Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Puah, Ser Hon; Young, Barnaby Edward; Chia, Po Ying; Ho, Vui Kian; Loh, Jiashen; Gokhale, Roshni Sadashiv; Tan, Seow Yen; Sewa, Duu Wen; Kalimuddin, Shirin; Tan, Chee Kiat; Pada, Surinder; Cove, Matthew E.; Chai, Louis Yi Ann; Parthasarathy, Purnima; Ho, Benjamin Choon Heng; Ng, Jensen; L, Li; Abisheganaden, John; Lee, Vernon J M; Tan, Cher Heng; Lin, Raymond T. P.; Leo, Yee Sin; Lye, David Chien; Yeo, Tsin Wen; Lim, Poh Lian; Ang, Brenda; Lee, Cheng Chuan; Lee, Lawrence S.; Ng, Oon Tek; Chan, Mónica; Marimuthu, Kalisvar; Vasoo, Shawn; Wong, Chen Seong; Lee, Tau Hong; Sadarangani, Sapna; Lin, Ray Junhao; Sadasiv, Mucheli Sharavan; Ng, Deborah Hee Ling; Choy, Chiaw Yee; Tan, Glorijoy Shi En; Tan, Yu Kit; Ong, Sean Wei Xiang; Sutjipto, Stephanie; Lee, Pei Hua; Tay, Jun Yang; Ding, Ying; Khoo, Bo Yan; Tay, Woo Chiao; Ng, Gabrielle; Mah, Yun Yuan; Tan, Wilnard; Lew, Sennen Jin Wen; Fong, Raymond Kok Choon; Oh, H. M. L.; Chien, Jaime Mei Fong; Shafi, Humaira; Cheong, Hau Yiang; Teo, Darren Cheng Han; Tan, Thuan Tong; Tan, Ban Hock; Low, Jenny Guek Hong; Wijaya, Limin; Venkatachalam, Indumathi; Chua, Ying Ying; Cherng, Benjamin Pei Zhi; Chan, Yvonne; Phua, Ghee Chee; Goh, Ken Junyang; Soh, Jade Xiao Jue; Zheng, Shuwei; Lingegowda, Pushpalatha Bangalore; Peh, Wee Ming; Lee, Yi Lin; Ho, Jun Yang; Chia, April Yu Jie; Ooi, Say Tat; Anantharajah, Tambyah Paul; Somani, Jyoti; Oon, Jolene; Yan, Gabriel

doi:10.1038/s41598-021-81377-3

Cited by 19 publications

(17 citation statements)

References 20 publications

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“…Thus, the measurement of blood oxygen saturation is a standard screening tool in clinical settings to assess the performance of the respiratory system [ 54 , 55 ]. Low oxygen saturation and elevated respiratory rate have been consistently associated with disease severity in patients hospitalized with COVID-19 [ 56 , 57 , 58 , 59 ]. Measurement of oxygen saturation is one of the critical indications for monitoring patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

et al. 2022

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Vaccines against severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection, which causes coronavirus disease–19 (COVID-19) in humans, have been developed and are being tested for safety and efficacy. We conducted the cross-sectional prospective cohort study on 820 patients who were positive for SARS-CoV-2 and were admitted to Princess Krishnajammanni trauma care centre (PKTCC), Mysore, which was converted to a designated COVID hospital between April 2021 to July 2021. After obtaining the informed consent, RT-PCR report, vaccination certificate and patient history, patients were classified according to their vaccination status. Results from the study showed decreases in serum ferritin levels, clinical symptoms, improvement in oxygen saturation, early recovery in patients having diabetes and hypertension, and a substantial reduction in the overall duration of hospital stay in vaccinated patients compared to unvaccinated patients. Further, fully vaccinated patients showed better outcomes compared to single dose vaccinated and nonvaccinated patients. Taken together, our findings reaffirm the vaccine’s effectiveness in reducing case fatality and promoting faster recovery compared to nonvaccinated patients. Efforts to increase the number of immunized subjects in the community help to achieve herd immunity and offer protection against the severity of COVID-19 and associated complications while minimizing the public health and economic burden.

