Background: Coronaviruses are ribonucleic acid viruses, in humans the viruses may infect the respiratory, gastrointestinal, hepatic, and central nervous systems. Infection with four of the most common coronaviruses strains. usually lead to mild, self-limiting upper respiratory tract infections However, other corona viruses, are associated with severe acute respiratory syndrome (SARS-CoV) and the Middle East respiratory syndrome (MERS-CoV). Aim: to assess the use of systemic steroid either pulse steroid or regular dose of steroid in patient with severe form of covid 19 as regard hospital stay, need for mechanical ventilation. Methods: a cross sectional study, carried out on 50 patients who were suspected with covid 19 by history, laboratory investigation, chest imaging and confirmed with PCR selected from the critical care unit and isolation critical care unit at Benha university Hospital. And were classified into two groups, Group1: 25 patients were received dexamethasone (8 mg per day) and Group 2: 25 patients were received solumedrol (2mg per Kg). All data will be tabulated and statistically analyzed. Results: the mean ICU length of stay in critically ill patients who received Dexamethasone was 12.5±4.286 versus 14.68±7.851 in critically ill patients who received Methylprednisolone (p-value=0.08). Patients in Dexamethasone group, by the 10th day, had a significantly better D dimer (1153.04±725.34 vs 1633.12±1244.8, p=0.020), ferritin, (899.14±344.22 vs 1523.8±994.44, p<0.001), NLR (3.108±0.430 vs 3.506±0.536, p<0.001), however, Methyl prednisolone group had lower mortality rate (p0.001). Conclusion Covid 19 is global pandemic with worldwide mortality rate that need urgent interventions from all world to face this catastrophe. However, ICU stay, d dimer, ferritin, NLR among patients who treated with Dexamethasone lower than among patients who treated with Methylprednisolone, those treated with Methylprednisolone had better mortality rates.
Several scoring systems were developed for prognosis and outcome prediction in sepsis. This study aims to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis. The study included 50 adult septic patients in a prospective observational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. This study also evaluated the need for mechanical ventilation, inotropic or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality. In a population with Mean±SD 51.4±16.3 (19-82) year old with 34 (68%) males, we found that the ACR2 is correlated with both APACHE IV and SOFA scores (P <0.001). ACR2 was higher in patients who needed mechanical ventilation and inotropic or vasoactive support [121(21-235) and 166.5(89-235) mg/g respectively] compared to [49(22-120) and 56.5(21-211) mg/g], P <0.001 in both. ΔACR, ACR2, increasing ACR and APACHE IV were predictors of mortality. The AUC for mortality prediction was largest for ΔACR (1), increasing ACR (0.985), ACR2 (0.963) then APACHE IV (0.90). ∆ACR and ACR2 of 91.5 mg/g and -22 was 88.2% & 100% sensitive and 90.9% & 100% specific respectively to predict mortality. We concluded that the urinary ACR might be used as a simple test for prognosis and mortality prediction in sepsis.
Several scoring systems were developed for prognosis and outcome prediction in sepsis. This study aims to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis. The study included 50 adult septic patients in a prospective observational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. This study also evaluated the need for mechanical ventilation, inotropic or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality. In a population with Mean±SD 51.4±16.3 (19-82) year old with 34 (68%) males, we found that the ACR2 is correlated with both APACHE IV and SOFA scores (P <0.001). ACR2 was higher in patients who needed mechanical ventilation and inotropic or vasoactive support [121(21-235) and 166.5(89-235) mg/g respectively] compared to [49(22-120) and 56.5(21-211) mg/g], P <0.001 in both. ΔACR, ACR2, increasing ACR and APACHE IV were predictors of mortality. The AUC for mortality prediction was largest for ΔACR (1), increasing ACR (0.985), ACR2 (0.963) then APACHE IV (0.90). ∆ACR and ACR2 of 91.5 mg/g and -22 was 88.2% & 100% sensitive and 90.9% & 100% specific respectively to predict mortality. We concluded that the urinary ACR might be used as a simple test for prognosis and mortality prediction in sepsis.
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