scholarly journals The urgency of severity and mortality risk assessments for COVID-19: A summary from death cases in Wuhan, China

2020 ◽  
Author(s):  
Feihong Yang ◽  
Jiaohong Gan ◽  
Hao Zou ◽  
Zhongxiang Zhang ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Disease Severity ◽  
Mortality Risk ◽  
Apache Ii ◽  
Risk Levels ◽  
Risk Of Death ◽  
Potential Factors ◽  
Medical Histories ◽  
Critical Patients ◽  
Death Cases ◽  
D Dimer

Abstract Background To investigate the clinical characteristics of 21 death cases and evaluate potential factors of disease severity and mortality risk in COVID-19. Methods Retrospective analysis was used to study the clinical data of 21 death cases with COVID-19. The assessment of disease severity and mortality risk were conducted by APACHE II, SOFA, MuLBSTA and PSI scores. Results The age was 66±14 years-old and 15 (71.4%) were men. 16 (76.2%) patients had chronic medical illnesses. 12 (57.1%) patients were overweight. Decreased lymphocytes were observed in 17 (81.0%) patients on admission. Elevated D-dimer levels were noticed in 11 (52.4%) patients and increased much more when pneumonia deteriorated. The initial APACHE II and SOFA scores demonstrated 18 (85.7%) and 13 (61.9%) patients in middle-risk levels, respectively. MuLBSTA and PSI scores after admission showed high-risk mortality in 13 (61.9%) patients. Most patients developed sequent organ failure and finally caused death. Conclusion Older, male, overweight patients, combined with chronic medical histories, continuous decreased lymphocyte proportion and increased D-dimer might have a higher risk of death. The combination of general scoring (SOFA) and pneumonia specific scoring (MuLBSTA and PSI) after admission might be more sensitive to assess the mortality risk for critical patients in COVID-19.

scholarly journals FRAILTY AND MORTALITY RISK IN PATIENTS WITH SEVERE COVID-19: PROGNOSIS BEYOND THE AGE CRITERION

2021 ◽  
Author(s):  
Márlon Juliano Romero Aliberti ◽  
Claudia Szlejf ◽  
Claudia Kimie Suemoto ◽  
Murilo Bacchini Dias ◽  
Wilson Jacob-Filho ◽  
...  
Keyword(s):  
Disease Severity ◽  
Scale Score ◽  
Mortality Risk ◽  
Frailty Index ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Adjusted Hazard Ratio ◽  
Acute Disease ◽  
Clinical Frailty Scale ◽  
Risk Of Death

OBJECTIVE: To investigate the association between frailty and death in hospitalized patients with COVID-19. METHODOLOGY: Prospective cohort study with patients ≥ 50 years hospitalized with COVID-19. Frailty was assessed using the Clinical Frailty Scale and the frailty index. Patients with a Clinical Frailty Scale score ≥ 5 were considered frail. The primary endpoints were mortality at 30 and 100 days after hospital admission. We used Cox proportional hazard models to investigate the association between frailty and mortality. We also explored whether frailty predicted different mortality levels among patients within strata of similar age and acute disease severity (Sequential Organ Failure Assessment score). RESULTS: A total of 1,830 patients were included (mean age 66 years; 58% men; 27% frail according to Clinical Frailty Scale score). The mortality risk at 30 days (adjusted hazard ratio = 1.7; 95% CI 1.4 - 2.1; p <0.001) and 100 days (adjusted hazard ratio = 1.7; 95% CI 1.4 - 2.1; p <0.001) was almost double for frail patients. The Clinical Frailty Scale also predicted different mortality levels among patients within strata of similar age and acute disease severity. Frailty intensified the effect of acute disease severity on the risk of death (p for interaction = 0.01). Of note, the Clinical Frailty Scale achieved outstanding accuracy to identify frailty according to the frailty index (area under the ROC curve = 0.94; 95% CI 0.93 - 0.95). CONCLUSIONS: Our results encourage the use of the Clinical Frailty Scale in association with measures of acute disease severity to determine prognosis and promote adequate resource allocation in hospitalized patients with COVID-19.

