Background: Determine the impact of tobacco smoking status on patients hospitalized with COVID-19 pneumonia in the need for ICU care, mechanical ventilation and mortality. Methods: We performed a retrospective cohort study, that involved chart review. All adults 18 years or older with a diagnosis of COVID-19 pneumonia hospitalized from March 15th, 2020 to May 06th, 2020 with a positive reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19. We used chi-squared test for categorical variables and student t-tests or Wilcoxon rank sum tests for continuous variables. We further used adjusted and unadjusted logistic regression to assess risk factors for mortality and intubation.Results: Among 577 patients hospitalized with COVID-19 pneumonia, 268 (46.4%) had a history of smoking including 187 former and 81 active smokers. The former smokers when compared with non-smokers were predominantly older with more comorbidities. Also, when compared with never smokers D Dimer levels were elevated in active (p=0.05) and former smokers (p<0.01). The former smokers versus non-smokers required increased need for advanced non-invasive respiratory support on admission (p<0.05), ICU care (p<0.05) and had higher mortality [1.99 (CI 95% 1.03-3.85, p<0.05)]. Active smokers versus non-smokers received more mechanical ventilation [OR 2.11 (CI 95% 1.06-4.19, p<0.05)].Conclusions: In our cohort of hospitalized patients with COVID-19 pneumonia, former smokers had higher need for non-invasive respiratory support on admission, ICU care, and mortality compared to non-smokers. Also, active smokers versus non-smokers needed more mechanical ventilation.
Background: Surges in COVID-19 disease cases can rapidly overwhelm healthcare resources; triaging to appropriate levels of care can assist in resource planning. At the beginning of the pandemic, we developed a simple triage tool, the Temple COVID-19 Pneumonia Triage Tool (TemCOV) based on a combination of clinical and radiographic features that are readily available on presentation to categorize and predict illness severity. Methods: We prospectively examined 579 sequential cases admitted to Temple University Hospital who were assigned severity categories on admission. Our primary outcome was to compare the performance of TemCOV in predicting patients who have the highest likely of admission to the ICU at 24 and at 72 hours to other standard triage tools: the National Early Warning System (NEWS), the Modified Early Warning System (MEWS) and the CURB65 score. Additional endpoints included need for invasive mechanical ventilation (IMV) within 72 hours, total hospital admission charges, and mortality. Results: 26% of patients fell within our highest risk Category 4 and were more likely to require ICU admission at 24 hours (OR 11.51) and 72 hours (OR 8.6). Additionally they had the highest likelihood of needing IMV (OR 29.47) and in-hospital mortality (OR 2.37). , TemCOV performed similar to MEWS in predicting ICU admission at 24 hours (receive operator characteristic (ROC) curve area under the curve (AUC) 0.77 vs. 0.74, p=0.21) but better than NEWS2 and CURB65 (ROC AUC 0.77 vs. 0.69 and 0.77 vs. 0.64, respectively, p<0.01). While all severity scores had a weak correlation to hospital charges, the TemCOV performed the best among all severity scores measured (r=0.18); median hospital charges for Category 4 patients was $170,468 ($96,972-$487,556). Conclusion: TemCOV is a simple triage score that can be used upon hospitalization in patients with COVID-19 that predicts the need for hospital resources such as ICU bed capacity, invasive mechanical ventilation and personnel staffing.
Hintergrund: Der Spontanpneumothorax ist eine selten auftretende Komplikation der Viruspneumonie bei COVID-19. Die genaue Inzidenz sowie die Risikofaktoren sind weiter unklar. In der vorliegenden Arbeit untersuchen wir die Inzidenz und die Outcomes von mehr als 3.000 Patienten mit Pneumothorax, die mit Verdacht auf COVID-19-Pneumonie in unsere Klinik aufgenommen wurden. Methoden: Wir überprüften retrospektiv die Fälle von COVID-19-Patienten, die in unsere Klinik aufgenommen worden waren. Zur Berechnung der Inzidenz dieses Ereignisses wurden Patienten mit diagnostiziertem Spontanpneumothorax identifiziert und ihre klinischen Merkmale wurden umfassend dokumentiert. Es wurden Daten zum klinischen Outcome erhoben. Die einzelnen Fälle werden jeweils in Form einer kurzen Zusammenfassung vorgestellt. Ergebnisse: Zwischen 1. März und 8. Juni 2020 wurden 3368 Patienten mit Verdacht auf eine COVID-19-Pneumonie in unsere Klinik aufgenommen; von diesen wiesen 902 Patienten einen positiven Nasopharyngealabstrich auf. Es wurden sechs COVID-19-Patienten, die einen Spontanpneumothorax entwickelten, identifiziert (0,66 %). Die Baseline-Bildgebung zeigte bei diesen Patienten diffuse bilaterale Milchglastrübungen und Konsolidierungen, überwiegend in den posterioren und peripheren Lungenregionen. Vier der sechs Patienten wurden mechanisch beatmet. Bei allen Patienten war eine Thoraxdrainage erforderlich. In allen Fällen bestand kein direkter Zusammenhang zwischen dem Pneumothorax und der Mortalität (66,6%). Schlussfolgerung: Der Spontanpneumothorax ist eine seltene Komplikation der Viruspneumonie bei COVID-19, die auch ohne mechanische Beatmung auftreten kann. Kliniker sollten im Hinblick auf die Diagnose und Behandlung dieser Komplikation wachsam sein.
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