scholarly journals Laboratory Predictors for COVID-19 ICU Admissions in a Caribbean Territory.

2020 ◽  
Author(s):  
Chavin Gopaul ◽  
Dale Ventour ◽  
Davlin Thomas
Keyword(s):  
Univariate Analysis ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Good Test ◽  
Icu Patients ◽  
High Odds ◽  
Icu Admission ◽  
Admission Data ◽  
Significant Area ◽  
Life Threatening

Abstract Introduction. Understanding the symptoms associated with COVID-19 cases that require intensive care unit (ICU) attention is important in management of the life threatening case of the disease. Method : This study was carried out with the aim of determining the laboratory indicators of ICU admission. Data from 126 COVID-19 patients (ICU patients, n = 18, Non-ICU, n = 98) were analyzed from a Caribbean Territory.Results: The median age for the non-ICU patients was 59.0 (IQR = 23.5) years while the ICU patients had a median age of 62.5 (IQR = 17.5). The univariate analysis indicted that laboratory indicators that were significantly associated with ICU admission included WBC (P = 0.037), lymphocyte (P = 0.016), LDH (P = 0.002), AST (P = 0.005) and CRP (P = 0.0001). However, multivariate analysis that included WBC, neutrophil, lymphocyte, PLT, AST, LDH, ALT, and CRP indicated that only AST was associated with high odds of patients being admitted to ICU (OR .002, 95% CI 0.000-.004, P = 0.017). Statistically significant area under the curve (AUC) were obtained for Neutrophil (AUC = 0.704, P = 0.007), CRP (AUC = 0.81, p= 0.00) and LDH (AUC=0.766, P= 0.00) and AST (AUC= 0.729, P= 0.003). Conclusion: The findings indicate that neutrophils, AST and LDH’s ROC curves are good tests while CRP curve is a very good test. However, lymphocyte curve is a poor test for determining COVID-19 patient for ICU admission. Neutrophil, AST, LDH and CRP are suitable predictors of COVID-19 patients that should receive ICU care

scholarly journals Predictive Value of Eosinophil Count on COVID-19 Disease Progression and Outcomes, a Retrospective Study of Leishenshan Hospital in Wuhan, China

2021 ◽  
pp. 088506662110373
Author(s):  
Wei Xuan ◽  
Xuliang Jiang ◽  
Lili Huang ◽  
Shuting Pan ◽  
Caiyang Chen ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Protective Role ◽  
General Ward ◽  
Icu Patients ◽  
Icu Admission ◽  
Virus Clearance ◽  
Asthma Patients ◽  
Infection Resistance ◽  
Eosinophil Counts

Background The potential protective role of eosinophils in the COVID-19 pandemic has aroused great interest, given their potential virus clearance function and the infection resistance of asthma patients to this coronavirus. However, it is unknown whether eosinophil counts could serve as a predictor of the severity of COVID-19. Methods A total of 1004 patients with confirmed COVID-19 who were admitted to Leishenshan Hospital in Wuhan, China, were enrolled in this study, including 905 patients in the general ward and 99 patients in the intensive care unit (ICU). We reviewed their medical data to analyze the association between eosinophils and ICU admission and death. Results Of our 1004 patients with COVID-19, low eosinophil counts/ratios were observed in severe cases. After adjusting for confounders that could have affected the outcome, we found that eosinophil counts might not be a predictor of ICU admission. In 99 ICU patients, 58 of whom survived and 41 of whom died, low eosinophil level was an indicator of death in severe COVID-19 patients with a cutoff value of 0.04 × 109/L, which had an area under the curve of 0.665 (95% CI = 1.089-17.839; P = .045) with sensitivity and specificity of 0.569 and 0.7317, respectively. Conclusion Our research revealed that a low eosinophil level is a predictor of death in ICU patients rather than a cause of ICU admission.

