritin, LDH and d-dimer) were analyzed. Patient status was classified as either alive or deceased at hospital discharge or the end of follow up period. Results: Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariable logistic regression analysis identified four factors (age, prior history of diabetes, prior history of atrial fibrillation and elevated troponin) that had significant and independent contributions to the likelihood of survival. Each increase in decade of age above 40 (p = 0.010) was predicted to reduce survival by 30%, the presence of diabetes (p = 0.041) by 57%, a prior history of atrial fibrillation (p= 0.011) by 75%, and each increase of 0.1 ng/mL of troponin above 0.05 ng/ml (p = 0.001) by 55%. Conclusion: Mortality of critically ill COVID-19 patients is high. Early aggressive treatment of high-risk patients identified in this study (advanced age, history of diabetes and atrial fibrillation and elevated troponin) could improve clinical outcome. The highly predictive value of elevated troponin levels on survival may indicate cardiac involvement of COVID-19 infection as a determinant of mortality. Additionally, of available published literature at this time, this is the first study that suggests a relationship between atrial fibrillation and increased mortality from COVID-19. Larger studies are needed to confirm these findings.

scholarly journals Using modified early warning score to predict need of lifesaving intervention in adult non-trauma patients in a tertiary state hospital

2018 ◽  
Vol 25 (3) ◽  
pp. 146-151 ◽  
Author(s):  
Leong Shian Peng ◽  
Azhana Hassan ◽  
Aida Bustam ◽  
Muhaimin Noor Azhar ◽  
Rashidi Ahmad
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Early Warning ◽  
Demographic Data ◽  
Vital Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Level Of Consciousness

Background: Modified early warning score has been validated in many uses in the emergency department. We propose that the modified early warning score performs well in predicting the need of lifesaving interventions in the emergency department, as a predictor of patients who are critically ill. Objective: The study aims to evaluate the use of modified early warning score in sorting out critically ill patients in the emergency department. Methods: The patients’ demographic data and first vital signs (blood pressure, heart rate, temperature, respiratory rate, and level of consciousness) were collected prospectively. Individual modified early warning score was calculated. The outcome was a patient received one or more lifesaving interventions toward the end of stay in emergency department. Multivariate logistic regression analysis was utilized to assess the association between modified early warning score and other potential predictors with outcome. Results: There are a total of 259 patients enrolled into the study. The optimal modified early warning score in predicting lifesaving intervention was ≥4 with a sensitivity of 95% and specificity of 81%. Modified early warning score ≥4 (odds ratio = 96.97, 95% confidence interval = 11.82–795.23, p < 0.001) was found to significantly increase the risk of receiving lifesaving intervention in the emergency department. Conclusion: Modified early warning score is found to be a good predictor for patients in need of lifesaving intervention in the emergency department.

scholarly journals Prognostic value of cardiac biomarkers in COVID-19 infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aakash Sheth ◽  
Malak Modi ◽  
Desiree’ Dawson ◽  
Paari Dominic
Keyword(s):  
Critically Ill ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Analysis Model ◽  
Significant Difference ◽  
Multiple Biomarkers ◽  
Mean Differences

AbstractMultiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. The goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. PubMed, Embase and Web of Science were searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it. Troponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.57, 95% CI 0.43–0.70, p < 0.001). Additionally, BNP levels were also significantly higher in patients who died or were critically ill (WMD 0.45, 95% CI − 0.21–0.69, p < 0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26–35.1, p = 0.03). A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.79, 95% CI 0.25–1.33, p = 0.004). Cardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.

scholarly journals Social Support and the Risk of Hypertension in an Open Population in Russia/ Siberia (Who Monica-Psychosocial Program)

2021 ◽  
pp. 1-9
Author(s):  
Valery Gafarov ◽  
◽  
EA Gromova ◽  
DO Panov ◽  
◽  
...  
Keyword(s):  
Social Support ◽  
Demographic Data ◽  
Men And Women ◽  
Never Married ◽  
Open Population ◽  
The Impact ◽  
Screening Survey ◽  
Close Contacts