scholarly journals Potential Factors for Prediction of Disease Severity of COVID-19 Patients

2020 ◽  
Author(s):  
Huizheng Zhang ◽  
Xiaoying Wang ◽  
Zongqiang Fu ◽  
Ming Luo ◽  
Zhen Zhang ◽  
...  
Keyword(s):  
Disease Severity ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Medical Center ◽  
Demographic Data ◽  
Contributing Factors ◽  
Global Epidemic ◽  
Potential Factors ◽  
Critical Patients ◽  
Blood Specimens

AbstractObjectiveCoronavirus disease 2019 (COVID-19) is an escalating global epidemic caused by SARS-CoV-2, with a high mortality in critical patients. Effective indicators for predicting disease severity in SARS-CoV-2 infected patients are urgently needed.MethodsIn this study, 43 COVID-19 patients admitted in Chongqing Public Health Medical Center were involved. Demographic data, clinical features, and laboratory examinations were obtained through electronic medical records. Peripheral blood specimens were collected from COVID-19 patients and examined for lymphocyte subsets and cytokine profiles by flow cytometry. Potential contributing factors for prediction of disease severity were further analyzed.ResultsA total of 43 COVID-19 patients were included in this study, including 29 mild patients and 14 sever patients. Severe patients were significantly older (61.9±9.4 vs 44.4±15.9) and had higher incidence in co-infection with bacteria compared to mild group (85.7%vs27.6%). Significantly more severe patients had the clinical symptoms of anhelation (78.6%) and asthma (71.4%). For laboratory examination, 57.1% severe cases showed significant reduction in lymphocyte count. The levels of Interluekin-6 (IL6), IL10, erythrocyte sedimentation rate (ESR) and D-Dimer (D-D) were significantly higher in severe patients than mild patients, while the level of albumin (ALB) was remarkably lower in severe patients. Further analysis demonstrated that ESR, D-D, age, ALB and IL6 were the major contributing factors for distinguishing severe patients from mild patients. Moreover, ESR was identified as the most powerful factor to predict disease progression of COVID-19 patients.ConclusionAge and the levels of ESR, D-D, ALB and IL6 are closely related to the disease severity of COVID-19 patients. ESR can be used as a valuable indicator for distinguishing severe COVID-19 patients in early stage, so as to increase the survival of severe patients.

Does Acute Physiology and Chronic Health Evaluation II Provide a Valid Metric to Directly Compare Disease Severity in Trauma versus Surgical Intensive Care Unit Patients?

2012 ◽  
Vol 78 (11) ◽  
pp. 1261-1269
Author(s):  
Robert D. Becher ◽  
Michael C. Chang ◽  
J. Jason Hoth ◽  
Jennifer L. Kendall ◽  
H. Randall Beard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Chronic Health ◽  
Risk Of Death

The Acute Physiology and Chronic Health Evaluation II (APACHE II) score has never been validated to risk-adjust between critically ill trauma (TICU) and general surgical (SICU) intensive care unit patients, yet it is commonly used for such a purpose. To study this, we evaluated risk of death in TICU and SICU patients with pneumonia. We hypothesized that mortality for a given APACHE II would be significantly different and that using APACHE II to directly compare TICU and SICU patients would not be appropriate. We conducted a retrospective review of patients admitted to the TICU or SICU at a tertiary medical center over an 18-month period with pneumonia. Admission APACHE II scores, in-hospital mortality, demographics, and illness characteristics were recorded. One hundred eighty patients met inclusion criteria, 116 in the TICU and 64 in the SICU. Average APACHE II scores were not significantly different in the TICU versus SICU (25 vs 24; P = 0.4607), indicating similar disease severity; overall mortality rates, however, were significantly different (24 vs 50%; P = 0.0004). Components of APACHE II, which contributed to this mortality differential, were Glasgow Coma Score, age, presence of chronic health problems, and operative intervention. APACHE II fails to provide a valid metric to directly compare the severity of disease between TICU and SICU patients with pneumonia. These groups represent distinct populations and should be separated when benchmarking outcomes or creating performance metrics in ICU patients. Improved severity scoring systems are needed to conduct clinically relevant and methodologically valid comparisons between these unique groups.