Ambulant erworbene Pneumonie: Die Mortalität nachhaltig senken

2020 ◽  
Vol 8 (5) ◽  
pp. 252-253
Author(s):  
Stefan Krüger
Keyword(s):  
Operating Characteristic ◽  
Distress Syndrome ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Roc Curves ◽  
Community Acquired Pneumonia ◽  
Ambulant Erworbene Pneumonie ◽  
Icu Admission ◽  
Failure Assessment

Background: The study aimed to investigate the predictive value of the quick sequential organ failure assessment (qSOFA) for clinical outcomes in emergency patients with community-acquired pneumonia (CAP). Methods: A total of 742 CAP cases from the emergency department (ED) were enrolled in this study. The scoring systems including the qSOFA, SOFA and CURB-65 (confusion, urea, respiratory rate, blood pressure and age) were used to predict the prognostic outcomes of CAP in ICU-admission, acute respiratory distress syndrome (ARDS) and 28-day mortality. According to the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, the accuracies of prediction of the scoring systems were analyzed among CAP patients. Results: The AUC values of the qSOFA, SOFA and CURB-65 scores for ICU-admission among CAP patients were 0.712 (95%CI: 0.678–0.745, P < 0.001), 0.744 (95%CI: 0.711–0.775, P < 0.001) and 0.705 (95%CI: 0.671–0.738, P < 0.001), respectively. For ARDS, the AUC values of the qSOFA, SOFA and CURB-65 scores were 0.730 (95%CI: 0.697–0.762, P < 0.001), 0.724 (95%CI: 0.690–0.756, P < 0.001) and 0.749 (95%CI: 0.716–0.780, P < 0.001), respectively. After 28 days of follow-up, the AUC values of the qSOFA, SOFA and CURB-65 scores for 28-day mortality were 0.602 (95%CI: 0.566–0.638, P < 0.001), 0.587 (95%CI: 0.551–0.623, P < 0.001) and 0.614 (95%CI: 0.577–0.649, P < 0.001) in turn. There were no statistical differences between qSOFA and SOFA scores for predicting ICU-admission (Z = 1.482, P = 0.138), ARDS (Z = 0.321, P = 0.748) and 28-day mortality (Z = 0.573, P = 0.567). Moreover, we found no differences to predict the ICU-admission (Z = 0.370, P = 0.712), ARDS (Z = 0.900, P = 0.368) and 28-day mortality (Z = 0.768, P = 0.442) using qSOFA or CURB-65 scores. Conclusion: qSOFA was not inferior to SOFA or CURB-65 scores in predicting the ICU-admission, ARDS and 28-day mortality of patients presenting in the ED with CAP.

scholarly journals Total Amylase Value in Drains After Gastrectomy for Predicting Postoperative Pancreatic Fistula

2020 ◽  
Author(s):  
Toshitaka Sugawara ◽  
Hisashi Shinohara ◽  
Shusuke Haruta ◽  
Junichi Shindo ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Concentration Ratio ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Roc Curves ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Anastomotic Site ◽  
Drainage Fluid

Objective: Postoperative pancreatic fistula (POPF) is defined using the ratio of the bilirubin concentration in abdominal drainage fluid to the upper normal range of serum amylase level. However, we hypothesized that the total amylase value in discharge (AVD) on POD 3 may be more sensitive for predicting grade II or higher severe POPF sPOPF, and compared the predictive power of the conventional definition of POPF and AVD for sPOPF. Methods: One hundred and fifty-one patients who underwent gastrectomy between October 2011 and February 2013 were analyzed. A drainage tube was placed in all the cases through the stump of the right gastroepiploic vein and the front of the pancreas to the back of the anastomotic site. The drainage volume and amylase concentration in the discharge were examined on POD 1, 3, and 5. AVD was calculated by multiplying the volume by the amylase concentration. Results: Eight patients (5.3%) developed sPOPF. In univariate analysis, both AVD and the amylase concentration ratio was significantly correlated with sPOPF (P = 0.002 and 0.007, respectively). AVD on POD 3 showed the best predictive performance compared with the amylase concentration ratio on POD 3 (area under the curve 0.876 vs. 0.844). Based on the cutoff values calculated from the ROC curves, AVD was more specific than amylase concentration ratio in predicting sPOPF (specificity: 97.6% vs. 86.0%; PPV: 62.5% vs. 23.1%). Conclusion: AVD on POD 3 is a more specific parameter than conventional amylase concentration ratio in predicting sPOPF.

