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Kaddoura R, Mohamed Ibrahim MI, Al-Amri M, Prabhakaran Nair A, Alharafsheh A, Alyafei SA, Albakri M. COVID-19-associated hypertriglyceridemia and impact of treatment. Front Med (Lausanne) 2024; 11:1326156. [PMID: 38449886 PMCID: PMC10915025 DOI: 10.3389/fmed.2024.1326156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) associated hypertriglyceridemia was observed among patients admitted to intensive care units (ICU) in Qatar. This study aimed to describe COVID-19-associated-hypertriglyceridemia in ICU patients and the impact of treating hypertriglyceridemia on clinical outcomes. Methods A retrospective observational cohort study of adult patients who were admitted to the ICU with a confirmed diagnosis of COVID-19 pneumonia according to the World Health Organization criteria. Hypertriglyceridemia was defined as triglyceride level of 1.7 mmol/L (≥150 mg/dL) and severe hypertriglyceridemia as fasting TG of ≥5.6 mmol/L (≥500 mg/dL). Results Of 1,234 enrolled patients, 1,016 (82.3%) had hypertriglyceridemia. Median age was 50 years and 87.9% were males. Patients with hypertriglyceridemia showed significantly longer time to COVID-19 recovery, ICU and hospital stay, and time to death (29.3 vs. 16.9 days) without a difference in mortality between groups. Of patients with hypertriglyceridemia, 343 (33.8%) received treatment (i.e., fibrate and/or omega-3). Patients in treatment group showed longer time to COVID-19 recovery and hospital stay with no difference in death rates in comparison with those in no-treatment group. Relatively older patients were less likely to experience hypertriglyceridemia (odd ratio (OR) 0.976; 95% CI: 0.956, 0.995) or to receive treatment (OR 0.977; 95% CI: 0.960, 0.994). Whereas patients who received tocilizumab were more likely to experience high TG level (OR 3.508; 95% CI: 2.046, 6.015) and to receive treatment for it (OR 2.528; 95% CI: 1.628, 3.926). Conclusion Hypertriglyceridemia associated with COVID-19 did not increase death rate, but prolonged time to death and length of stay. Treating hypertriglyceridemia did not translate into improvement in clinical outcomes including mortality.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Maha Al-Amri
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Arun Prabhakaran Nair
- Department of Infectious Disease, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Alharafsheh
- Pharmacy Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mutaz Albakri
- Pulmonary Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Shehatta AL, Kaddoura R, Orabi B, Ibrahim MIM, El-Menyar A, Alyafei SA, Alkhulaifi A, Ibrahim AS, Hassan IF, Omar AS. Extracorporeal Membrane Oxygenation Pathway for Management of Refractory Cardiac Arrest: A Retrospective Study from A National Center of Extracorporeal Cardiopulmonary Resuscitation. Crit Pathw Cardiol 2024:00132577-990000000-00067. [PMID: 38381697 DOI: 10.1097/hpc.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiac arrest remains a critical condition with high mortality and catastrophic neurological impact. Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as an adjunct in cardiopulmonary resuscitation modalities. However, survival with good neurological outcomes remains a major concern. This study aims to explore our early experience with ECPR and identify the factors associated with survival in patients presenting with refractory cardiac arrest. METHODS A retrospective cohort study analyzing six-year data from a tertiary center, the country reference for ECPR. SETTING A national center of ECPR. PARTICIPANTS Adult patients who experienced witnessed refractory cardiopulmonary arrest and were supported by ECPR. INTERVENTIONS ECPR for eligible patients as per local service protocol. RESULTS Data from 87 patients were analyzed; of this cohort, 62/87 patients presented with in-hospital cardiac arrest (IHCA), and 25/87 presented with out-of-hospital cardiac arrest (OHCA). Overall survival to decannulation and hospital discharge rates were 26.4% and 25.3%, respectively. Among survivors (n=22), 19 presented with IHCA (30.6%), whilst only 3 survivors presented with OHCA (12%). A total of 15/87 (17%) patients were alive at 6-month follow-up. All survivors had good neurological function assessed as Cerebral Performance Category 1 or 2. Multivariate logistic regression to predict survival to hospital discharge showed that IHCA was the only independent predictor (Odds Ratio 5.8, p =0.042), however, this positive association disappeared after adjusting for the first left ventricular ejection fraction after resuscitation. CONCLUSION In this study, the use of ECPR for IHCA was associated with a higher survival to discharge compared to OHCA. This study demonstrated a comparable survival rate to other established centers, particularly for IHCA. Neurological outcomes were comparable in both IHCA and OHCA survivors. However, large multicenter studies are warranted for better under-standing and improving the outcomes.
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Affiliation(s)
- Ahmed Labib Shehatta
- Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Doha, Qatar; (AL); (AS) ; (IH)
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rasha Kaddoura
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (RK) ; (BO); (SA)
| | - Bassant Orabi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (RK) ; (BO); (SA)
| | | | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (AA), (AO)
| | - Sumaya Alsaadi Alyafei
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (RK) ; (BO); (SA)
| | - Abdulaziz Alkhulaifi
- Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (AA), (AO)
| | - Abdulsalam Saif Ibrahim
- Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Doha, Qatar; (AL); (AS) ; (IH)
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Doha, Qatar; (AL); (AS) ; (IH)
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Amr S Omar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar, (AA), (AO)
- Department of Critical Care Medicine, Beni Suef University, Egypt (AO)
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Al-Badriyeh D, Kaddoura R, AlMaraghi F, Homosy A, Hail MA, El-Kassem W, Rouf PVA, Fadul A, Mahfouz A, Alyafei SA, Abushanab D. Impact of clinical pharmacist interventions on economic outcomes in a cardiology setting in Qatar. Curr Probl Cardiol 2023:101838. [PMID: 37244514 DOI: 10.1016/j.cpcardiol.2023.101838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
We sought to investigate the economic impact of preventing adverse events in a cardiology setting in Qatar as an effect of the clinical pharmacist as an intervention. This is a retrospective study of interventions by clinical pharmacists within an adult cardiology setting in a public healthcare setting (i.e Hamad Medical Corporation). The study included interventions that took place in March 2018, July 15, 2018-August 15, 2018, and January 2019. The economic impact was measured via calculating the total benefit, defined as the sum of the cost savings and the cost avoidance. Sensitivity analyses were adopted to confirm the robustness of the results. The pharmacist intervened in 262 patients, resulting in 845 interventions, with appropriate therapy (58.6%) and dosing/administration (30.2%) being the most frequent categories of reported interventions. Cost savings and cost avoidance resulted in QAR-11,536 (USD-3,169) and QAR1,607,484 (USD 441,616), respectively, yielding a total benefit of QAR1,595,948 (USD438,447) per three months and QAR6,383,792 (USD1,753,789) per a year.
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Affiliation(s)
| | - Rasha Kaddoura
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima AlMaraghi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Homosy
- Department of Pharmacy, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El-Kassem
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdalla Fadul
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Dina Abushanab
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar.
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