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Section: Discussionmentioning

confidence: 99%

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

et al. 2022

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“…Upon admission, the need for oxygen support upon admission was an independent and powerful factor for poor outcomes in both endpoints. Recently introduced models also emphasized the predictive factor for baseline oxygen saturation and the need for supplemental oxygen [21,25]. Low oxygen saturation may reflect the extent of the alveolicapillary unit destruction, as some patients might not always respond to non-pressurized nasal oxygen support since damaged areas of the lung could cause shunting of non-oxygenated blood from right-to-left, and result in ventilationperfusion (V/P) mismatch [26,27].…”

Section: Discussionmentioning

confidence: 99%

Independent predictors of in-hospital mortality and the need for intensive care in hospitalized non-critical COVID-19 patients: a prospective cohort study

et al. 2022

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One of the most helpful strategies to deal with ongoing coronavirus pandemics is to use some prudence when treating patients infected with SARS-CoV-2. We aimed to evaluate the clinical, demographic, and laboratory parameters that might have predictive value for in-hospital mortality and the need for intensive care and build a model based on them. This study was a prospective, observational, single-center study including non-critical patients admitted to COVID-19 wards. Besides classical clinic-demographic features, basic laboratory parameters obtained on admission were tested, and then new models for each outcome were developed built on the most significant variables. Receiver operating characteristics (ROC) analyses were performed by calculating each model's probability. A total of 368 non-critical hospitalized patients were recruited, the need for ICU care was observed in 70 patients (19%). The total number of patients who died in either ICU or wards was 39 (10.6%). The first two models (based on clinical features and demographics) were developed to predict ICU and death, respectively; older age, male sex, active cancer, and low baseline saturation were noted to be independent predictors. The area under the curve values of the first two models were noted 0.878 and 0.882 (p < .001; confidence interval [CI] 95% [0.837-0.919], p < .001; CI 95% [0.844-0.922]). Following two models, the third and fourth were based on laboratory parameters with clinicdemographic features. Initial lower sodium and lower albumin levels were determined as independent factors in predicting the need for ICU care; higher blood urea nitrogen and lower albumin were independent factors in predicting in-hospital mortality. The area under the curve values of the third and fourth model was noted 0.938 and 0.929, respectively (p < .001; CI 95% [0.912-0.965], p < .001; CI 95% [0.895-962]). By integrating the widely available blood tests results with simple clinic demographic data, non-critical patients can be stratified according to their risk level. Such stratification is essential to filter the patients' non-critical underlying diseases and conditions that can obfuscate the physician's predictive capacity.

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“…It is critical to categorize severity and outcome based on biochemical indicators. In this regard, bilirubin, ALT, AST, creatinine kinase (CK), C reactive protein (CRP), lactic dehydrogenase (LDH), cardiac troponin, ferritin, and fibrinogen have all been studied [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Manifestations of Sars-CoV-2 in Elderly Population (55 Years +): A Retrospective Cohort Study

Manu¹

2022

JCCM

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Background: Several studies have demonstrated that age, comorbidities, and abnormalities in different clinical biomarkers can be important in understanding disease severity. Although clinical features of COVID-19 have been widely described, the assessment of alterations of the most common biochemical markers that are reported in patients with COVID-19 still has not been well established especially in the elderly population.Methods: Here, we report the blood biochemical indicators of fifty-eight elderly patients (Age: 61.03±7.29) with COVID-19. Throatswab upper respiratory samples were obtained from patients, and real-time PCR was used to confirm SARS-CoV-2 infection. Then, biochemical parameters were categorized and analyzed according to these clinical characteristics. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar in July 2020.Results: Of the 58 investigated patients, 58.62% were male and 41.38% were Female. 5.17% of the patients had low viral load (i.e., cycle threshold (Ct) ≥ 30) and 94.83% had a high viral load (ie; Ct < 30). Hypocalcemia and uremia affected 12.07% and hypochloremia affected 17.23% of the patients. 27.59% suffered from hyponatremia, 27.59 % had low creatinine, 24.14% had high levels of Alanine transaminase (ALT), 25.86% had high levels of aspartate transferase (AST), and 65.52% had a high level of C-reactive protein (CRP). Conclusion:Elderly COVID-19 positive patients have been shown to have a disturbance in their biochemical parameters. Indeed, various biochemical parameters measured at baseline can provide useful prognostic information among COVID-19-affected patients. It can also help in the early identification of patients who merit aggressive institutional care, thereby potentially mitigating mortality.

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Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Cited by 19 publications

References 20 publications

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

Independent predictors of in-hospital mortality and the need for intensive care in hospitalized non-critical COVID-19 patients: a prospective cohort study

Biochemical Manifestations of Sars-CoV-2 in Elderly Population (55 Years +): A Retrospective Cohort Study

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