scholarly journals C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit

2012 ◽  
Vol 7 ◽  
Author(s):  
Özkan Devran ◽  
Zuhal Karakurt ◽  
Nalan Adıgüzel ◽  
Gökay Güngör ◽  
Özlem Yazıcıoğlu Moçin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Mortality Rate ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Icu Patients ◽  
Predictors Of Mortality ◽  
Reactive Protein ◽  
Chest Disease

Background: Severe sepsis is a primary cause of morbidity and mortality in the intensive care unit (ICU). Numerous biomarkers have been assessed to predict outcome and CRP is widely used. However, the relevance for mortality risk of the CRP level and the day when it is measured have not been well studied. We aimed to assess whether initial and/or third dayCRP values are as good predictors of mortality in ICU patients with severe sepsis as other well-known complex predictors of mortality, i.e., SOFA scores. Methods: An observational cohort study was performed in a 20-bed respiratory ICU in a chest disease center. Patients with severe sepsis due to respiratory disease were enrolled in the study. SOFA scores, CRP values on admission and on the third day of hospital stay, and mortality rate were recorded. ROC curves for SOFA scores and CRP values were calculated. Results: The study included 314 ICU patients with sepsis admitted between January 2009 and March 2010. The mortality rate was 14.2% (n = 45). The area under the curve (AUC) for CRP values and SOFA scores on admission and on the 3rd day in ICU were calculated as 0.57 (CI: 0.48-0.66); 0.72 (CI: 0.63-0.80); 0.72 (CI: 0.64-0.81); and 0.76 (CI: 0.67-0.86), respectively. Sepsis due to nosocomial infection, a CRP value > 100 mg/L and higher SOFA scores on 3rd day, were found to be risk factors for mortality (odds ratio [OR]: 3.76, confidence interval [CI]: 1.68-8.40, p < 0.001, OR: 2.70, CI: 1.41-2.01, p < 0.013, and OR: 1.68, CI: 1.41-2.01, p < 0.0001, respectively). Conclusions: The risk of sepsis related mortality appears to be increased when the 3rd day CRP value is greater than 100 mg/dL. Thus, CRP appears to be as valuable a predictor of mortality as the SOFA score.

Abstract 62: Recovery-based Prediction of Who Is Using a G-tube at 6 Weeks Post-stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Christopher Leon-Guerrero ◽  
Jasmin Chua ◽  
Lynda Loehr ◽  
David Carpenter ◽  
...  
Keyword(s):  
Speech Therapy ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Tube Placement ◽  
Icu Admission ◽  
Post Stroke ◽  
Standard Clinical Practice ◽  
Point G ◽  
Dysphagic Patients

Background: Decision-making regarding gastrostomy tube (G-tube) placement prolongs hospital stay in the inpatient stroke setting. Studies have predicted who receives G-tube placement at discharge, but have not assessed which factors predict who is actually using a G-tube long-term by assessing dysphagia recovery and G-tube needs in follow-up. Methods: Stroke patients from an inpatient stroke service were prospectively recruited if dysphagia was identified on the clinical speech therapy dysphagia test, defined as Mann Assessment of Swallowing Ability (MASA) score < 178. Variables associated with dysphagia were prospectively collected. G-tubes were placed in patients according to standard clinical practice based on speech therapy recommendations and family discussion. Follow-up included a 6 week swallowing quality of life survey (SWAL-QOL, 12 items including if a G-tube is currently being used). Univariate predictors of G-tube use at 6 weeks were assessed allowing calculation of a “G-tube Score” for prediction of who required a G-tube at 6 weeks. Score performance was measured by receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: Of 146 dysphagic patients (median NIHSS=15), 31% were discharged with a G-tube. Of those completing 6 week SWAL-QOL (N=61), 26% of patients who had received a G-tube, no longer needed a G-tube. Univariate predictors of needing a G-tube included: age ≥ 70 (p=0.017), NIHSS ≥ 18 (p=0.006), ICU admission (p=0.007), respiratory failure requiring intubation (p=0.001), and MASA score < 110 (p<0.0001). 4 and 5 point G-tube scores performed well in predicting 6 week G-tube needs (AUCs 0.88 and 0.92, respectively). The optimal cut-off for both scores, preserving sensitivity and maintaining specificity, was a score of 2 points (Fig). Conclusion: Carrying 2 of the following early factors: age ≥ 70, NIHSS ≥ 18, ICU admission, and intubation, yields a high likelihood of requiring a G-tube beyond 6 weeks post-stroke.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

