Physicochemical acid-base parameters and mortality in 1,070 ICU patients: a retrospective cohort study

Abstract Background There are recent reports that identify severe influenza pneumonia as an independent risk factor for the development of invasive pulmonary aspergillosis (IPA), even in patients without immunocompromise. We aimed to understand the incidence of IPA as well as other coinfections over multiple seasons in patients with RSV pneumonia in the intensive care unit (ICU). Methods A retrospective cohort study was conducted in a single center in Chicago. Data was collected over 9 seasons (January 2009-March 2018) from adult patients admitted to the ICU at a large urban tertiary care center with severe RSV pneumonia. Patients were included if they had a positive RSV PCR test, older than 18 years, admitted to the ICU with acute respiratory failure, and had pulmonary infiltrates on imaging. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria (Schauwvlieghe et al). Descriptive statistics were calculated. In univariable analysis, we compared categorical variables by Fisher’s exact test and Chi-square test, continuous variables by Wilcoxon Rank Sum where appropriate. Results Of 224 patients admitted to the ICU with RSV (median ICU LoS 10.5 d), IPA was diagnosed in 8 (3.5%). Patients diagnosed with IPA had an increased LoS in the hospital (23.7 days vs. 11.6 days, p=0.01). Although the mortality was numerically higher (3, 37.5% vs 26, 17.9%) this was statistically not significant). History of hematological malignancy, stem cell transplant, and neutropenia were significant factors in the development of IPA. Those with lung disease had significantly lower rates of IPA. All patients with IPA were treated with voriconazole. Other coinfections among RSV-infected ICU patients included bacterial (21, 13.7%), viral (10, 6.5%), and non-IPA fungal (13, 8.5%) pathogens. Baseline Characteristics and Mortality/Morbidity Patient Characteristics in Invasive Pulmonary Aspergillosis Conclusion Although IPA is relatively uncommon in patients admitted to the ICU with severe RSV pneumonia, patients with IPA had significant increased LOS and tended to have underlying host factors. Other coinfections with bacterial, viral, and non-IPA fungal pathogens are common in those with severe RSV pneumonia. Disclosures Michael G. Ison, MD MS, AlloVir (Consultant)

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COVID-19 related treatment and outcomes among COVID-19 ICU patients: A retrospective cohort study

Journal of Infection and Public Health ◽

10.1016/j.jiph.2021.08.030 ◽

2021 ◽

Vol 14 (9) ◽

pp. 1274-1278

Author(s):

Abdullah Assiri ◽

Mir J. Iqbal ◽

Atheer Mohammed ◽

Abdulrhman Alsaleh ◽

Ahmed Assiri ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Icu Patients

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Thromboembolic Rates Are Similar Between Intensive Care Unit and Nonintensive Care Unit Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Retrospective Cohort Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211053315 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110533

Author(s):

Heidi Worth ◽

Kasey Helmlinger ◽

Renju Raj ◽

Eric Heidel ◽

Ronald Lands

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Thromboembolic Event ◽

Hospitalized Patients ◽

Thromboembolic Events ◽

Icu Patients ◽

Increased Risk

High rates of thromboembolic events have been described in intensive care unit (ICU) patients. Data regarding thromboembolic events in all hospitalized patients has been less frequently reported, raising concerns that thromboembolic events in non-ICU may be underrecognized. In addition, optimal anticoagulation type and dose is still unsettled at this time. This is a retrospective cohort study of 159 hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia during a 9-month period to determine an association between the frequency of thromboembolic rates and hospitalized patients with COVID-19. Secondary outcomes sought to investigate association of thromboembolic events with relation to place of admission, risk factors, anticoagulation, mortality, hospital length of stay, and discharge disposition. Among the cohort of 159 hospitalized patients who met criteria, 16 (10%) were diagnosed with a thromboembolic event. There were a total of 18 thromboembolic events with 12 venous and 6 arterial. Admission to the ICU was not associated with a higher frequency of thromboembolic events compared with non-ICU patients (37.5% vs 62.5%), p = .71. Patients with a thromboembolic event had a significantly higher mortality compared with those with no thromboembolic event (37.5% vs 13.3%), p = .012. Patients hospitalized with COVID-19 have increased rates of thromboembolic events, both venous and arterial, which contribute to a significant increase in mortality. However, the frequency of thromboembolism in patients admitted to the ICU was similar to events in non-ICU patients. We hope to increase awareness of the increased risk of hypercoagulability in all hospitalized patients with COVID-19 including non-ICU patients.

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