Purpose: To study the impact of social support (indices of close contacts and social netwotks) on the risk of arterial hypertension (AH) in an open population of 25-64 years in Novosibirsk. Methods: A random representative sample of the population of both sexes of 25-64 years old in Novosibirsk in 1994 (men: n = 657 44.3 ± 0.4 years response - 82.1% women: n = 689 45.4 ± 0.4 years response - 72.5%). The screening survey program included: registration of socio-demographic data determination of the level of social support (ICC - index of close contacts SNI - index of social networks). The period of prospective follow-up of participants was 16 years. Results: In the open population of 25-64 years low rates of ICC and SNI were in 62% and 43.5% of men and 56.8% and 33.9% of women. During the first 5 years the risk of hypertension in men and women with a low ICC was the same in men HR = 2.063 (95% CI 1.019-5.213 p <0.05) and women with HR = 2.009 (95% CI 1.025- 3.938 p <0.05). The increase in the risk of AH in persons with low SNI over 5 years was higher in men in 5.9 (95% CI 1.278-8.361 p <0.05) times 10 years later the risk of developing AH in women 25-64 was 1.884 (95% CI 1.09-3.255 p <0.05). The risk of hypertension was highest among men: never married divorced and widowed with low ICC and SNI. Among women at risk were widowed women with low ICC as well as women with primary education with low ICC and SNI. Conclusion: Low level of social support increased the risk of AH in men and women.

scholarly journals Effect of stress at work on the risk of cardiovascular diseases among the population of 25-64 years in Russia/Siberia (WHO program “MONICA-psychosocial”)

2019 ◽  
Vol 91 (1) ◽  
pp. 13-18 ◽  
Author(s):  
V V Gafarov ◽  
E A Gromova ◽  
D O Panov ◽  
I V Gagulin ◽  
A V Gafarova
Keyword(s):  
Myocardial Infarction ◽  
Demographic Data ◽  
Open Population ◽  
The Social ◽  
Stress At Work ◽  
High Level ◽  
The Impact ◽  
Gender Specific

The aim of the study was to determine the impact of stress on work on the risk of cardiovascular disease over a 16-year period in an open population of 25-64 years in Russia/Siberia. Materials and methods. A random representative sample of the population of both sexes of 25-64 years old in Novosibirsk in 1994 (men: n=657, 44.3±0.4 years, response - 82.1%, women: n=689, 45.4±0.4 years, response - 72.5%). The screening survey program included: registration of socio-demographic data, determination of stress at work (Karazek scale). The period of prospective follow-up of participants was 16 years. The study identified the following "end points": the first cases of myocardial infarction (MI), stroke. Results. A high level of stress at work was in 29.5% of men and 31.6% of women, the average level in 48.9% of men and 50.7% of women (χ2=2.574, υ=2, p=0.276). The risk of developing MI for a 16-year period, among people experiencing stressful situations at work, was: in men, HR=3.592, and women HR=3.218 (95% CI 1.146-9.042); stroke risk - among men, HR=2.603 (95% CI 1.06-4.153) in women HR=1.956 (95% CI 1.008-3.795). In multivariate analysis, in men with stress at work, the risk of MI among men was HR=1.15 (95% CI 0.6-2.2), among women - HR=2.543 (95% CI 1.88-7.351); risk of stroke, was in men, HR=3.8 (95% CI 1.6-8.8), in women - HR=1.95 (95% CI 0.984-3.887). The risk of stroke was higher among single, divorced and widowed men, HR=4.2 (95% CI 1.5-13.2), and in women with secondary or primary education, HR=3 (95% CI 0.852-11.039). Conclusion. It was established that a high level of stress at work is not gender-specific; the risk of developing MI over a 16-year period is higher in women than in men, stroke in men; the risk of myocardial infarction and stroke in both sexes is affected by the social gradient.

scholarly journals Prevalence of Obesity and Hypertension and Related Factors among Bank Employees in Zahedan, 2017

2019 ◽  
Vol 6 (4) ◽  
pp. 164-170
Author(s):  
Farzaneh Montazerifar ◽  
Mansour Karajibani ◽  
Mazaher Abbasi ◽  
Ahmad Bolouri
Keyword(s):  
Demographic Data ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Overweight And Obesity ◽  
Related Factors ◽  
Cross Sectional ◽  
Education Levels ◽  
Prevalence Of Obesity ◽  
Bank Employees