scholarly journals Imbalance of arginine and asymmetric dimethylarginine is associated with markers of circulatory failure, organ failure and mortality in shock patients

2011 ◽  
Vol 107 (10) ◽  
pp. 1458-1465 ◽  
Author(s):  
Marlieke Visser ◽  
Mechteld A. R. Vermeulen ◽  
Milan C. Richir ◽  
Tom Teerlink ◽  
Alexander P. J. Houdijk ◽  
...  
Keyword(s):  
Organ Failure ◽  
Disease Severity ◽  
Sofa Score ◽  
Asymmetric Dimethylarginine ◽  
Circulatory Failure ◽  
Apache Ii ◽  
Pathophysiological Mechanism ◽  
Organ Perfusion ◽  
Risk Of Death ◽  
Adma Concentration

In shock, organ perfusion is of vital importance because organ oxygenation is at risk. NO, the main endothelial-derived vasodilator, is crucial for organ perfusion and coronary patency. The availability of NO might depend on the balance between a substrate (arginine) and an inhibitor (asymmetric dimethylarginine; ADMA) of NO synthase. Therefore, we investigated the relationship of arginine, ADMA and their ratio with circulatory markers, disease severity, organ failure and mortality in shock patients. In forty-four patients with shock (cardiogenic n 17, septic n 27), we prospectively measured plasma arginine and ADMA at intensive care unit admission, Acute Physiology and Chronic Health Evaluation (APACHE) II-(predicted mortality) and Sequential Organ Failure Assessment (SOFA) score, and circulatory markers to investigate their relationship. Arginine concentration was decreased (34·6 (sd 17·9) μmol/l) while ADMA concentration was within the normal range (0·46 (sd 0·18) μmol/l), resulting in a decrease in the arginine:ADMA ratio. The ratio correlated with several circulatory markers (cardiac index, disseminated intravascular coagulation, bicarbonate, lactate and pH), APACHE II and SOFA score, creatine kinase and glucose. The arginine:ADMA ratio showed an association (OR 0·976, 95 % CI 0·963, 0·997, P = 0·025) and a diagnostic accuracy (area under the curve 0·721, 95 % CI 0·560, 0·882, P = 0·016) for hospital mortality, whereas the arginine or ADMA concentration alone or APACHE II-predicted mortality failed to do so. In conclusion, in shock patients, the imbalance of arginine and ADMA is related to circulatory failure, organ failure and disease severity, and predicts mortality. We propose a pathophysiological mechanism in shock: the imbalance of arginine and ADMA contributes to endothelial and cardiac dysfunction resulting in poor organ perfusion and organ failure, thereby increasing the risk of death.

scholarly journals D-Dimer as a Prognostic Indicator in Critically Ill Patients Hospitalized With COVID-19 in Leishenshan Hospital, Wuhan, China

2020 ◽  
Vol 11 ◽  
Author(s):  
Jinpeng Li ◽  
Zeming Liu ◽  
Gaosong Wu ◽  
Meilin Yi ◽  
Yongfeng Chen ◽  
...  
Keyword(s):  
Disease Severity ◽  
Early Warning ◽  
Prognostic Indicator ◽  
Underlying Disease ◽  
Protein Fragment ◽  
Risk Of Death ◽  
Increased Risk ◽  
High Flow Oxygen ◽  
D Dimer

