Research Article
Predicting Mortality Rate in ICU-Admitted COVID-19 Patients Implementing Visual Semi-Quantitative CT Severity Scoring System
Javid Azadbakht, Zahra Sadat Lajevardi, Amir Hossein Abdoli
Middle East Research Journal of Medical Sciences; 6-12.
DOI: 10.36348/merjms.2021.v01i01.002
Abstract: Objectives: The aim of this study was to identify the clinical and laboratory features and CT scan (CT intensity score and pleural effusion) associated with COVID-19 pneumonia to evaluate the relationship between CT scan findings and mortality by comparing deceased patients with normal patients. Methods: In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 150 deceased patients (with confirmed COVID-19 related death) were extracted from the COVID-19 registry of the affiliated university hospital belonging to mentioned period of time (in-hospital mortality subgroup, case), and 150 patients who survived the admission course were randomly selected from the same data set (surviving subgroup, control). Available electronic records for each patient were enlisted, including laboratory and clinical information, and their on-admission computed tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups. Results: The mean age of deceased patients (68.20±16.07) was significantly higher than that of the surviving patients (54.72± 19.50) (p <0.001). Diabetes, hypertension, and chronic kidney disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (p = 0.001). Lymphocyte count, neutrophil to lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), fasting blood sugar (BS), blood urea nitrogen (BUN), and Creatinine (Cr), mean CT severity score (CT-ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (p <0.05). Pleural effusion showed no significant correlation with short-term mortality. CT-ss of >11, in isolation or in combination with above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality. Conclusions: Factors such as advanced age, underlying diseases such as diabetes, hypertension, and CKD, decreased air-room SPO2, and increased lymphocyte count, higher NLR, ESR, CRP, LDH, BS, BUN, and Cr level, as well as higher CT-ss and O2 supportive therapy, are all significantly correlated with higher mortality in ICU-admitted COVID-19 patients.
Research Article
Chest CT Severity Score, CURB-65 Score, and Their Relationship with In-Hospital- Mortality in COVID-19 Patients
Javid Azadbakht, Zahra Sadat Lajevardi
Middle East Research Journal of Medical Sciences; 13-20.
DOI: 10.36348/merjms.2021.v01i01.003
Abstract: Objective: With every new strain of the SARS-CoV-2 spreading on a fast pace across the borders, an easy-to-calculate and reliable scoring system seems invaluable to identify high-risk patients. This study aims to investigate the relationship between CT severity score (CTSS) and CURB-65 score with mortality in COVID-19 patients. Methods: This study was conducted on RT-PCR confirmed COVID-19 patients admitted to a tertiary teaching center during fifth national wave of disease in one of the early disease epicenters in the country. All enrolled patients underwent chest CT scan within first day of admission. CTSS and CURB-65 scores were calculated and assigned to patients, while radiologist was blinded to clinical and laboratory findings, and they were evaluated for their correlation with in-hospital mortality, additively and separately. Results: Total number of 216 patients (140 males) with a mean age of 56.02 ± 17.34 years (ranging from 4 to 95) were enrolled. We found no significant relationship between CURB-65 score and CTSS (correlation coefficient: 0.065; P: 0.338). CURB-65 scores above 1 was predictive of in-hospital mortality with sensitivity of 56.4% and specificity of 81.9% (P: 0), those for CTSS above 11 were 79.5% and 4 51.5%, respectively (P: 0.001). CURB-65 score >1 and CTSS >11 predicted in-hospital mortality with sensitivity and specificity of 61.5% and 79.7% (P: 0.000). CURB-65 score and CTSS had a higher sensitivity and specificity to predict mortality comparing to each of those separately, but these enhanced statistics were not significant. Conclusion: CURB-65 score is meaningfully stronger than CTSS to prognosticate in-hospital mortality in patients with COVID-19, and it is not significantly correlated with CTSS.
Research Article
A Comparative Study of Safety & Efficacy of Foley’s Induction with Prostaglandin E2 Gel Induction
Dr. Sonalika Agarwal, Dr. Pratik K. Kakani, Dr. Ajit Deshpande, Dr. Mrs. Sarita Deshpande, Dr. V. B. Bangal
Middle East Research Journal of Medical Sciences; 21-24.
DOI: 10.36348/merjms.2021.v01i01.004
Abstract: Background: To compare maternal and fetal outcome with intracervical foley’s catheter and intracervical PGE2 gel on pre-induction cervical ripening for induction of labor. Methods: A Prospective Longitudinal study was carried out in antenatal cases beyond 37 weeks at tertiary care hospital, maharashtra. Pertinent data was collected and analyzed. Results: 50% patients were induced with PGE2 Gel (Group 1) and 50% patients were induced with Foley’s catheter (Group 2). The mean time interval between time of induction and delivery was 14.63±3.42 hours in Group 1 and 15.73±2.20 hours in Group 2. 52 (69.4%) patients in Group 1 had Full Term Normal Delivery (FTND) while 21 (28%) had Lower Segment Caesarean Section (LSCS). 73 (97.4%) patients in Group 2 had FTND while 1 (1.3%) patient had LSCS. The preinduction and postinduction bishops score between the groups was (3.53±0.84 vs. 3.44±0.74) and (6.91±1.24 vs. 7.33±0.83) respectively. Conclusion: Induction with foley’s catheter has significant improvement in Bishop’s score and shorter induction delivery interval as compared to PGE2 gel. Foleys catheter is advantageous as it lacks specific storage condition. It could be considered a cost effective alternative for pre induction cervical ripening.
Research Article
Predicting ICU Length of Stay in COVID-19 Patients Using a Multivariable Model Incorporating Clinical, Laboratory, and Imaging Features
Javid Azadbakht, Zahra sadat Lajevardi
Middle East Research Journal of Medical Sciences; 25-31.
DOI: 10.36348/merjms.2021.v01i01.005
Abstract: Objective: To predict ICU length of stay (LOS) using a multivariable model incorporating clinical, and laboratory and imaging features in hospitalized COVID-19 patients, thereby stratifying patients and allocating resources accordingly. Methods: In this retrospective cohort study, 139 hospitalized patients (Aged between 3 to 99) with rRT-PCR confirmed COVID-19 pneumonia requiring intensive care, which had been discharged or deceased, were enrolled. Demographic, clinical, and laboratory findings of eligible patients were all extracted from electronic medical records and, if needed, through phone calls. Semi-quantitative CT severity score (CTSS) was calculated and assigned to each encoded patient independently and blindly. We used cox regression model to investigate the prognostic role of semi-quantitative CTSS, clinical and laboratory features to anticipate ICU-LOS. Results: 139 patients with rRT-PCR confirmed COVID-19 pneumonia (including 60 females and 79 males) with a mean age of 58.52 ± 20.58 (ranging from 3 to 99) were included. CTSS was not predictive of ICU-LOS. Additionally, CTSS of more than 11 was predictor of mortality (sensitivity, 60.3%; specificity, 58%; AUC, 0.605; 95% confidence interval, 0.508-0.702; P-value, 0.034), and CTSS of above 10 was predictor of oxygen therapy dependency (sensitivity, 70.2%; specificity, 68%; AUC, 699 /0; 95% confidence interval, 0.580-0.818; P-value, 0.002). CTSS was not significantly associated with respiratory rate and on-admission dyspnea, while it was inversely related to air-room SpO2 on the first day of admission (P <0.0001, r = -0.341). Conclusion: CTSS is capable of anticipating mortality rate and the chance of undergoing supportive oxygen therapy during ICU hospitalization, while it does not predict ICU-LOS, rate of mechanical ventilation, or corticosteroid therapy.
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