scholarly journals Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project

2021 ◽  
Vol 10 (5) ◽  
pp. 992
Author(s):  
Martina Barchitta ◽  
Andrea Maugeri ◽  
Giuliana Favara ◽  
Paolo Marco Riela ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Support Vector ◽  
Icu Admission ◽  
Risk Of Death ◽  
Saps Ii ◽  
Svm Algorithm

Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with additional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission.

scholarly journals Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes according to Clinical and/or Ultrasound Evaluation

2021 ◽  
Vol 10 (15) ◽  
pp. 3407
Author(s):  
Giuseppa Graceffa ◽  
Giuseppina Orlando ◽  
Gianfranco Cocorullo ◽  
Sergio Mazzola ◽  
Irene Vitale ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Univariate Analysis ◽  
Roc Curves ◽  
Central Compartment ◽  
Central Neck Dissection ◽  
Level Of Evidence ◽  
Cervical Lymph Nodes ◽  
Kaplan Meier ◽  
Ultrasound Evaluation ◽  
Central Lymph

Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).

scholarly journals Comparison of host endothelial, epithelial and inflammatory response in ICU patients with and without COVID-19: a prospective observational cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Pavan K. Bhatraju ◽  
Eric D. Morrell ◽  
Leila Zelnick ◽  
Neha A. Sathe ◽  
Xin-Ya Chai ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Epithelial Cell ◽  
Acute Phase ◽  
Cell Injury ◽  
Acute Phase Proteins ◽  
Invasive Mechanical Ventilation ◽  
Icu Patients ◽  
Icu Admission ◽  
Amyloid A ◽  
Epithelial Cell Injury

Abstract Background Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19. Methods We prospectively enrolled 171 ICU patients, including 78 (46%) patients positive and 93 (54%) negative for SARS-CoV-2 infection from April to September, 2020. We compared 22 plasma biomarkers in blood collected within 24 h and 3 days after ICU admission. Results In critically ill COVID-19 and non-COVID-19 patients, the most common ICU admission diagnoses were respiratory failure or pneumonia, followed by sepsis and other diagnoses. Similar proportions of patients in both groups received invasive mechanical ventilation at the time of study enrollment. COVID-19 and non-COVID-19 patients had similar rates of acute respiratory distress syndrome, severe acute kidney injury, and in-hospital mortality. While concentrations of interleukin 6 and 8 were not different between groups, markers of epithelial cell injury (soluble receptor for advanced glycation end products, sRAGE) and acute phase proteins (serum amyloid A, SAA) were significantly higher in COVID-19 compared to non-COVID-19, adjusting for demographics and APACHE III scores. In contrast, angiopoietin 2:1 (Ang-2:1 ratio) and soluble tumor necrosis factor receptor 1 (sTNFR-1), markers of endothelial dysfunction and inflammation, were significantly lower in COVID-19 (p < 0.002). Ang-2:1 ratio and SAA were associated with mortality only in non-COVID-19 patients. Conclusions These studies demonstrate that, unlike other well-studied causes of critical illness, endothelial dysfunction may not be characteristic of severe COVID-19 early after ICU admission. Pathways resulting in elaboration of acute phase proteins and inducing epithelial cell injury may be promising targets for therapeutics in COVID-19.

scholarly journals Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space

2021 ◽  
Author(s):  
Rei Nakamichi ◽  
Toshiaki Taoka ◽  
Hisashi Kawai ◽  
Tadao Yoshida ◽  
Michihiko Sone ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Predictive Performance ◽  
Roc Curves ◽  
Imaging Findings ◽  
Spearman’S Rank Correlation ◽  
Sagittal Sinus ◽  
Magnetic Resonance Cisternography

Abstract Purpose To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

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