scholarly journals Predictors of Hypoxemia and Related Adverse Outcomes in Patients Hospitalized with COVID-19: A Double-Center Retrospective Study

2021 ◽  
Vol 10 (16) ◽  
pp. 3581
Author(s):  
Rabea Asleh ◽  
Elad Asher ◽  
Oren Yagel ◽  
Tal Samuel ◽  
Gabby Elbaz-Greener ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Arterial Oxygen Saturation ◽  
Ventilatory Support ◽  
Adverse Outcomes ◽  
Older Age ◽  
Arterial Oxygen ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Elevated Liver Enzymes ◽  
Multivariable Regression

Hypoxemia is a hallmark of coronavirus disease 2019 (COVID-19) severity. We sought to determine predictors of hypoxemia and related adverse outcomes among patients hospitalized with COVID-19 in the two largest hospitals in Jerusalem, Israel, from 9 March through 16 July 2020. Patients were categorized as those who developed reduced (<94%) vs. preserved (≥94%) arterial oxygen saturation (SpO2) within the first 48 h after arrival to the emergency department. Overall, 492 hospitalized patients with COVID-19 were retrospectively analyzed. Patients with reduced SpO2 were significantly older, had more comorbidities, higher body surface area (BSA) and body mass index (BMI), lower lymphocyte counts, impaired renal function, and elevated liver enzymes, c-reactive protein (CRP), and D-dimer levels as compared to those with preserved SpO2. In the multivariable regression analysis, older age (odds ratio (OR) 1.02 per year, p < 0.001), higher BSA (OR 1.16 per 0.10 m2, p = 0.003) or BMI (OR 1.05 per 1 kg/m2, p = 0.011), lower lymphocyte counts (OR 1.72 per 1 × 103/μL decrease, p = 0.002), and elevated CRP (1.11 per 1 mg/dL increase, p < 0.001) were found to be independent predictors of low SpO2. Severe hypoxemia requiring ventilatory support, older age, and pre-existing comorbidities, including underlying renal dysfunction and heart failure, were found to be significantly associated with in-hospital mortality. These findings suggest that assessment of predictors of hypoxemia early at the time of hospitalization with COVID-19 may be helpful in risk stratification and management.

scholarly journals Association Between Elevated Liver Enzymes and C-Reactive Protein

2005 ◽  
Vol 25 (1) ◽  
pp. 193-197 ◽  
Author(s):  
Arthur Kerner ◽  
Ophir Avizohar ◽  
Ron Sella ◽  
Peter Bartha ◽  
Oren Zinder ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Elevated Liver Enzymes

Een geriatrische patiënte met een perirectaal abces, pyleflebitis en multipele pyogene leverabcessen: een gevalsbespreking

2021 ◽  
Author(s):  
K. VAN GEYT ◽  
M. PETROVIC ◽  
W. JANSSENS
Keyword(s):  
Geriatric Patient ◽  
Liver Enzymes ◽  
C Reactive Protein ◽  
Perirectal Abscess ◽  
Reactive Protein ◽  
Non Invasive ◽  
Elevated Liver Enzymes ◽  
Invasive Diagnostics ◽  
Very High

A geriatric patient with a perirectal abscess, pylephlebitis and multiple pyogenic liver abscesses: a case-report. In this case study, an 86-year-old patient is presented with fever, anorexia and drowsiness, a very high C-reactive protein (CRP) level and elevated liver enzymes. Given the frailty of the patient, a non-invasive diagnostic approach was chosen. Initially, a pancreatic carcinoma with liver metastases was suspected, but the presence of positive blood cultures raised doubts about the initially suggested diagnosis. Ultimately, a perirectal abscess with Streptococcus intermedius bacteremia, pylephlebitis and multiple liver and pancreatic abscesses were diagnosed. After a course of 9 weeks of antibiotics, the patient's condition improved. The vague complaints in this geriatric patient and the lack of invasive diagnostics pose a challenge for the clinician in recognizing this disease.

scholarly journals Fever as a predictor of adverse outcomes in COVID-19

QJM ◽  
2021 ◽  
Author(s):  
N W Chew ◽  
J N Ngiam ◽  
S M Tham ◽  
Z Y Lim ◽  
T Y W Li ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
End Point ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Design And Methods ◽  
Group 1

Summary Background/Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. Aim We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. Design and Methods Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever—Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P&lt;0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P&lt;0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. Discussion/Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.

scholarly journals No Clear Benefit to the Use of Corticosteroid as Treatment in Adult Patients with Coronavirus Disease 2019 : A Retrospective Cohort Study

2020 ◽  
Author(s):  
Dan Wang ◽  
Juan Wang ◽  
Qunqun Jiang ◽  
Juan Yang ◽  
Jun Li ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Fold Increase ◽  
Corticosteroid Treatment ◽  
Adverse Outcomes ◽  
Adult Patients ◽  
C Reactive Protein ◽  
Icu Admission ◽  
Reactive Protein ◽  
Global Health Issue ◽  
Logistic Regressions

AbstractBackgroundCoronavirus disease 2019 (COVID-19) is becoming an increasing global health issue which has spread across the globe. We aimed to study the effect of corticosteroids in the treatment of adult inpatients with COVID-19.MethodsA retrospective cohort of 115 consecutive adult COVID-19 patients admitted to The Third People’s Hospital of Hubei Province between Jan 18, 2020, and Feb 28, 2020 was analysed to study the effectiveness of corticosteroid. They were categorized according to whether or not corticosteroid therapy was given, and compared in terms of demographic characteristics, clinical features, laboratory indicators and clinical outcomes. The primary endpoint was defined as either mortality or intensive care unit (ICU) admission. Known adverse prognostic factors were used as covariates in multiple logistic regressions to adjust for their confounding effects on outcomes.ResultsAmong 115 patients, 73 patients (63.5%) received corticosteroid. The levels of age, C-reactive protein, D-dimer and albumin were similar in both groups. The corticosteroid group had more adverse outcomes (32.9% vs. 11.9%) and statistically significant differences were observed (p=0.013). In multivariate analysis, corticosteroid treatment was associated with a 2.155-fold increase in risk of either mortality or ICU admission, although not statistically significant.ConclusionNo evidence suggests that adult patients with COVID-19 will benefit from corticosteroids, and they might be more likely to be harmed with such treatment.

scholarly journals Is pulse oximeter a reliable tool for non-critically ill patients with COVID-19?

2021 ◽  
Author(s):  
Aslıhan Gürün Kaya ◽  
Miraç Öz ◽  
İREM AKDEMİR KALKAN ◽  
Ezgi Gülten ◽  
güle AYDIN ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximeter ◽  
Lymphocyte Count ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Reactive Protein ◽  
Arterial Blood ◽  
The Difference ◽  
Clinical Conditions

Introduction: Guidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID-19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical conditions. We aimed to assess the reliability of pulse oximeter in patients with COVID-19 Methods: We retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalized in COVID-19 wards. Results: We categorized total 117 patients into two groups; in whom the difference between SpO2 and SaO2 was 4% (acceptable difference) and >4% (large difference). Large difference group exhibited higher neutrophil count, C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for large difference between SpO2 and SaO2. The total study group demonstrated the negative bias of 4.02% with the limits of agreement of −9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count. Conclusion: Pulse oximeters may not be sufficient to assess actual oxygen saturation especially in COVID-19 patients with high ferritin and fibrinogen levels and low lymphocyte count low SpO2 measurements.

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