VERISHA KHANAM JURGENA TUSHA DANYAL TAHERI ABKOUH LAITH AL-JANABI VESNA TEGELTIJA AND SARWAN KUMAR PURPOSE: Throughout the years, several scoring systems have been established to measure disease severity in efforts to predict patient mortality and help guide management. In patients with sepsis, organ failure has been proven to worsen outcome, therefore utility of scores such as Sequential Organ Failure Assessment (SOFA) has helped determine the severity of disease and predict mortality. Patients infected with SARS COV-2 were observed to have varying disease progression with multiorgan involvement. Through this study, we intend to investigate the use of the SOFA score in predicting mortality in critically ill patients who tested positive for SARS COV-2. The aim of this study is to determine if the SOFA score is a strong predictor of mortality in critical care patients admitted with SARS-COV2 infection.
SARS-CoV2 is known for causing atypical pneumonia with rapidly progressive respiratory failure requiring intubation. Usage of steroids have been shown to be of benefit in similar disease processes caused by other coronaviruses specifically SARS/MERS. Currently in the literature there is lack of consensus regarding steroids use in severely ill patients with COVID-19 pneumonia. We conducted a retrospective analysis to evaluate the efficacy of systemic corticosteroids and outcomes in COVID-19 patients with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan. METHODS: This retrospective cohort study was conducted with 181 patients of COVID-19 with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan March 18 to April 15, 2020. Patients were then divided into 2 groups, with or without steroid treatment. Treatment group received oral prednisone, doses range from 10 to 60mg twice daily for an average of 5 days, most of which received a loading dose of intravenous methylprednisolone. The primary outcome for the study was mortality rate, secondary outcome was extubation rate. RESULTS: 177 patients met inclusion criteria and among those, 93 patients received systemic steroids. Of the total 93 patients in the treatment group, 42 patients were admitted to ICU, 38 of which were intubated. Of the total 84 patients in the control group, 14 patients were admitted to ICU and 10 were intubated. The mortality rate was 53% in the treatment group compared to 57% in the control group (p>0.05); the extubation rate was 71% in the treatment group compared to 50% in the control group (p>0.05). Our results showed a clinically important difference between the two groups.
The SARS-CoV2 virus is known to cause atypical pneumonia, but in this uncertain time with a lack of sensitive testing, laboratory values such as inflammatory markers, procalcitonin, and brain natriuretic peptide (BNP) may suggest a diagnosis of COVID-19 pneumonia, bacterial pneumonia, or CHF exacerbation. Commonly, the patients with respiratory symptoms, bilateral infiltrates on imaging and a negative COVID-19 nasopharyngeal swab test have been continued to be isolated with suspicion of having COVID-19 pneumonia. There is still a lack of significant research, that evaluates the benefits of biomarkers towards getting a definite diagnosis. We conducted a prospective study to analyse the difference in clinical markers in COVID positive patients compared to COVID-19 negative patients with respiratory symptoms and bilateral infiltrates on imaging, to get a better understanding of characteristics that may help differentiate COVID-19 pneumonia from bacterial pneumonia or CHF on admission. METHODS: We conducted a prospective observational single health center study. Inclusion criteria were patients who were admitted to our hospital with confirmed COVID-19 testing by nasopharyngeal swab (Confirmed group) or COVID-19 negative patients with respiratory symptoms and bilateral infiltrates on imaging (High Suspicion group). Lab markers measured on these patients were ferritin, procalcitonin, BNP, and CRP. RESULTS: Out of 100 patients analyzed to have suspected pneumonia, 26 were in the Confirmed group, 74 were in the High suspicion group. 0% COVID positive patients had a history of CHF, whereas 20.2% of those High suspicion group had a h/o CHF. The Confirmed group had a Procalcitonin >0.2 in 42.8%, BNP $800 in 23%, Ferritin $800 in 45.5%, and CRP >4 in 69.5%. The High suspicion group had Procalcitonin >0.2 in 28.4% and BNP $800 in 40.5%. CONCLUSIONS: Many studies discussed a biomarker-based test to distinguish between bacterial and viral etiologies of pneumonia with sufficient accuracy and specificity for clinical. Based on our data there appears to be an importance of initial lab testing and thorough clinical examination to narrow down differentials between CHF, COVID pneumonia, and bacterial pneumonia. Procalcitonin, for example, was more elevated in the COVID group. We found that many patients in the High Suspicion group were empirically treated as COVID patients and isolated as such. Through more studies, developing a biomarker scoring system may help diagnose COVID pneumonia. CLINICAL IMPLICATIONS: Currently, there are no biomarker-based algorithms for establishing the etiology of pneumonia. Further studies are required to explore a combination of biomarkers and symptoms for use as a definitive diagnostic tool for COVID patients.
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