Hospital Admission Factors Independently Affecting the Risk of Mortality of COVID-19 Patients

INTRODUCTION

COVID-19 is a disease characterized by high in-hospital mortality, which seems to be dependent on many predisposing factors.

OBJECTIVES

The aim of this study was to analyze the clinical symptoms, abnormalities in the results of laboratory tests, and coexisting chronic diseases that independently affected the risk of in-hospital mortality in patients with COVID-19.

PATIENTS AND METHODS

We analyzed the records of patients with COVID-19 who were hospitalized from 6 March 2020 to 30 November 2021.

RESULTS

Out of the entire group of 2138 patients who were analyzed, 12.82% died during hospitalization. In-hospital mortality was independently associated with older age (OR 1.53, 95% CI 1.20-1.97); lower arterial blood oxygen saturation (OR 0.95, 95% CI 0.92-0.99); the presence of a neoplasm (OR 4.45, 95% CI 2.01-9.62), a stomach ulcer (OR 3.35, 95% CI 0.94-11.31), and dementia (OR 3.40, 95% CI 1.36-8.26); a higher score on the SOFA scale (OR 1.73, 95% CI 1.52-1.99); higher lactate dehydrogenase (LDH) (OR 1.08, 95% CI 1.05-1.12); higher N-terminal pro-brain natriuretic peptide (NT pro BNP) (OR 1.06, 95% CI 1.01-1.11); and lower total bilirubin in blood concentration (OR 0.94, 95% CI 0.90-0.99).

CONCLUSIONS

We found that low oxygen saturation, old age, and the coexistence of cancer, gastric ulcers, and dementia syndrome were variables that independently increased mortality during hospitalization due to COVID-19. Moreover, we found that decreased platelet count and bilirubin concentration and increased levels of LDH and NT-proBNP were laboratory test results that independently indicated a higher risk of mortality. We also confirmed the usefulness of the SOFA scale in predicting treatment results. The ability to identify mortality risk factors on admission to hospital will facilitate both adjusting the intensity of treatment and the monitoring of patients infected with SARS-CoV-2.

The Clinical Course and Outcomes of Patients Hospitalized Due to COVID-19 during Three Pandemic Waves in Poland: A Single Center Observational Study

Background: The first case of coronavirus disease 2019 (COVID-19) in Poland was reported on 4 March 2020. We aim to compare the clinical course and outcomes of patients hospitalized in the Hospital for Infectious Diseases in Warsaw due to COVID-19 during three pandemic waves. Materials and methods: The medical data were collected for all patients diagnosed with COVID-19 hospitalized in our hospital from 6 March 2020 till 30 November 2021. COVID-19 diagnosis was confirmed by nasopharyngeal swabs using real-time polymerase chain reaction assay (RT-PCR) or SARS-CoV-2 antigen test. COVID-19 waves were defined based on the number and dynamics of cases. Results: Altogether, 2138 patient medical records were analyzed. The majority of the cohort was male (1235/2138, 57.8%), and the median age was 65 years [IQR: 50−74 years]. Patients hospitalized during the third wave had lower oxygen saturation on admission (p < 0.001) and were more likely to receive oxygen supplementation (p < 0.001). Serious complications, including pneumothorax (p < 0.001) and thromboembolic complications (p < 0.001), intensive care unit admission (p = 0.034), and death (p = 0.003), occurred more often in patients of the third wave. Conclusions: During the third wave, patients in our cohort experienced a more severe course of the disease and poorer outcomes.

How to follow-up a patient who received tocilizumab in severe COVID-19: a case report

BACKGROUND

COVID-19 is characterized by fast deterioration in the mechanism of cytokine storm. Therefore, treatment with immunomodulating agents should be initiated as soon as hyperinflammation is established. Evidence for the use of tocilizumab (TCZ) in COVID-19 is emerging, but the drug in this setting is used "off label" with limited data on both effectiveness and safety. Therefore, Hospital for Infectious Diseases in Warsaw established a Standard Operating Procedure (SOP) for the use of TCZ in severe COVID-19 cases.

CASE PRESENTATION

Here, we present a case of 27-year-old, otherwise healthy man, who was successfully treated with chloroquine, azithromycin, tocilizumab and a standard of care. Initially the magnitude of lung devastation, clinical deterioration and the need for mechanical ventilation suggested unfavorable prognosis. However, we observed complete regression in radiological changes and rapid clinical improvement. Irrespective of this, patient's serum interleukin 6 and aminotransferases remained elevated even after a month from treatment.

CONCLUSIONS

An overlapping effect of hyperinflammation, hypoxic organ injury and drug-related toxicity warrants a long-term follow-up for COVID-19 survivors. In addition, residual IL-6 receptors blockage may mask new infections. A standardized approach to follow-up for COVID-19 survivors is urgently needed. Current and future research should also investigate the impact of experimental therapies on lung tissue healing and regeneration, as well as long-term treatment toxicities.

Usefulness of SOFA score and artesunate - based treatment in severe malaria – a single center study

INTRODUCTION

This study was conducted to assess the usefulness of the guidelines of treatment recommended in Malaria diagnosis and treatment guideline published by University College London Hospitals-NHS Foundation Trust on 26th June 2013, usefulness of artesunate-based therapy and usefulness of SOFA (sepsis-related organ failure assessment) score in treatment of severe malaria. Severe malaria is usually caused by Plasmodium falciparum and most of the time fulfills the criteria of sepsis which are specified in the new definition of sepsis. The other malaria species are commonly considered to be the cause of mild course of malaria, however more and more cases of severe malaria are reported in the course of tertian fever malaria caused by Plasmodium vivax and in the disease caused by Plasmodium knowlesi.

MATERIALS AND METHODS

Fourteen patients with malaria were hospitalized in the Department of Adults’ Infectious Diseases and in the Intensive Care Unit of the Hospital for Infectious Diseases in Warsaw between December 2013 and April 2017. All patients were treated according to Malaria diagnosis and treatment guideline UCLH.

RESULTS

Thirteen patients in our study fulfilled the criteria of severe malaria. All fourteen patients presented with a SOFA score ≥2 points. Intravenous artesunate was administered to all patients in doses recommended in the UCLH guidelines. All patients presented with thrombocytopenia and elevated level of D-Dimers. The main factor influencing the dynamics of SOFA score was thrombocytopenia. All the patients fully recovered without any complications.

CONCLUSIONS

The malaria treatment guidelines used in the Department for Infectious Diseases in Adults and in the Intensive Care Unit of the Hospital for Infectious Diseases in Warsaw in years 2013-2017 are effective. In assessing the severity of malaria SOFA score is useful especially as a warning of possibility of a severe course of the disease.

The application of continuous thoracic epidural anaesthesia in outpatient oncological and reconstructive surgery of the breast

The use of continuous thoracic epidural anaesthesia allows several oncological and reconstructive operations of the breast to be performed on an outpatient basis. The method is easy and safe in the hands of an experienced anaesthetist, and the recovery is immediate. The potential side effects (transient haemodynamic changes) may result from the sympathetic blockade and can be easily controlled during the operation. The method is not advocated in cases in which substantial blood loss is anticipated.