scholarly journals COVID-IRS: A novel predictive score for risk of invasive mechanical ventilation in patients with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248357
Author(s):  
José Antonio Garcia-Gordillo ◽  
Antonio Camiro-Zúñiga ◽  
Mercedes Aguilar-Soto ◽  
Dalia Cuenca ◽  
Arturo Cadena-Fernández ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
Lactic Dehydrogenase ◽  
Total Sample ◽  
Adverse Outcomes ◽  
Predictive Score ◽  
Neutrophil Lymphocyte Ratio ◽  
Predictive Variables

Background Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. Objective To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. Study design Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. Results We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823–0.931) using the NLR based score and 0.891 (0.843–0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. Conclusion The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

2020 ◽  
Author(s):  
GUSTAVO CASAS ◽  
MARIA-ISABEL LEON ◽  
MAURICIO GONZALEZ-NAVARRO ◽  
CLAUDIA ALVARADO DE LA BARRERA ◽  
Santiago Avila-Rios ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Vasoactive Drugs ◽  
D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

scholarly journals Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients: a multicenter machine learning study with highly granular data from the Dutch Data Warehouse

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Lucas M. Fleuren ◽  
Michele Tonutti ◽  
Daan P. de Bruin ◽  
Robbert C. A. Lalisang ◽  
Tariq A. Dam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Data Warehouse ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Relative Probability ◽  
Icu Mortality ◽  
Probability Of Death ◽  
Demographic Risk ◽  
Demographic Risk Factor

Abstract Background The identification of risk factors for adverse outcomes and prolonged intensive care unit (ICU) stay in COVID-19 patients is essential for prognostication, determining treatment intensity, and resource allocation. Previous studies have determined risk factors on admission only, and included a limited number of predictors. Therefore, using data from the highly granular and multicenter Dutch Data Warehouse, we developed machine learning models to identify risk factors for ICU mortality, ventilator-free days and ICU-free days during the course of invasive mechanical ventilation (IMV) in COVID-19 patients. Methods The DDW is a growing electronic health record database of critically ill COVID-19 patients in the Netherlands. All adult ICU patients on IMV were eligible for inclusion. Transfers, patients admitted for less than 24 h, and patients still admitted at time of data extraction were excluded. Predictors were selected based on the literature, and included medication dosage and fluid balance. Multiple algorithms were trained and validated on up to three sets of observations per patient on day 1, 7, and 14 using fivefold nested cross-validation, keeping observations from an individual patient in the same split. Results A total of 1152 patients were included in the model. XGBoost models performed best for all outcomes and were used to calculate predictor importance. Using Shapley additive explanations (SHAP), age was the most important demographic risk factor for the outcomes upon start of IMV and throughout its course. The relative probability of death across age values is visualized in Partial Dependence Plots (PDPs), with an increase starting at 54 years. Besides age, acidaemia, low P/F-ratios and high driving pressures demonstrated a higher probability of death. The PDP for driving pressure showed a relative probability increase starting at 12 cmH2O. Conclusion Age is the most important demographic risk factor of ICU mortality, ICU-free days and ventilator-free days throughout the course of invasive mechanical ventilation in critically ill COVID-19 patients. pH, P/F ratio, and driving pressure should be monitored closely over the course of mechanical ventilation as risk factors predictive of these outcomes.

scholarly journals Correlations Between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study

2020 ◽  
Author(s):  
yaowang lin ◽  
jie yuan ◽  
yong zhu ◽  
Huadong Liu ◽  
xinli pang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Death ◽  
Invasive Mechanical Ventilation ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Intravenous Morphine

Abstract Background: The available data regarding the safety of morphine use in cases of STEMI with AHF (Killip ≥2) remain insufficient. The aim of the study was to further examine the safety of intravenous morphine in patients with STEMI and AHF over 1 year of follow-up after primary percutaneous coronary intervention (PPCI).Methods: 275 consecutive patients with STEMI and AHF were included and divided into groups that did or did not receive in-hospital intravenous morphine. Endpoints included major adverse cardiovascular events (MACEs) and the need for invasive mechanical ventilation during hospitalization and 1 year of follow-up. Results: The in-hospital occurrences of cardiac death and cardiogenic shock were much higher in patients who received morphine than that those who did not (15.20% vs 6.67%, p=0.035; odds ratio [OR]=2.509, 95% confidence interval [CI] 1.121–5.620, and 14.40% vs 6.00%, p=0.033; OR=2.636, 95% CI 1.139-6.097, respectively). Additionally, more patients in the group treated with morphine experienced the secondary outcome of in-hospital invasive mechanical ventilation compared with the group not treated with morphine (19.20% vs 10.67%, p=0.031; OR=2.308, 95% CI 1.138–4.684). However, no difference between-group differences were observed for the incidence of MACEs, cardiac death, or all-cause death over 1 year of follow-up.Conclusions: Intravenous morphine administration is highly correlated with in-hospital MACEs and the need for additional invasive mechanical ventilation in STEMI patients with AHF after PPCI, but not for long-time adverse outcomes.

scholarly journals Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia

2021 ◽  
Author(s):  
Milenka Cuevas Guaman ◽  
Nikou Pishevar ◽  
Steven H. Abman ◽  
Martin Keszler ◽  
William E. Truog ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Inhospital Mortality ◽  
Increased Risk ◽  
Grade 3 ◽  
Using Data

Abstract Objectives To determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD. Study design Observational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry. Results Five hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD. Conclusions Patients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.

scholarly journals Clinical and biological markers for predicting ARDS and outcome in septic patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jesús Villar ◽  
Rubén Herrán-Monge ◽  
Elena González-Higueras ◽  
Miryam Prieto-González ◽  
Alfonso Ambrós ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
Clinical Markers ◽  
Common Cause ◽  
Risk Of Death ◽  
Therapeutic Trials ◽  
Patients At Risk ◽  
And Biological Markers