Background: D-dimer is a small protein fragment and high levels of D-dimer have been associated with increased mortality in patients presenting to emergency departments with infection. Previous studies have reported increased levels of D-dimer in COVID-19; however, it is unclear whether an increased D-dimer level provides early warning of poor prognosis. Therefore, this study aimed to assess the usefulness of D-dimer as an early indicator of prognosis in patients with coronavirus disease (COVID-19).Methods: We conducted a retrospective study of patients with COVID-19 admitted to Leishenshan Hospital in Wuhan, China, from February 15 to March 30, 2020. The final date of follow-up was April 11, 2020.Results: Of the 1,643 patients with COVID-19, 691 had elevated D-dimer levels. Their median age was 65 years. Of the patients with elevated D-dimer levels, 45% had comorbidities, with cardiovascular disease (205 [29.7%]) being the most common. Patients with elevated D-dimer were more likely to require treatment with high-flow oxygen, anticoagulation, antibiotics, and admission to the intensive care unit They were also more likely to have increased interleukin-6, monocytes, and lymphocytes. Patients with elevated D-dimer levels had significantly higher mortality than those with normal or low D-dimer levels.Conclusion: In patients with COVID-19, elevated D-dimer was associated with abnormal immunity, underlying disease, increased disease severity, and increased mortality. Taken together, D-dimer may be a marker for the early warning of disease severity and increased risk of death. These findings provide insights into the potential risk of elevated D-dimer in patients with COVID-19.

scholarly journals Serum biomarkers of cardiovascular complications in COVID-19

2021 ◽  
Vol 26 (2S) ◽  
pp. 4456
Author(s):  
R. M. Gumerov ◽  
D. F. Gareeva ◽  
P. A. Davtyan ◽  
R. F. Rakhimova ◽  
T. I. Musin ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Endothelial Dysfunction ◽  
Disease Severity ◽  
Creatine Phosphokinase ◽  
Evidence Base ◽  
Cardiovascular Complications ◽  
Serum Biomarkers ◽  
Risk Of Death ◽  
Cardiovascular Biomarkers ◽  
D Dimer

The coronavirus disease 2019 (COVID-19) affects not only the respiratory system, but also the cardiovascular system in 20-28% of cases, causing endothelial dysfunction, vasculitis, hyper- and hypocoagulation, myocarditis, endothelial dysfunction and other adverse effects. The presence of cardiovascular risk factors and diseases has been shown to worsen the disease severity and increase mortality from COVID-19. Recent studies have also found that elevations in some serum cardiovascular biomarkers can stratify the disease severity, in particular rates of hospitalizations to an internal medicine or intensive care unit, intubation, and mortality. They can be divided into markers of damage (TnT/I, creatine phosphokinase (CPK) and CPK-MB, myoglobin, NT-proBNP), coagulation (prothrombin time, fibrinogen and D-dimer), as well as prospective biomarkers for which the available evidence base is limited but there is a pathophysiological rationale (homocysteine and sST2). This review presents studies on the use of above serum biomarkers to stratify the risk of death in patients with COVID-19.

scholarly journals Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kátia M. Wahrhaftig ◽  
Luis C. L. Correia ◽  
Denise Matias ◽  
Carlos A. M. De Souza
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Risk Of Death ◽  
Rifle Classification ◽  
Critical Patients

Introduction.The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients.Objective.To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients.Methods.An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011.Results.The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, ), grade injury (RR = 3.7 CI:1.71–8.08, ), and class failure (RR = 4.79 CI:2.10–10.6, ). The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, ) and 0.80 (95% CI:0.74 to 0.86, ) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, .Conclusion.The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

scholarly journals Coexisting illness and COVID-19

2020 ◽  
Author(s):  
Rui Hu ◽  
Zhiyang Han ◽  
Chunling Zhang ◽  
Huajing Ren ◽  
Xiang Chen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cerebrovascular Disease ◽  
Disease Severity ◽  
Laboratory Finding ◽  
Inclusion Criteria ◽  
Risk Of Death ◽  
Medical University ◽  
D Dimer ◽  
Inaccurate Result

