Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study

Domenico, Sandro Luigi Di; Coen, Daniele; Bergamaschi, Marta; Albertini, Valentina; Ghezzi, Leonardo; Cazzaniga, Michela; Tombini, Valeria; Colombo, Riccardo; Capsoni, Nicolò; Coen, Tommaso; Cazzola, Katia Barbara; Fiore, Marina Di; Angaroni, Laura; Strozzi, Marco

doi:10.1007/s11739-020-02548-0

Cited by 44 publications

(48 citation statements)

References 29 publications

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“…The current analysis did not cover the period of COVID-19 pandemic, and therefore, did not take into account that pericardial effusion is one of the manifestations of COVID-19, with the possibility of cardiac tamponade in the setting of a severe clinical course [ 30 ]. Future studies will have to consider also this etiology of pericardial effusions [ 30 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes

et al. 2021

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Pericardial effusion can dangerously precipitate patient’s hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010–2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1–78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76–29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65–20.01, and OR 5.81, 95% CI 2.11–15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45–11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.

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Section: Discussionmentioning

confidence: 99%

Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes

et al. 2021

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“…19 The mortality and the rate of intubation in the ST only group was similar to that of current literature where patients with COVID 19 on non-invasive ventilation who were for further escalation was 47% and 57% respectively. 27 The higher dose cotrimoxazole used in our study is indicated in patients with nocardiasis with excellent safety profile. 28 This results in higher concentration of the trimethoprim in the blood which is a potentent anti-inflammatory agent resulting in increased inactivation of neutrophils and monocytes in the blood, thus blocking the cytokine storm mediated ARDS.…”

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

Singh¹,

John

Kumar³

et al. 2021

Preprint

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BackgroundCOVID-19 can be fatal in a significant proportion of people who develop critical illness, resulting in hypoxic respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) which is thought to be mediated by a cytokine storm syndrome. Steroids have been shown to be of some benefit, but the mainstay of treatment remains supportive.MethodsThe data was collected retrospectively from consecutive, newly diagnosed patients presenting to the critical care facility of I Q City Medical College Hospital, Durgapur, India between June and November 2020 with critical COVID-19 on non-invasive ventilation treated with high dose oral cotrimoxazole (CTX) in addition to standard therapy (ST) and compared with patients with critical COVID-19 receiving standard therapy alone.Results201 patients were identified. Of which 151 patients received CTX in addition to ST (mean age ± SD 59 ± 13 years, 81% male and mean BMI ± SD 28 ± 2) and 50 patients received ST alone (mean age ± SD 63 ± 12, 64% male and mean BMI ± SD 27 ± 2). We observed that the patients with critical COVID-19 receiving CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (13% versus 40%, p <0.001), length of hospital and critical care unit stay (mean, 11 versus 15 days (p <0.001) and 6 versus 11 days (p <0.001) respectively), and the need for mechanical ventilation (16% versus 42%, p <0.001) with improved CRP at day 7 (mean, 38mg/L versus 62mg/L, p = 0.001).ConclusionThese results may be due to the antibiotic and anti-cytokine effects of CTX. Clinical trials are currently underway to test our observations.

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“…18 Although high prevalence, no statistically significant impact on death was found here in Brazil. Many other countries, such as Italy, 20 Spain, 21 and Egypt, 22 found a correlation of dyspnea or low oxygen saturation with higher hospital deaths. Our data corroborate this, showing that a combination of both symptoms more than doubles hospital death risk.…”

Section: Discussionmentioning

confidence: 98%

Prevalent comorbidities among young and underprivileged: Death portrait of COVID-19 among 235 555 hospitalized patients in Brazil

Pietre

et al. 2021

Preprint

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Background COVID 19 has been alarmingly spreading worldwide, with Brazil ranking third in total number of cases and second in deaths. Being a continental country, which comprises many ethnic groups and an engrained social inequality, the pandemic evidenced this heterogeneous discrepancy. We aimed to estimate the impact of associated risk factors, isolated or combined, on COVID 19 severeness, detecting specific epidemiological profiles for multiple age ranges in hospitalized Brazilians. Methods In this large retrospective cohort study, we used open-access data from the Ministry of Health of Brazil with COVID 19 confirmed hospitalized patients annotated in SRAG system between February and August 2020, a total of 235555 entries. The association of COVID 19 death with socio-demographic and clinical characteristics was analysed and presented as odds ratios adjusted by confounding co-variables. We also presented marginal mean aOR values for high-order interactions either by or not another fixed level or condition. We kept all other variables in the multivariate logistic models in their mean values or equal proportions. Findings Younger individuals with one or more comorbidities had an adjusted odds ratio up to four-fold compared to those without it, in the same age interval. Younger diabetic patients either self-declared as brown ethnicity (aOR 5,58, 95% CI 4,97-6,25; p < 0,0001) or with some other associated comorbidities, mainly chronic hematologic disease (21,09, 13,64-32,6; p < 0,0001) and obesity (aOR 21,7, 95% CI not calculated; p < 0,0001), resulted in outstanding death risk. Age over 60, particularly over 90 (28,91, 24,5-34,11; p < 0,001), usage of invasive ventilatory support (16,23, 14,05-18,75; p < 0,001), admission to intensive care units (3,14, 2,82-3,48; p < 0,001), multiple respiratory symptoms (3,24, 2,79-3,75; p < 0,0001), black ethnicity (1,78, 1,52-2,07; p < 0,05), and diagnosis previous to hospitalization (1,32, 1,19-1,47; p < 0,05) were associated with higher death odds. As protective factors, with roughly one third less death risk, we found hospitalization duration of (4, 7] days and illness onset to hospitalization over 6 days. Interpretation We found evidence for increased COVID 19 risk in two distinct groups: younger patients with prevalent comorbidities, especially in brown ethnicity, and patients with black ethnicity. We speculate that the pro-inflammatory synergism of COVID 19 and comorbidities, promoting an overproduction of cytokines, is partially the cause of higher mortality in this young group. Brazilian black and brown are underprivileged populations, with structural social inequality, limited healthcare access and, thus, remarkable disease vulnerability. Our study supplies essential data to patient stratification upon admission, optimizing hospital management, and to guide public policy determinations, including group prioritization for COVID 19 vaccination in Brazil.

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Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study

Cited by 44 publications

References 29 publications

Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes

Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes

The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

Prevalent comorbidities among young and underprivileged: Death portrait of COVID-19 among 235 555 hospitalized patients in Brazil

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