scholarly journals Association between Early Absolute Neutrophil Count and Level of D-Dimer among Patients with COVID-19 Infection in Central Taiwan

2021 ◽  
Vol 10 (17) ◽  
pp. 3891
Author(s):  
Wen-Cheng Chao ◽  
Chieh-Liang Wu ◽  
Jin-An Huang ◽  
Jyh-Wen Chai ◽  
Chieh-Lin Teng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Underlying Mechanism ◽  
Critical Event ◽  
Thromboembolic Events ◽  
Airborne Infection ◽  
Number Of Patients ◽  
Central Taiwan ◽  
D Dimer

Thromboembolism is a critical event in patients with coronavirus disease (COVID)-19 infection and highly associated with neutrophil extracellular traps. D-dimer has been found to be an essential thromboembolism-associated biomarker; however, the association between absolute neutrophil count (ANC) and level of D-dimer in patients with COVID-19 infection remains unclear. In this study, we enrolled consecutive patients with COVID-19 admitted to Taichung Veterans General Hospital (TCVGH), a referral center in central Taiwan with 20 airborne infection isolation rooms. Spearman correlation was used to determine the association between ANC and level of D-dimer in distinct time periods. A total of 28 consecutive patients with COVID-19 infection were enrolled, and 32.1% (9/28) of them required mechanical ventilation. Patients requiring mechanical ventilation had a higher ANC (8225 vs. 3427/µL, p < 0.01) and levels of D-dimer (6.0 vs. 0.6 mg/L, p < 0.01) compared with those without mechanical ventilation. Notably, we identified five patients with image-proven thromboembolic events during the hospital course, with the number of patients with pulmonary embolism, venous thrombosis and acute ischemic stroke were 2, 1, and 2, respectively. We found that ANC within 4 days correlated with the level of D-dimer to a moderate level (r = 0.71, p < 0.05), and the association between ANC and D-dimer no longer exist after day 5. In conclusion, we found highly prevalent thromboembolic events among patients with severe COVID-19 infection in central Taiwan and identified the association between early ANC and D-dimer. More studies are warranted to elucidate the underlying mechanism.

scholarly journals Explainable Machine Learning to Predict Successful Weaning Among Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Cohort Study in Central Taiwan

2021 ◽  
Vol 8 ◽  
Author(s):  
Ming-Yen Lin ◽  
Chi-Chun Li ◽  
Pin-Hsiu Lin ◽  
Jiun-Long Wang ◽  
Ming-Cheng Chan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Mechanical Ventilation ◽  
Prediction Model ◽  
Prolonged Mechanical Ventilation ◽  
Number Of Patients ◽  
Extreme Gradient Boosting ◽  
Feature Importance ◽  
Successful Weaning ◽  
Central Taiwan ◽  
Weaning Outcome

Objective: The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, but the weaning outcome prediction model in these patients is still lacking. We hence aimed to develop an explainable machine learning (ML) model to predict successful weaning in patients requiring PMV using a real-world dataset.Methods: This retrospective study used the electronic medical records of patients admitted to a 12-bed respiratory care center in central Taiwan between 2013 and 2018. We used three ML models, namely, extreme gradient boosting (XGBoost), random forest (RF), and logistic regression (LR), to establish the prediction model. We further illustrated the feature importance categorized by clinical domains and provided visualized interpretation by using SHapley Additive exPlanations (SHAP) as well as local interpretable model-agnostic explanations (LIME).Results: The dataset contained data of 963 patients requiring PMV, and 56.0% (539/963) of them were successfully weaned from mechanical ventilation. The XGBoost model (area under the curve [AUC]: 0.908; 95% confidence interval [CI] 0.864–0.943) and RF model (AUC: 0.888; 95% CI 0.844–0.934) outperformed the LR model (AUC: 0.762; 95% CI 0.687–0.830) in predicting successful weaning in patients requiring PMV. To give the physician an intuitive understanding of the model, we stratified the feature importance by clinical domains. The cumulative feature importance in the ventilation domain, fluid domain, physiology domain, and laboratory data domain was 0.310, 0.201, 0.265, and 0.182, respectively. We further used the SHAP plot and partial dependence plot to illustrate associations between features and the weaning outcome at the feature level. Moreover, we used LIME plots to illustrate the prediction model at the individual level. Additionally, we addressed the weekly performance of the three ML models and found that the accuracy of XGBoost/RF was ~0.7 between weeks 4 and week 7 and slightly declined to 0.6 on weeks 8 and 9.Conclusion: We used an ML approach, mainly XGBoost, SHAP plot, and LIME plot to establish an explainable weaning prediction ML model in patients requiring PMV. We believe these approaches should largely mitigate the concern of the black-box issue of artificial intelligence, and future studies are warranted for the landing of the proposed model.

scholarly journals Clinical and angiographic characteristics of patients with STEMI and confirmed diagnosis of COVID-19: an experience of Tanta University Hospital

