To generate a preliminary version of a novel risk score to predict the need for invasive mechanical ventilation (MV) in patients with COVID-19. METHODS: Retrospective analysis of patients >18 years-of-age with laboratory-confirmed COVID-19 admitted between March 15-April 15, 2020 to a tertiary-care center. Demographic, laboratory, clinical, and outcome information were recorded, using a standard data-collection format. RESULTS: The cohort included 265 subjects (mean age 59.3 AE16.4 years, 55.1% male) and 54 (20.4%) required invasive MV. Significant between-group univariate results, based on the need for invasive MV, were used in multiple-regression analysis. Admission heart rate (HR) (OR 1.032 [CI 1.013-1.015]; p<0.001), SpO2/FIO2 (S/F) ratio (OR .619 [CI .463-.829]; p=0.001), and any positive initial troponin (TnI) (OR 4.18 [CI 1.93-9.036]; p<0.001] independently predicted the need for invasive MV. The best cutoff points for the variables HR and S/F ratio were also determined: HR >101.5 BPM (AUC 0.686, 68.5% sensitivity & 66.4% specificity) and S/F ratio <4.4 (AUC 0.714, 72.2% sensitivity & 61.6% specificity). The overall model showed good calibration (Hosmer-Lemeshow = 6.3; p=0.39) and predictive ability (AUC = .80). Patients with a single, positive variable had an invasive MV risk = 15.4%, but this increased to 29% with 2 variables and 60.5% (p<0.001) with the presence of all 3. CONCLUSIONS: This pilot study provides insight into early factors related to patient acuity and the use of medical resources. Thresholds for 3 common clinical variables-HR, S/F ratio and TnIpredicted the need for invasive MV with good accuracy and provide an easily-applied scoring system to determine risk. CLINICAL IMPLICATIONS: We developed a simple, novel risk score to quantify the need for invasive MV in COVID-19 patients, with preliminary testing showing the 3 components had good predictive ability.
To examine COVID-19 patients requiring invasive mechanical ventilation (MV) and/or Extracorporeal Membrane Oxygenation (ECMO) to better understand patient selection for ECMO, clinical management, and short-term outcomes. METHODS: Retrospective study of patients >18-years-old admitted to the hospital with COVID-19 requiring MV. Lungprotective ventilation was used in all patients with initial set PEEP of 8-10 cm H20 for plateau pressure <30 cm H20. ECMO was considered per pre-specified institutional criteria for refractory hypoxemia despite maximum-medical therapy, in qualifying patients. Exclusion criteria for ECMO included age >65 years, multi-system organ failure, and MV >10 d. Data captured included baseline patient characteristics, co-morbidities, pre-ECMO respiratory support, ECMO settings, laboratory results, and COVID-19 therapeutic interventions.
The whole world is suffering from COVID-19 pandemic. This disease has halted life and has a negative impact on physical and mental health of all individuals. Objectives: To identify impact of BMI on Covid-19 clinical features and its management in terms of relationship among patients at government hospitals, Pakistan. Study Design: Cross-sectional study. Methodology: This study enrolled 206 patients having both genders and was carried at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan following ethical review committee’s (ERC) approval. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of BMI with COVID-19 symptoms having P-value greater than 0.05. There was an association of BMI with gender as P-value (0.000*). There was an association of BMI with age having P-value (0.000*). Conclusion: From present study, we concluded that there was a correlation between BMI and individuals with higher BMI as they developed more serious symptoms and required active management strategies in comparison to individuals who were either underweight or normal weight. Key Words: Covid-19, BMI, Treatment and Gender.
Background: The whole world is facing one of the biggest health related disaster (COVID-19) of the century. Aim: To identify age and gender-based differences in Covid-19 clinical features and its management among patients at government hospitals, Pakistan. Study design: Cross-sectional study. Methodology: This study with enrolled subjects (n=206) was carried out after ethical review committee’s (ERC) approval at Life Diabetes Centre, Gujrat and CMH Kharian Medical College (CKMC), over a period of 3 months, Kharian-Pakistan. Both male and female medical subjects were enrolled. Statistical analysis: Data was analyzed by SPSS software, version 17. Parameters like age, gender and treatment taken were presented as frequency. Chi square was applied to see the correlation with p-value <0.05 as significant. Results: Total 206 patients were randomly selected, 89 male and 117 females. Among 206, patients (n=133) showed symptoms while rest of the patients (73) remained asymptomatic. There was no association of age and gender with COVID-19 symptoms having P-value greater than 0.05. There was a significant association between treatments given was significantly related with age having P-value (0.006*). Conclusion: We concluded that there was no strong association between age and gender-based differences in Covid-19 clinical features; this could be due to small sample size. Keywords: Covid-19, Age, Treatment and Gender.
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