Early predictors of intensive care unit admission among COVID-19 patients in Qatar

Background

COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19.

Methods

This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender.

Results

A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001).

Conclusion

Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.

Characteristics and outcomes of adult patients with asthma presenting with COVID-19: A comparative cohort study

BACKGROUND

Bronchial asthma affects about 20% of Qatar's population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19-related morbidity and mortality in a cohort of asthma patients infected by COVID-19.

METHODS

This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities.

RESULTS

Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13-1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43-3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77-0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78-3.43; p = 0.193). No difference in mortality rate was observed between the two groups.

CONCLUSIONS

In Qatar, adult patients with asthma do not appear to be at higher risk of COVID-19-related hospitalization or ICU admission compared to the general adult COVID-19-infected population. Older age and hypertension were the only significant predictors of COVID-19-related hospitalization among patients with asthma. Further larger studies are required to confirm such an association.

First Episode of Psychosis in the Context of Varenicline Treatment for Smoking Cessation

Smoking is one of the leading causes of preventable death worldwide. Several pharmacological therapies have been established over the years to aid in smoking cessation, including Varenicline, a partial nicotine agonist. Neuropsychiatric adverse events have been reported in patients treated with Varenicline. Here, we present a case of first-episode psychosis in the context of Varenicline therapy. The patient's chart was retrospectively reviewed for relevant medical and psychiatric history, in addition to the use of current or past medications. Routine laboratory investigations and brain imaging were performed. The Naranjo Adverse Drug Reaction Probability Scale was also done independently by two physicians involved in the patient's treatment. He was admitted for psychotic symptoms elicited in the context of a probable adverse reaction to Varenicline. The current evidence linking Varenicline to psychosis remains controversial. Speculatively, there could be a link between Varenicline, which supposedly increases dopamine levels in the prefrontal cortex through the mesolimbic pathways, and psychotic symptoms. It is therefore beneficial to be cognizant, in a clinical setting, of the possibility of the emergence of these symptoms with Varenicline therapy.

Endogenous endophthalmitis due to Serratia marcescens secondary to late-onset empyema Post-Cardiac surgery in an End-Stage renal disease patient on peritoneal dialysis

Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital-acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end-stage renal disease (ESRD) on peritoneal dialysis, who had late-onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61-year-old gentleman presented with a two-day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high-dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long-term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital-acquired, and the source can be late-onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.

Characteristics and Early Predictors of Intensive Care Unit Admission among COVID-19 Patients in Qatar

Purpose

This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with Coronavirus disease (COVID-19).

Methods & Materials

This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Univariate and multivariate logistic regression models were used to identify the predictors for ICU admission and in-hospital mortality among the COVID‐19 patients.

Results

A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range, IQR=18). Predictors independently associated with ICU admission included having cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p= 0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), body mass index ≥30 kg/m2 (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphocytes ≤0.8 × 103/μL (aOR=2.69, 95% CI: 1.80-4.02, p<0.001), aspartate aminotransferase (AST) >120 U/L (aOR= 2.59, 95% CI: 1.53-4.36, p<0.001), ferritin >600 μg/L (aOR=1.96, 95% CI: 1.40-2.74, p<0.001), C-reactive protein (CRP) >100 mg/L (aOR=4.09, 95% CI: 2.81-5.96, p<0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p <0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphocytes ≤0.8 x,103/μL (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and AST >120 U/L (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036).

Conclusion

Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were also associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.

395. Early Predictors of Intensive Care Unit Admission among COVID-19 Patients in Qatar

Background

Coronavirus disease (COVID-19) is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with COVID-19.

Methods

This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender.

Results

A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p=0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), obesity (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphopenia (aOR=2.69, 95% CI: 1.80-4.02, p< 0.001), high aspartate aminotransferase (AST) (aOR= 2.59, 95% CI: 1.53-4.36, p< 0.001), high ferritin (aOR=1.96, 95% CI: 1.40-2.74, p< 0.001), high C-reactive protein (CRP) (aOR=4.09, 95% CI: 2.81-5.96, p< 0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p< 0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphopenia (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and high AST (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036).

Risk Factors for ICU admission among patients with COVID-19 (N=1560)

Conclusion

Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.

Disclosures

Adel Abou-Ali, PharmD, PhD, Astellas Pharma Global Development, Inc. (Employee)

Critical Appraisal of the Clinical Practice Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk: European Society of Cardiology (ESC) and European Atherosclerosis Society (ESC/EAS) 2019 Guidelines

Objective

The aim of the study was to assess the quality of the recently published European clinical practice guidelines for the management of dyslipidaemias, utilizing the refined Appraisal of Guidelines for Research & Evaluation tool.

Method

The 2019 European Society of Cardiology and European Atherosclerosis Society Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk was appraised and scored for methodological rigour and transparency by 5 independent appraisers using a validated tool.

Key findings

The guideline scored highest in the domains that evaluated editorial independence (100%) and clarity of presentation (98.6%) and lowest in the domains that addressed stakeholder involvement (55.56%) and rigour of development (63%). Overall the quality of the guideline was high, and all reviewers recommended its use in practice.

Conclusion

The guideline’s overall quality was judged to be high, and all appraisers recommended its use in practice without modifications.

The airway in inhalational injury: diagnosis and management

It is estimated that 13.000 to 22.000 individuals suffer from inhalational burns each year in the United States alone. Despite these high numbers, inhalational burns remain a major challenge to otolaryngologists. In this paper, a review of literature is presented in order to provide otolaryngologists with a systematic approach to patients with inhalational burns to optimize treatment, cost, morbidity and, most importantly, mortality. For this purpose, a broad PubMed search was conducted. The available literature was found to highlight the importance of airway management in terms of the timing of intubation, method of intubation, trachea-esophageal (TE) fistula formation and TE rupture. It also emphasizes the importance of carbon monoxide intoxication and prompt correction. Drugs such as heparin sulfate, N-acetylcysteine and albuterol have been proven to help in the treatment of patients with inhalational burns, and more research is currently underway with the purpose of developing chelating drugs that scavenge the toxic substances in the smoke before they can damage the airway.

Maternal cultural participation and child health status in a Middle Eastern context: evidence from an urban health study

BACKGROUND

The negative effect of poverty on child health has been well established. However, rapid urbanization in developing countries prompts new research questions relating to socio-cultural practices and other related variables in these settings.

OBJECTIVE

To examine the association between maternal cultural participation and child health status in impoverished neighbourhoods of Beirut, Lebanon.

METHODS

A cross-sectional survey of 1241 mothers with children aged less than 5 years was conducted from randomly selected households in three impoverished neighbourhoods of diverse ethnic and religious make-up. The outcome variable was child health status (good/bad) as assessed by the mother. Maternal variables, including cultural participation, education, demographic and environmental/structural factors, were studied. Descriptive statistics and bivariate associations were provided using Pearson's chi-square tests. Unadjusted and adjusted odds ratios were then obtained from binary logistic regression models.

RESULTS

Two indicators of maternal cultural participation, namely watching entertaining television and attending movies/art exhibitions, were found to be significantly associated with child health status after controlling for other risk factors. The quality of water, the quality of local health services and maternal education were also significantly associated with child health status. Household income, child gender and household dampness had no significant association with child health status in this context.

CONCLUSION

Maternal cultural participation was a significant predictor of child health status in impoverished urban communities. Improving child health through culturally focused interventions for mothers, especially in deprived areas, may be greatly important.