scholarly journals Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study

2021 ◽  
Vol 11 (12) ◽  
pp. 1359
Author(s):  
Sebastian Voicu ◽  
Thomas Lacoste-Palasset ◽  
Isabelle Malissin ◽  
Shana Bekhit ◽  
Eléonore Cauchois ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Icu Admission ◽  
Failure Assessment ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Group Survival ◽  
Retrospective Observational Cohort Study

(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission.

scholarly journals Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0238552
Author(s):  
Ana C. Monteiro ◽  
Rajat Suri ◽  
Iheanacho O. Emeruwa ◽  
Robert J. Stretch ◽  
Roxana Y. Cortes-Lopez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Observational Cohort Study ◽  
Smoking History ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Purpose To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and methods A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Results Our cohort had median age of 61 (IQR 45–74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74–19.48), former (OR 8.06, CI 1.51–43.06) and current smoking status (OR 10.33, CI 1.43–74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11–0.96), procalcitonin (OR 1.27, CI 1.02–1.57), IL-6 (OR 1.17, CI 1.03–1.33), ferritin (OR 1.05, CI 1.005–1.11), LDH (OR 1.57, 95% CI 1.13–2.17) and CRP (OR 1.13, CI 1.06–1.21), were associated with IMV by univariate analysis. Conclusions Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

scholarly journals Obesity and Smoking as Risk Factors for Invasive Mechanical Ventilation in COVID-19: a Retrospective, Observational Cohort Study

2020 ◽  
Author(s):  
Ana Carolina Costa Monteiro ◽  
Rajat Suri ◽  
Ileanacho Obi Emeruwa ◽  
Robert J Stretch ◽  
Roxana Y Cortes Lopez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Observational Cohort Study ◽  
Smoking History ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Purpose: To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and Methods: A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Results: Our cohort had median age of 61 (IQR 45-74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. Conclusions: Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

Selenium and All-cause Mortality in End-Stage Renal Disease. Retrospective Observational Cohort Study

2020 ◽  
Vol 30 (6) ◽  
pp. 484-492 ◽  
Author(s):  
Aránzazu Anadón Ruiz ◽  
Elena Martín Jiménez ◽  
Pilar Bermejo-Barrera ◽  
Rafael Lozano ◽  
Victoria Martínez-Echevarría Seijas
Keyword(s):  
Cohort Study ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Observational Cohort Study ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Stage Renal Disease ◽  
End Stage ◽  
Retrospective Observational Cohort Study

scholarly journals The FRAIL-FIT 30 Study – Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study

2021 ◽  
pp. 175114372098516
Author(s):  
David Hewitt ◽  
Michael Ratcliffe ◽  
Malcolm G Booth
Keyword(s):  
Cohort Study ◽  
Single Point ◽  
Observational Cohort Study ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Clinical Frailty Scale ◽  
Icu Admission ◽  
Frail Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Background Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty’s effect on mortality after ICU admission are unclear. This study assessed frailty’s impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14–2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03–1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13–1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01–1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.

scholarly journals Critically ill patients with COVID-19 in Hong Kong: a multicentre retrospective observational cohort study

2020 ◽  
Vol 22 (2) ◽  
pp. 119-125 ◽  
Author(s):  
Lowell Ling ◽  
◽  
Christina So ◽  
Hoi Ping Shum ◽  
Paul KS Chan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hong Kong ◽  
Supportive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Cohort Study ◽  
Icu Discharge ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

OBJECTIVE: To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes. DESIGN: Multicentre retrospective observational cohort study. SETTING: Three multidisciplinary intensive care units (ICUs) in Hong Kong. PARTICIPANTS: All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020. MAIN OUTCOME MEASURES: 28-day mortality. RESULTS: Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42–70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4–7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days. CONCLUSION: Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.

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