Abstract Background: Coronavirus disease 2019 (COVID-19) has rapidly spread throughout worldwide. Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease were the most common coexisting illness among patients with severe SARS-CoV-2 infection. We aim to analyze the effect of them on the result of laboratory finding in patients with severe or critical SARS-CoV-2 infection.Methods: The date of a total of 49 patients who met the inclusion criteria from January 12 to March 20, 2020, from the first affiliated hospital of Harbin medical university were analyzed in our study.Results: Compared with patients without any coexisting illness, we found that PT levels were decreased in patients with cerebrovascular disease, hypertension or cardiovascular disease, and D-Dimer levels were decreased in patients with cerebrovascular disease, hypertension or diabetes. Similarly, LDH and ALT levels were lower in patients with cerebrovascular disease than that without any coexisting illness.Conclusions: Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease are associated with an increased disease severity and risk of death in patients with COVID-19. Recently study also reported that the levels of PT, D-dimer, and LDH were increased and predicted the deterioration of disease in severe patients with SARS-CoV-2 infection. Interestingly, our results demonstrate that the levels of laboratory indicators such as PT, D-dimer, LDH and ALT were decreased in patients with coexisting illness than without any coexisting illness. It may give us the inaccurate result when we use those laboratory indicators to predict the deterioration of the patients and we need to pay more attention to it.

scholarly journals All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A Real-World Observational Study

2020 ◽  
Author(s):  
Javier Mancilla-Galindo ◽  
Jorge Óscar García-Méndez ◽  
Jessica Márquez-Sánchez ◽  
Rodrigo Estefano Reyes-Casarrubias ◽  
Eduardo Aguirre-Aguilar ◽  
...  
Keyword(s):  
Clinical Trials ◽  
General Population ◽  
Observational Study ◽  
Mexico City ◽  
Mortality Risk ◽  
Real World ◽  
List Type ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Critical Patients

ABSTRACTAimTo evaluate all-cause mortality risk in patients with laboratory-confirmed COVID-19 in Mexico City treated with repurposed antivirals and antibiotics.MethodsThis real-world retrospective cohort study contemplated 395,343 patients evaluated for suspected COVID-19 between February 24 and September 14, 2020 in 688 primary-to-tertiary medical units in Mexico City. Patients were included with a positive RT-PCR for SARS-CoV-2; those receiving unspecified antivirals, excluded; and antivirals prescribed in <30 patients, eliminated. Survival and mortality risks were determined for patients receiving antivirals, antibiotics, both, or none.Results136,855 patients were analyzed; mean age 44.2 (SD:16.8) years; 51.3% were men. 16.6% received antivirals (3%), antibiotics (10%), or both (3.6%). Antivirals studied were Oseltamivir (n=8414), Amantadine (n=319), Lopinavir-Ritonavir (n=100), Rimantadine (n=61), Zanamivir (n=39), and Acyclovir (n=36). Survival with antivirals (73.7%, p<0.0001) and antibiotics (85.8%, p<0.0001) was lower than no antiviral/antibiotic (93.6%). After multivariable adjustment, increased risk of death occurred with antivirals (HR=1.72, 95%CI:1.61-1.84) in ambulatory (HR=4.7, 95%CI:3.94-5.62) and non-critical (HR=2.03, 95%CI:1.86-2.21) patients. Oseltamivir increased mortality risk in the general population (HR=1.72, 95%CI:1.61-1.84), ambulatory (HR=4.79, 95%CI:4.01-5.75), non-critical (HR=2.05, 95%CI:1.88-2.23), and pregnancy (HR=8.35, 95%CI:1.77-39.30); as well as hospitalized (HR=1.13, 95%CI:1.01-1.26) and critical patients (HR:1.22, 95%CI:1.05-1.43) after propensity score-matching. Antibiotics were a risk factor in general population (HR=1.13, 95%CI:1.08-1.19) and pediatrics (HR=4.22, 95%CI:2.01-8.86), but a protective factor in hospitalized (HR=0.81, 95%CI:0.77-0.86) and critical patients (HR=0.67, 95%CI:0.63-0.72).ConclusionsNo significant benefit for repurposed antivirals was observed; oseltamivir was associated with increased mortality. Antibiotics increased mortality risk in the general population but may increase survival in hospitalized and critical patients.WHAT IS ALREADY KNOWNCurrent recommendations for using repurposed antivirals and antibiotics for COVID-19 are conflicting.Few antivirals (i.e. lopinavir-ritonavir) have been shown to provide no additional benefit for COVID-19 in clinical trials; other antivirals may be having widespread use in real-world settings without formal assessment in clinical trials.Real-world use of repurposed antivirals and antibiotics for COVID-19 in population-based studies have not been performed; important populations have been left largely understudied (ambulatory patients, pregnant women, and pediatrics).WHAT THIS STUDY ADDSThis is the first real-world observational study evaluating amantadine, rimantadine, zanamivir, and acyclovir for COVID-19; no registered studies to evaluate these drugs exist. Only one study has evaluated risk of death for oseltamivir. Lopinavir-ritonavir have been previously evaluated in clinical trials.Repurposed antivirals and antibiotics were commonly prescribed in 688 ambulatory units and hospitals of Mexico City despite unclear recommendations for their use out of clinical trials.Oseltamivir was associated with increased mortality risk; other repurposed antivirals (zanamivir, amantadine, rimantadine, and acyclovir) had no significant and consistent impact on mortality. Antibiotics were associated with increased mortality risk in the general population but may increase survival in hospitalized and critical patients.