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Ahmed Alaarag ◽  
Timoor Hassan ◽  
Sameh Samir ◽  
Mohamed Naseem
Keyword(s):  
Poor Prognosis ◽  
Management Strategy ◽  
Clinical Presentation ◽  
Underlying Mechanism ◽  
Fibrinolytic Therapy ◽  
University Hospital ◽  
Total Occlusion ◽  
St Elevation ◽  
Primary Management ◽  
D Dimer

Abstract Background Patients with established cardiovascular diseases have a poor prognosis when affected by the coronavirus disease 2019 (COVID-19). Also, the cardiovascular system, especially the heart, is affected by COVID-19. So we aimed to evaluate the angiographic and clinical characteristics of COVID-19 patients presented by ST-elevation myocardial infarction (STEMI). Results Our retrospective study showed that STEMI patients with COVID-19 had elevated inflammatory markers with mean of their CRP (89.69 ± 30.42 mg/dl) and increased laboratory parameters of thrombosis with mean D-dimer (660.15 ± 360.11 ng/ml). In 69.2% of patients, STEMI was the first clinical presentation and symptoms suggestive of COVID-19 developed during the hospital stay; about one third of patients had a non-obstructive CAD, while patients with total occlusion had a high thrombus burden. Conclusion STEMI may be the initial presentation of COVID-19. A non-obstructive CAD was found in about one third of patients; on the other hand, in patients who had a total occlusion of their culprit artery, the thrombus burden was high. Identification of the underlying mechanism responsible for the high thrombus burden in these patients is important as it may result in changes in their primary management strategy, either primary PCI, fibrinolytic therapy, or a pharmaco-invasive strategy. Furthermore, adjunctive anticoagulation and antiplatelet therapy may need to be revised.

scholarly journals Home Mechanical Ventilation: A Patient’s Perspective Survey Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4048
Author(s):  
Magdalena Kwiatosz-Muc ◽  
Bożena Kopacz
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Alternative Methods ◽  
Survey Study ◽  
Home Mechanical Ventilation ◽  
Patient’S Satisfaction ◽  
Satisfaction Index ◽  
Number Of Patients ◽  
The Difference

Background: An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years. The study aimed to assess the patients opinion concerning the expected and perceived quality of care in an HMV system and a patient’s satisfaction with care. Methods: In 2017, patients treated with HMV were surveyed in Poland with the modified SERVQUAL questionnaire. Results: One hundred correctly completed surveys were analyzed. Patient Satisfaction Index was high. In every examined area, the expectations were statistically significant larger than the perception of the services. The biggest gap was in the tangibility dimension and the smallest gap was in the empathy dimension. Perceived respect and understanding for a patient’s needs are close to the expectations. Conclusions: The level of satisfaction with health care among patients treated with HMV in majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. Further investigations with alternative methods are needed.

scholarly journals Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

2021 ◽  
Vol 25 (03) ◽  
pp. e459-e462
Author(s):  
Darwin Kaushal ◽  
Shilpa Goyal ◽  
Nithin Prakasan Nair ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Present Article ◽  
Critically Ill ◽  
Current Literature ◽  
Literature Search ◽  
Scientific Evidence ◽  
Early Tracheostomy ◽  
Life Saving ◽  
Number Of Patients ◽  
Elective Tracheostomy

AbstractThe number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

scholarly journals A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Benoît Misset ◽  
Eric Hoste ◽  
Anne-Françoise Donneau ◽  
David Grimaldi ◽  
Geert Meyfroidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neutralizing Antibodies ◽  
Ethical Issues ◽  
High Titer ◽  
Passive Immunization ◽  
University Hospital ◽  
Optimal Time ◽  
Relative Reduction ◽  
Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

Benign ethnic neutropenia: What is a normal absolute neutrophil count?

1999 ◽  
Vol 133 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Theresa B. Haddy ◽  
Sohail R. Rana ◽  
Oswaldo Castro
Keyword(s):  
Absolute Neutrophil Count ◽  
Neutrophil Count

Diagnostic Accuracy of a New d-Dimer Assay (Sclavo Auto d-Dimer) for Exclusion of Deep Vein Thrombosis in Symptomatic Outpatients

2016 ◽  
Vol 23 (3) ◽  
pp. 221-228 ◽  
Author(s):  
Cristina Legnani ◽  
Michela Cini ◽  
Mirella Frascaro ◽  
Giuseppina Rodorigo ◽  
Michelangelo Sartori ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Imaging Techniques ◽  
False Negative ◽  
High Specificity ◽  
Predictive Values ◽  
Cutoff Value ◽  
Vein Thrombosis ◽  
Number Of Patients ◽  
Deep Vein ◽  
D Dimer