Background and aims: Obesity and hypertension are the major threats to health in a sedentary lifestyle and stressful jobs. The bank employees have sedentary jobs with high mental stress. The aim of this study was to determine the prevalence of hypertension and obesity and related factors among bank employees in Zahedan, located in Sistan and Baluchistan province, Iran. Methods: In this cross-sectional study, 350 employees aged 23 to 57 years were randomly selected out of 15 bank branches from December 2016 to February 2017. An information form including demographic data (i.e., age, education levels, experience years in the banking profession, and physical activity) was completed for each participant. Body mass index (BMI) was assessed for the determination of general obesity. In addition, waist circumference (WC) and waist-to-height ratio (WHtR) were measured for the evaluation of abdominal obesity. Two recordings of blood pressure (BP) were obtained in a sitting position. Finally, a multivariate logistic regression analysis was used to examine the independent predictors of hypertension. Results: The prevalence of pre-hypertension and hypertension were 33.1% and 61.1%, respectively. Further, the rates of overweight and obesity were 49.1% and 10.3%, respectively. Furthermore, elevated WC and high WHtR were 20.9% and 59.4%, respectively. Based on the results, the prevalence of obesity and hypertension increased significantly by aging. Conclusion: In general, the results of the study showed that the prevalence of overweight and hypertension among bank employees was high compared to the general population. Thus, periodic screening is recommended for an early determination of hypertension.

Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Martina Spaziante ◽  
Alessandra Oliva ◽  
Giancarlo Ceccarelli ◽  
Francesco Alessandri ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cultures ◽  
Gram Negative

EVALUASI KESESUAIAN PELAKSANAAN PROBITY AUDIT PADA BPKP PUSAT DENGAN PEDOMAN PROBITY AUDIT PENGADAAN BARANG/JASA PEMERINTAH

INFO ARTHA ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 17-34
Author(s):  
Fadlil Usman
Keyword(s):  
Public Sector ◽  
Real Time ◽  
Procurement Process ◽  
Assessment Activity

Probity audit is an independence assessment activity to ensure the goods/services procurement processes have been implemented consistently appropriate with the principle of upholding integrity, uprightness, honesty and fulfill certain occur legislation aimed for improving the accountability for the use of public sector fund. Probity audit is done in real time simultaneously with the goods/services procurement process. This study aims to evaluate the suitability of the implementation of probity audit conducted by BPKP Headquarter as agency that initiated the implementation of probity audit in Indonesia compared with the Probity audit Guidelines for Procurement of Goods/Services as criteria. The results of this study indicate that the implementation of probity audit conducted by BPKP Headquarter has been implemented adequately, but there are activities that do not fit the criteria, especially in the activities of the determination of the scope of the audit, the preparation of working papers and the follow-up monitoring of the audit results. Probity audit merupakan kegiatan penilaian (independen) untuk memastikan bahwa proses pengadaan barang/jasa telah dilaksanakan secara konsisten sesuai dengan prinsip penegakan integritas, kebenaran, kejujuran dan memenuhi ketentuan perundangan yang berlaku yang bertujuan meningkatkan akuntabilitas penggunaan dana sektor publik. Probity audit dilakukan secara real time yaitu bersamaan dengan pelaksanaan pengadaan barang/jasa. Penelitian ini bertujuan untuk melakukan evaluasi kesesuaian pelaksanaan probity audit yang dilakukan oleh BPKP Pusat selaku instansi yang menginisiasi pelaksanaan probity audit di Indonesia dibandingkan dengan kriteria berupa Pedoman Probity audit Pengadaan Barang/Jasa Pemerintah. Hasil dari penelitian ini menunjukkan bahwa pelaksanaan probity audit yang dilakukan oleh BPKP Pusat sudah dilaksanakan secara memadai, namun masih terdapat hal yang belum sesuai dengan kriteria terutama dalam kegiatan penentuan ruang lingkup audit, penyusunan kertas kerja dan pemantauan terhadap tindak lanjut hasil audit.

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