BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has resulted in high mortality among patients in critical intensive care units. Hence, identifying mortality markers in the follow-up and treatment of these patients is essential. This study aimed to evaluate the relationships between mortality rates in patients with COVID-19 and the neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic inflammation response index (SII), and systemic inflammatory response index (SIRI). MethodologyIn this study, we assessed 466 critically ill patients diagnosed with COVID-19 in the adult intensive care unit of Kastamonu Training and Research Hospital. Age, gender, and comorbidities were recorded at the time of admission along with NLR, dNLR, MLR, PLR, SII, and SIRI values from hemogram data. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and mortality rates over 28 days were recorded. Patients were divided into survival (n = 128) and non-survival (n = 338) groups according to 28-day mortality. ResultsA statistically significant difference was found between leukocyte, neutrophil, dNLR, APACHE II, and SIRI parameters between the surviving and non-surviving groups. A logistic regression analysis of independent variables of 28-day mortality identified significant associations between dNLR (p = 0.002) and APACHE II score (p < 0.001) and 28-day mortality. ConclusionsInflammatory biomarkers and APACHE II score appear to be good predictive values for mortality in COVID-19 infection. The dNLR value was more effective than other biomarkers in estimating mortality due to COVID-19. In our study, the cut-off value for dNLR was 3.64.
Introduction: Despite significant advances in the management of patients with COVID-19, there is a need for markers to guide treatment and predict disease severity. In this study, we aimed to evaluate the relationship of the ferritin/albumin (FAR) ratio with disease mortality. Methodology: Acute Physiology and Chronic Health Assessment II scores and laboratory results of patients diagnosed with severe COVID-19 pneumonia were retrospectively analyzed. The patients were divided into two groups: survivors and non-survivors. Data for ferritin, albumin, and ferritin/albumin ratio among COVID-19 patients were analyzed and compared. Results: The mean age was higher in non-survivors (p = 0.778, p < 0.001, respectively). The ferritin/albumin ratio was significantly higher in the non-survival group (p < 0.05). Taking the cut-off value of the ferritin/albumin ratio of 128.71 in the ROC analysis, it predicted the critical clinical status of COVID-19 with 88.4% sensitivity and 88.4% specificity. Conclusions: ferritin/albumin ratio is a practical, inexpensive, and easily accessible test that can be used routinely. In our study, the ferritin/albumin ratio has been identified as a potential parameter in determining the mortality of critically ill COVID-19 patients treated in intensive care.
Ultrasonography is an imaging tool that is increasingly used in the diagnosis and follow-up of many lung and heart diseases. Full lung ultrasonography is the examination of both hemithorax and protocols and image definitions have been created to make the examination more systematic and accurate. Cardiac ultrasonography is used to evaluate a moving organ. It requires users to be able to detect and interpret dynamic and variable values. Another feature of ultrasonography is its ability to guide interventional procedures. Ultrasonography will develop in the future and will be used more as a modern diagnostic tool in lung and heart evaluation by specialists.
Aim: Computed tomography (CT) images of the chest are often used to support the diagnosis of COVID-19 and infectious diseases.This study aims to question the importance of specific chest CT results in predicting the prognosis of COVID-19 patients being followed up in the intensive care unit (ICU). Material and Method:For this study, 20 critically ill patients whose RT-PCR tests were positive for COVID-19 were included. Mortality, invasive and non-invasive mechanical ventilator requirement, APACHE II scores and ICU staying days were compared chest CT scans with have poor prognosis results before admission to ICU.Results: Critical patients who were followed up in the ICU due to COVID-19 disease with crazy paving pattern on chest CT images, it was concluded that there is a statistically significant requirement for invasive mechanical ventilation support during the ICU period (p=0.04). We reported that all patients with pleural and pericardial effusion required invasive mechanical ventilation support. One of the chest CT results observed in critical COVID-19 patients ın ICU is that the consolidation / ground glass opacity pattern> 1 may have a higher (about five-fold) mortality rate. Most of our critical COVID-19 patients who stayed in intensive care for a long time had a crazy paving pattern on chest CT images. Conclusion:We believe that some results obtained from chest CT scans in COVID-19 disease may predict the prognosis of the patient during the intensive care period.
Background Our aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position. Methods Patients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients’ pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h. Results The evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001). Conclusion As a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.
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