In patients presenting non-high clinical pretest probability (PTP), a negative d-dimer can exclude venous thromboembolism without imaging tests. However, each d-dimer assay should be validated in prospective studies. We evaluated an automated d-dimer immunoassay using the Sclavo Auto d-dimer (Sclavo Diagnostics Int, Sovicille, Italy) provided by Dasit Diagnostica (Cornaredo, Milan, Italy). Three hundred two consecutive outpatients suspected of leg deep vein thrombosis (DVT) with non-high PTP were included. The Sclavo Auto d-dimer assay was evaluated on 2 analyzers (Sysmex CA-7000 and Sysmex CS-2100; Sysmex Corporation, Kobe, Japan, provided by Dasit). The cutoff value (200 ng/mL) was established a priori. Prevalence of DVT was 11.9%. Since no false-negative patients were detected, the sensitivity and negative predictive values (NPVs) were 100% (sensitivity = CA-7000: 100% [95% confidence interval, CI: 93.3-100], CS-2100: 100% [95% CI: 93.3-100]; NPV = CA-7000: 100% [95% CI: 97.9-100], CS-2100: 100% [95% CI: 98.0-100]). Specificity was 65.4% (95% CI: 59.4-71.1) and 69.2% (95% CI: 63.3-74.7) for CA-7000 and CS-2100, respectively. Specificity increased when a higher cutoff value (234 ng/mL) was used for patients aged ≥60 years without compromising the safety. Assay reproducibility was satisfactory at concentrations near the cutoff value (total coefficient of variations <10%). In conclusion, the Sclavo Auto d-dimer assay was accurate when used for DVT diagnostic workup in outpatients with non-high PTP. Based on its high sensitivity and NPV, it can be used as a stand-alone test in outpatients with non-high PTP. Given its high specificity, the number of patients in whom further imaging techniques can be avoided increased, improving the yield of the test.

Ruling out deep venous thrombosis in primary care

2005 ◽  
Vol 94 (07) ◽  
pp. 200-205 ◽  
Author(s):  
Karel G. M. Moons ◽  
Arno W. Hoes ◽  
Ruud Oudega
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Rule ◽  
Cross Sectional ◽  
Diagnostic Decision ◽  
Number Of Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

SummaryIn primary care, the physician has to decide which patients have to be referred for further diagnostic work-up. At present, only in 20% to 30% of the referred patients the diagnosis DVT is confirmed. This puts a burden on both patients and health care budgets. The question arises whether the diagnostic work-up and referral of patients suspected of DVT in primary care could be more efficient. A simple diagnostic decision rule developed in primary care is required to safely exclude the presence of DVT in patients suspected of DVT, without the need for referral. In a cross-sectional study, we investigated the data of 1295 consecutive patients consulting their primary care physician with symptoms suggestive of DVT, to develop and validate a simple diagnostic decision rule to safely exclude the presence of DVT. Independent diagnostic indicators of the presence of DVT were male gender, oral contraceptive use, presence of malignancy, recent surgery, absence of leg trauma, vein distension, calf difference and D-dimer test result. Application of this rule could reduce the number of referrals by at least 23% while only 0·7% of the patients with a DVT would not be referred. We conclude that by using eight simple diagnostic indicators from patient history, physical examination and the result of D-dimer testing, it is possible to safely rule out DVT in a large number of patients in primary care, reducing unnecessary patient burden and health care costs.

scholarly journals APHACHE Score as a Predictive Indices for Weanability from Mechanical Ventilation

2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Private Hospital ◽  
Total Duration ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Apache Score ◽  
Number Of Patients ◽  
Weaning Outcome

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22

Außerklinische Beatmung – Konzepte und Therapieempfehlungen

2017 ◽  
Vol 142 (16) ◽  
pp. 1197-1204 ◽  
Author(s):  
Sarah Schwarz ◽  
Friederike Magnet ◽  
Bernd Schönhofer ◽  
Wolfram Windisch
Keyword(s):  
Mechanical Ventilation ◽  
Scientific Evidence ◽  
Underlying Disease ◽  
Home Mechanical Ventilation ◽  
Term Survival ◽  
Number Of Patients ◽  
Related Quality ◽  
Außerklinische Beatmung ◽  
Health Related

AbstractThe prognosis of patients receiving home mechanical ventilation is very heterogeneous and depends on the underlying disease, the degree of respiratory dependency and the comorbidities. Due to the severe chronic diseases, the initiation of a long-term NIV must be done during an inpatient treatment. Two recently published randomized controlled trials using more aggressive forms of NPPV targeted at normalizing hypercapnic PaCO2 values, showed improved long term survival also in patients with an underlying diagnosis of COPD. Consequently, the number of patients receiving home mechanical ventilation has dramatically increased in recent years and more and more outpatient settings has been established without scientific evidence. Nevertheless, beside reliable care structures, ethical aspects and health related quality of life are of great importance in the context of home mechanical ventilation.

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