AbstractSepsis is a common cause of acute respiratory distress syndrome (ARDS) associated with a high mortality. A panel of biomarkers (BMs) to identify septic patients at risk for developing ARDS, or at high risk of death, would be of interest for selecting patients for therapeutic trials, which could improve ARDS diagnosis and treatment, and survival chances in sepsis and ARDS. We measured nine protein BMs by ELISA in serum from 232 adult septic patients at diagnosis (152 required invasive mechanical ventilation and 72 had ARDS). A panel including the BMs RAGE, CXCL16 and Ang-2, plus PaO2/FiO2, was good in predicting ARDS (area under the curve = 0.88 in total septic patients). Best performing panels for ICU death are related to the presence of ARDS, need for invasive mechanical ventilation, and pulmonary/extrapulmonary origin of sepsis. In all cases, the use of BMs improved the prediction by clinical markers. Our study confirms the relevance of RAGE, Ang-2, IL-1RA and SP-D, and is novel supporting the inclusion of CXCL16, in BMs panels for predicting ARDS diagnosis and ARDS and sepsis outcome.

scholarly journals Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 1036
Author(s):  
Ana Alberdi-Iglesias ◽  
Francisco Martín-Rodríguez ◽  
Guillermo Ortega Rabbione ◽  
Ana I. Rubio-Babiano ◽  
María G. Núñez-Toste ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
Non Invasive ◽  
Fraction Of Inspired Oxygen ◽  
Multi Center Study ◽  
Oxygen Ratio ◽  
Inspired Oxygen ◽  
Better Than

The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.

scholarly journals 295. SARS-CoV-2 Infection in a Referral Cancer Center in Mexico City During the First Year of the COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S255-S255
Author(s):  
Diana Vilar-Compte ◽  
Daniel De La Rosa Martinez ◽  
Alexandra Martín-Onraet ◽  
Carolina Pérez-Jiménez ◽  
Beda Islas-Muñoz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Strong Predictor ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Cancer Center ◽  
Solid Cancer ◽  
Patients With Cancer ◽  
Increased Risk

Abstract Background Literature on SARS-CoV-2 infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer in a referral center in Mexico. Methods We included patients with cancer and confirmed SARS-CoV-2 infection, from April, 19 to December 30, 2020, at the Instituto Nacional de Cancerología, Mexico. Clinical information was obtained from medical and epidemiological records. We conducted a descriptive analysis. For the association between variables with hospitalization, invasive mechanical ventilation (IMV), and mortality; univariate and multivariate logistic regression was performed; odds ratios and 95% confidence intervals were calculated. Results Four hundred thirty-three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty-five (31%), 130 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty-one (79%) had solid cancer; 82 (19%) hematological malignancy (HM), and 10 (2%) were under evaluation for cancer diagnosis. One hundred seventy (39%) had advanced or metastatic cancer. One hundred ninety-eight (46%) patients were hospitalized. Risk factors were: age (p= 0.001); woman (p=0.019); HM (p=0.050) and advanced or metastatic cancer (p= 0.041). Fourty-five (10%) patients required IMV. Age (p=0.018); DM (p=0.041); C-Reactive Protein (p= 0.002), and LDH (p= 0.033) were associated with invasive mechanical ventilation. Mortality within 30-days after diagnosis was 19% (82 cases). Associated characteristics were: age (p=0.041); lymphocytes (p=0.049); creatinine (p=0.005) and albumin (p=0.001). Conclusion In this study, patients with cancer showed higher mortality, need of hospitalization, and invasive mechanical ventilation compared with groups of patients without cancer. We did not find an increased risk in mortality for hematological malignancies. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID-19. Disclosures All Authors: No reported disclosures

scholarly journals Low Diaphragm Muscle Mass Predicts Adverse Outcome in Patients Hospitalized for Covid-19 Pneumonia

2020 ◽  
Author(s):  
Francesco Corradi ◽  
Alessandro Isirdi ◽  
Claudia Brusasco ◽  
Gregorio Santori ◽  
Marco Falcone ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Respiratory Failure ◽  
Muscle Mass ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Diaphragm Muscle ◽  
Multivariate Logistic Regression Model ◽  
Cumulative Probability ◽  
Patients At Risk

Abstract Purpose: The aim of this study was to evaluate whether measurement of diaphragm thickness by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. Methods: We retrospectively reviewed the records of consecutive of 77 patients with laboratory-confirmed Covid-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P<0.10 were entered into a multivariate logistic regression model. Cumulative probability for lack of adverse outcomes in patients with or without low baseline diaphragm muscle mass was calculated with the Kaplan–Meier product-limit estimator.Results: The main findings of this study are that 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs 2.2 mm, p:0.001), 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (-708, OR: 0.492, p: 0.018).Conclusion: Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO2/FiO2, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.

scholarly journals Recovery from Covid-19 critical illness: A secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

2021 ◽  
pp. 175114372110522
Author(s):  
Ellen Pauley ◽  
Thomas M Drake ◽  
David M Griffith ◽  
Louise Sigfrid ◽  
Nazir I Lone ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Illness ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
Secondary Analysis ◽  
Total Sample ◽  
Severe Fatigue ◽  
Fatigue Severity ◽  
Baseline Characteristics

Background: We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery. Methods: We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data were collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge. Results: Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs 5.0/10) of fatigue were similar between the Covid-19 and pre-pandemic populations, respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue were less in the Covid-19 cohort. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15–0.76, p=0.01). Conclusion: Fatigue may be less severe after Covid-19 than after other critical illness.

Sign in / Sign up

Export Citation Format

Share Document