Association of Increased Fibrin Turnover and Defective Fibrinolytic Capacity with Leg Atherosclerosis

1994 ◽  
Vol 72 (02) ◽  
pp. 292-296 ◽  
Author(s):  
M Cortellaro ◽  
E Cofrancesco ◽  
C Boschetti ◽  
L Mussoni ◽  
M B Donati ◽  
...  
Keyword(s):  
Arterial Disease ◽  
Venous Stasis ◽  
Stepwise Discriminant Analysis ◽  
Predisposing Factor ◽  
Risk Of Death ◽  
Peripheral Arterial ◽  
Fibrinolytic Potential ◽  
Fibrinolytic Capacity ◽  
Control Study ◽  
D Dimer

SummaryPatients with peripheral arterial disease have a high risk of death from cardiovascular events. As defective fibrinolysis associated with leg atherosclerosis has been suggested as a predisposing factor, we sought a relation among decreased fibrinolysis, the presence of leg atherosclerosis and the incidence of thrombotic events in a case control study nested in the PLAT.Fifty-eight patients with coronary and/or cerebral atherothrombotic disease, free of leg atherosclerosis at Doppler examination, were compared with 50 atherosclerotic patients with leg involvement. High D-dimer (153.0 vs 81.3 ng/ml, p <0.001) and tPA antigen before venous stasis (14.4 vs 11.8 ng/ml, p <0.03), and low tPA antigen (6.7 vs 15.6 ng/ml, p <0.01) and fibrinolytic activity released after venous stasis (fibrinolytic capacity: 113.2 vs 281.4 mm2, p <0.001) were found in patients with leg atherosclerosis. D-dimer and fibrinolytic capacity, in addition to age, were selected by stepwise discriminant analysis as characterizing patients with leg atherosclerosis. Moreover, higher D-dimer and tPA inhibitor characterized patients with leg atherosclerosis who subsequently experienced thrombotic events.These findings constitute evidence of high fibrin turnover and impaired fibrinolytic potential in patients with leg atherosclerosis. Thus impaired fibrinolysis may contribute to the prothrombotic state in these patients.

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