Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults

Nutrients ◽

10.3390/nu13041061 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1061

Author(s):

Roma Krzymińska-Siemaszko ◽

Ewa Deskur-Śmielecka ◽

Arkadiusz Styszyński ◽

Katarzyna Wieczorowska-Tobis

Keyword(s):

Risk Factors ◽

Older Adults ◽

Risk Assessment ◽

Predictive Value ◽

High Sensitivity ◽

Community Dwelling ◽

Nutritional Risk ◽

Polish Language ◽

Community Dwelling Older Adults ◽

Translation And Validation

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study’s aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7–47.2%) than the PL-MSRA-7 (33.1–34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9–29.5%; PL-MSRA-7: 14.4–25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8–95.9%; PL-MSRA-5: 92.3–98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0–55% vs. 39.4–45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.

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Predictive Value of Ionized Calcium in Critically Ill Patients: An Analysis of a Large Clinical Database MIMIC II

PLoS ONE ◽

10.1371/journal.pone.0095204 ◽

2014 ◽

Vol 9 (4) ◽

pp. e95204 ◽

Cited By ~ 24

Author(s):

Zhongheng Zhang ◽

Xiao Xu ◽

Hongying Ni ◽

Hongsheng Deng

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Predictive Value ◽

Ionized Calcium ◽

Clinical Database

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First day dynamic changes in antithrombin III activity after supplementation have a predictive value in critically ill patients

American Journal of Hematology ◽

10.1002/ajh.20696 ◽

2006 ◽

Vol 81 (12) ◽

pp. 907-914 ◽

Cited By ~ 16

Author(s):

Satoshi Gando ◽

Atsushi Sawamura ◽

Mineji Hayakawa ◽

Hirokatsu Hoshino ◽

Nobuhiko Kubota ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Predictive Value ◽

Antithrombin Iii ◽

Dynamic Changes ◽

Antithrombin Iii Activity

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Continuous Auscultation of Heart and Bilateral Breath Sounds

PEDIATRICS ◽

10.1542/peds.81.5.745b ◽

1988 ◽

Vol 81 (5) ◽

pp. 745-746

Author(s):

NATHAN SCHWARTZ ◽

JAMES B. EISENKRAFT

Keyword(s):

Heart Rate ◽

Critically Ill ◽

Vital Signs ◽

Sleep Pattern ◽

Monitoring Device ◽

Challenging Problem ◽

Breath Sounds ◽

Increased Risk ◽

Risk Of Exposure

To the Editor.— The frequent determination of vital signs, such as heart rate and bilateral breath sounds, is a mainstay in the care of critically ill infants. Unfortunately, the routine determination of such vital signs involves the manipulation and disturbance of the infant, unnecessary risk of exposure to cold, increased risk of apnea, and infection.1,2 In addition, the frequent disruption of the infant's sleep pattern may take an unaccountable physiologic and psychologic toll. To deal with this common and challenging problem we have devised a simple and inexpensive monitoring device, using readily available supplies, which facilitates the continuous or intermittent evaluation of heart rate and bilateral breath sounds.

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Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Biomedicines ◽

10.3390/biomedicines9111656 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1656

Author(s):

Emanuel Moisa ◽

Dan Corneci ◽

Silvius Negoita ◽

Cristina Raluca Filimon ◽

Andreea Serbu ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Systemic Inflammation ◽

Predictive Value ◽

Cox Regression ◽

Invasive Mechanical Ventilation ◽

Neutrophil To Lymphocyte Ratio ◽

Dynamic Changes ◽

Hematological Indices ◽

Lymphocyte Ratio

Background: Hematological indices can predict disease severity, progression, and death in patients with coronavirus disease-19 (COVID-19). Objectives: To study the predictive value of the dynamic changes (first 48 h after ICU admission) of the following ratios: neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), systemic inflammation index (SII), and derived neutrophil-to-lymphocyte (dNLR) for invasive mechanical ventilation (IMV) need and death in critically ill COVID-19 patients. Methods: Observational, retrospective, and multicentric analysis on 272 patients with severe or critical COVID-19 from two tertiary centers. Hematological indices were adjusted for confounders through multivariate analysis using Cox regression. Results: Patients comprised 186 males and 86 females with no difference across groups (p > 0.05). ΔNLR > 2 had the best independent predictive value for IMV need (HR = 5.05 (95% CI, 3.06–8.33, p < 0.0001)), followed by ΔSII > 340 (HR = 3.56, 95% CI 2.21–5.74, p < 0.0001) and ΔdNLR > 1 (HR = 2.61, 95% CI 1.7–4.01, p < 0.0001). Death was also best predicted by an NLR > 11 (HR = 2.25, 95% CI: 1.31–3.86, p = 0.003) followed by dNLR > 6.93 (HR = 1.89, 95% CI: 1.2–2.98, p = 0.005) and SII > 3700 (HR = 1.68, 95% CI: 1.13–2.49, p = 0.01). Conclusions: Dynamic changes of NLR, SII, and dNLR independently predict IMV need and death in critically ill COVID-19 patients.

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Nutrition support in critically ill COVID-19 patients

World Nutrition Journal ◽

10.25220/wnj.v04.s3.0006 ◽

2020 ◽

Vol 4 (1-3) ◽

pp. 8

Author(s):

Abdolreza Norouzy

Keyword(s):

Older Adults ◽

At Risk ◽

Critically Ill ◽

Diagnosis And Treatment ◽

Nutrition Support ◽

Patients At Risk ◽

Short And Long Term ◽

Long Term Prognosis ◽

Poor Outcomes

Diagnosis and treatment of malnutrition should be considered in the management of COVID-19 patients to improve both short- and long-term prognosis. Patients at risk for poor outcomes and higher mortality following infection with COVID-19, namely older adults and polymorbid individuals, should be checked for malnutrition through screening and assessment.

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