scholarly journals The Ichikado CT score as a prognostic tool for coronavirus disease 2019 pneumonia: a retrospective cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Alan Araiza ◽  
Melanie Duran ◽  
Cesar Patiño ◽  
Paul E. Marik ◽  
Joseph Varon
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Invasive Mechanical Ventilation ◽  
Chest Ct ◽  
Arterial Blood ◽  
All Cause Mortality

Abstract Background The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia. Methods Single-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for invasive mechanical ventilation and hospital length of stay. Cox regression models were used to test the association between potential independent predictors and all-cause mortality. Results Two hundred thirty-five patients, 197 survivors and 38 nonsurvivors, were studied. The median Ichikado CT score for nonsurvivors was significantly higher than survivors (P < 0.001). An Ichikado CT score of more than 172 enabled prediction of mortality, with a sensitivity of 84.2% and a specificity of 79.7%. Multivariate analysis identified Ichikado CT score (HR, 7.772; 95% CI, 3.164–19.095; P < 0.001), together with age (HR, 1.030; 95% CI, 1.030–1.060; P = 0.043), as independent predictors of all-cause in-hospital mortality. Conclusions Ichikado CT score is an independent predictor of both requiring invasive mechanical ventilation and all-cause mortality in patients hospitalized with COVID-19 pneumonia. Further prospective evaluation is necessary to confirm these findings. Trial registration: The WCG institutional review board approved this retrospective study and patient consent was waived due to its non-interventional nature (Identifier: 20210799).

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: a Retrospective Cohort Study

2020 ◽  
Author(s):  
Yi Yang ◽  
Jia Shi ◽  
Shuwang Ge ◽  
Shuiming Guo ◽  
Xue Xing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Intermittent Renal Replacement Therapy

AbstractBackgroundFor the coronavirus disease 2019 (COVID-19), critically ill patients had a high mortality rate. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation.MethodsIn this retrospective cohort study, we included all patients with COVID-19 undergoing invasive mechanical ventilation from February 12nd to March 2nd, 2020. All patients were followed until death or March 28th, and all survivors were followed for at least 30 days.ResultsFor 36 hospitalized COVID-19 patients with invasive mechanical ventilation, the mean age was 69.4 (± 10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group) and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments and most of the laboratory findings. During median follow-up period of 9.5 (interquartile range 4.3-33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (P = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in three different models, with adjusted hazard ratios varying from 0.332 to 0.398. Higher levels of IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP were significantly associated with an increased risk of mortality in patients with PIRRT.ConclusionPIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

scholarly journals Cognitive impairment is a common comorbidity in COVID-19 deceased patients. A hospital-based retrospective cohort study

2020 ◽  
Author(s):  
Paloma Martín-Jiménez ◽  
Mariana I. Muñoz-García ◽  
David Seoane ◽  
Lucas Roca-Rodríguez ◽  
Ana García-Reyne ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Non Invasive

ABSTRACTIntroductionLittle is known about the relation of cognitive impairment (CI) to COVID-19 mortality. Here, we analyse the frequency of CI in deceased COVID-19 patients.MethodsWe included 477 adult cases that died after admission from March 1 to March 31, 2020: 281 with confirmed COVID-19, 58 probable COVID-19, and 138 who died of other causes.ResultsThe number of comorbidities was high in the confirmed COVID-19, and CI was common (30%: 21.1% dementia; 8.9% mild cognitive impairment). Subjects with CI were older, more lived in nursing homes and had shorter times from symptom onset to death than those without CI. COVID-19 patients with CI were rarely admitted to the ICU and fewer received non-invasive mechanical ventilation, but palliative care was provided more often.ConclusionsDementia is a frequent comorbidity in COVID-19 deceased patients. The burden of COVID-19 in the dementia community will be high.

scholarly journals Bacterial co-infection of the respiratory tract in ventilated children with bronchiolitis; a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanke M. G. Wiegers ◽  
Lisa van Nijen ◽  
Job B. M. van Woensel ◽  
Reinout A. Bem ◽  
Menno D. de Jong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Disease Severity ◽  
Bacterial Growth ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Invasive Ventilation ◽  
Growth Duration

Abstract Background Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay. Methods Retrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10^5/BAL > 10^4 CFU), low bacterial growth (TA < 10^5/BAL < 10^4 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis. Results Of 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02). Conclusions In this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.

scholarly journals Antivirals With Adjunctive Corticosteroids Prevent Clinical Progression of Early Coronavirus 2019 Pneumonia: A Retrospective Cohort Study

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Say Tat Ooi ◽  
Purnima Parthasarathy ◽  
Yi Lin ◽  
Valliammai D/O Nallakaruppan ◽  
Shereen Ng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Clinical Progression

Abstract This is a retrospective cohort study of hospitalized adults with coronavirus disease 2019 (COVID-19). Fifty-seven patients received treatment alone, and 35 patients received treatment with adjunctive prednisolone. A combination of corticosteroids and antivirals was associated with lower risk of clinical progression and invasive mechanical ventilation or death in early COVID-19 pneumonia.

scholarly journals Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiao Hou ◽  
Li Tian ◽  
Lei Zhou ◽  
Xinhua Jia ◽  
Li Kong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Adjuvant Therapy ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Intravenous Immunoglobulin ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
Single Center

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

scholarly journals Association between Prolonged Intermittent Renal Replacement Therapy and All-Cause Mortality in COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Retrospective Cohort Study

2020 ◽  
pp. 1-8
Author(s):  
Yi Yang ◽  
Jia Shi ◽  
Shuwang Ge ◽  
Shuiming Guo ◽  
Xue Xing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Intermittent Renal Replacement Therapy

<b><i>Background:</i></b> The mortality rate of critically ill patients with coronavirus disease 2019 (COVID-19) was high. We aimed to assess the association between prolonged intermittent renal replacement therapy (PIRRT) and mortality in patients with COVID-19 undergoing invasive mechanical ventilation. <b><i>Methods:</i></b> This retrospective cohort study included all COVID-19 patients receiving invasive mechanical ventilation between February 12 and March 2, 2020. All patients were followed until death or March 28, and all survivors were followed for at least 30 days. <b><i>Results:</i></b> For 36 hospitalized COVID-19 patients receiving invasive mechanical ventilation, the mean age was 69.4 (±10.8) years, and 30 patients (83.3%) were men. Twenty-two (61.1%) patients received PIRRT (PIRRT group), and 14 cases (38.9%) were managed with conventional strategy (non-PIRRT group). There were no differences in age, sex, comorbidities, complications, treatments, and most of the laboratory findings. During the median follow-up period of 9.5 (interquartile range 4.3–33.5) days, 13 of 22 (59.1%) patients in the PIRRT group and 11 of 14 (78.6%) patients in the non-PIRRT group died. Kaplan-Meier analysis demonstrated prolonged survival in patients in the PIRRT group compared with that in the non-PIRRT group (<i>p</i> = 0.042). The association between PIRRT and a reduced risk of mortality remained significant in 3 different models, with adjusted hazard ratios varying from 0.332 to 0.398. Increased IL-2 receptor, TNF-α, procalcitonin, prothrombin time, and NT-proBNP levels were significantly associated with an increased risk of mortality in patients with PIRRT. <b><i>Conclusion:</i></b> PIRRT may be beneficial for the treatment of COVID-19 patients with invasive mechanical ventilation. Further prospective multicenter studies with larger sample sizes are required.

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