The prognostic value of red cell distribution width for in-hospital mortality in patients with methanol poisoning

Aim Red blood cell distribution width (RDW) is a numerical measure of variability in the size of circulating erythrocytes and is routinely reported as a component of a complete blood count panel. It has been shown that higher RDW is associated with increased mortality and morbidity in several types of intoxication. This study was designed to evaluate the prognostic value of RDW for in-hospital mortality and need of invasive mechanical ventilation in patients with methanol poisoning. Methods A retrospective chart review of patients with methanol poisoning was performed using data from Adana City Training and Research Hospital obtained between January 2019 and January 2020. Patients’ demographics, clinical features, the time elapsed between ingestion and presentation, the treatment applied, blood gas analysis, laboratory measures including RDW on admission, and clinical outcome were obtained. Results A total of 42 patients with methanol poisoning were included in the study with a mean age of 45 ± 11 years. The overall mortality was 21.4%. Values of RDW on admission were significantly higher in non-survivors than in survivors. The area under the receiver operating curve of RDW was 0.778 (95% CI: 0.567–0.988) for predicting in-hospital mortality and 0.762 (95% CI: 0.592–0.932) for predicting mechanical ventilator requirement. Conclusion This study suggests that increased RDW on the first admission is associated with mortality and with mechanical ventilator requirement in patients with methanol poisoning.

Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes

IntroductionTo evaluate whether outpatient insulin treatment, hemoglobin A1c (HbA1c), glucose on admission, or glycemic control during hospitalization is associated with SARS-CoV-2 (COVID-19) illness severity or mortality in hospitalized patients with diabetes mellitus (DM) in a geographical region with low COVID-19 prevalence.Research design and methodsA single-center retrospective study of patients hospitalized with COVID-19 from January 1 through August 31, 2020 to evaluate whether outpatient insulin use, HbA1c, glucose on admission, or average glucose during admission was associated with intensive care unit (ICU) admission, mechanical ventilation (ventilator) requirement, or mortality.ResultsAmong 111 patients with DM, 48 (43.2%) were on outpatient insulin and the average HbA1c was 8.1% (65 mmol/mol). The average glucose on admission was 187.0±102.94 mg/dL and the average glucose during hospitalization was 173.4±39.8 mg/dL. Use of outpatient insulin, level of HbA1c, glucose on admission, or average glucose during hospitalization was not associated with ICU admission, ventilator requirement, or mortality among patients with COVID-19 and DM.ConclusionsOur findings in a region with relatively low COVID-19 prevalence suggest that neither outpatient glycemic control, glucose on admission, or inpatient glycemic control is predictive of illness severity or mortality in patients with DM hospitalized with COVID-19.

Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran

Background There are limited number of studies with controversial findings regarding the association between anemia at admission and coronavirus disease 2019 (COVID-19) outcomes. Therefore, in this research, we aimed to investigate the prospective association between anemia and COVID-19 outcomes in hospitalized patients in Iran. Methods In this prospective study, the data of 1274 consecutive patients hospitalized due to COVID-19 were statistically analyzed. All biomarkers, including hemoglobin and high-sensitivity C-reactive protein (hs-CRP) levels were measured using standard methods. Anemia was defined as a hemoglobin (Hb) concentration of less than 13 g/dL and 12 g/dL in males and females, respectively. Assessing the association between anemia and COVID-19 survival in hospitalized patients was our primary endpoint. Results The mean age of the participants was 64.43 ± 17.16 years, out of whom 615 (48.27%) were anemic subjects. Patients with anemia were significantly older (P = 0.02) and had a higher frequency of cardiovascular diseases, hypertension, kidney disease, diabetes, and cancer (P < 0.05). The frequency of death (anemic: 23.9% vs. nonanemic: 13.8%), ICU admission (anemic: 27.8% vs. nonanemic:14.71%), and ventilator requirement (anemic: 35.93% vs. nonanemic: 20.63%) were significantly higher in anemic patients than in nonanemic patients (P < 0.001). According to the results of regression analysis, after adjusting for significant covariate in the univariable model, anemia was independently associated with mortality (OR: 1.68, 95% CI: 1.10, 2.57, P = 0.01), ventilator requirement (OR: 1.74, 95% CI: 1.19, 2.54, P = 0.004), and the risk of ICU admission (OR: 2.06, 95% CI: 1.46, 2.90, P < 0.001). Conclusion The prevalence of anemia in hospitalized patients with COVID-19 was high and was associated with poor outcomes of COVID-19.

Autosomal Dominant Polycystic Kidney Disease does not significantly alter major COVID-19 outcomes among veterans

Chronic kidney disease (CKD), as well as its common causes (e.g., diabetes and obesity), are recognized risk factors for severe COVID-19 illness. To explore whether the most common inherited cause of CKD, autosomal dominant polycystic kidney disease (ADPKD), is also an independent risk factor, we studied data from the VA health system and the VA COVID-19-shared resources (e.g., ICD codes, demographics, pre-existing conditions, pre-testing symptoms, and post-testing outcomes). Among 61 COVID-19-positive ADPKD patients, 21 (34.4%) were hospitalized, 10 (16.4%) were admitted to ICU, 4 (6.6%) required ventilator, and 4 (6.6%) died by August 18, 2020. These rates were comparable to patients with other cystic kidney diseases and cystic liver-only diseases. ADPKD was not a significant risk factor for any of the four outcomes in multivariable logistic regression analyses when compared with other cystic kidney diseases and cystic liver-only diseases. In contrast, diabetes was a significant risk factor for hospitalization [OR 2.30 (1.61, 3.30), p<0.001], ICU admission [OR 2.23 (1.47, 3.42), p<0.001], and ventilator requirement [OR 2.20 (1.27, 3.88), p=0.005]. Black race significantly increased the risk for ventilator requirement [OR 2.00 (1.18, 3.44), p=0.011] and mortality [OR 1.60 (1.02, 2.51), p=0.040]. We also examined the outcome of starting dialysis after COVID-19 confirmation. The main risk factor for starting dialysis was CKD [OR 6.37 (2.43, 16.7)] and Black race [OR 3.47 (1.48, 8.1)]. After controlling for CKD, ADPKD did not significantly increase the risk for newly starting dialysis comparing with other cystic kidney diseases and cystic liver-only diseases. In summary, ADPKD did not significantly alter major COVID-19 outcomes among veterans when compared to other cystic kidney and liver patients.

Analysis of COVID-19 cases and associated ventilator requirement in Indian States

Analysis of COVID-19 cases and prediction of quantity of associated ventilator requirement is very relevant during this pandemic. This paper presents a method for predictive estimation of ventilator requirement for COVID-19 patients in Indian states. It uses ARIMA (Autoregressive Integrated Moving Average) model for predicting the future cumulative cases and daily fatality. Taking cue from this, ventilator requirement is estimated for each state. State wise estimation of ventilator is important because public healthcare system in India is managed at state level. Dataset on Novel Corona Disease 2019 in India from Kaggle website is used in this work.

Outcome of Early vs. Delayed Invasive Intervention in Acute Coronary Syndrome Patients Attending a Selected Specialized Hospital: A Comparative Study

Background: This study was to compare the outcome of early versus delayed invasive intervention in acute coronary syndrome (ACS) patients. Methods: A total of 200 patients with ACS underwent early intervention group (d”24 h, n=100) and delayed intervention group (>24 to 72 h, n=100) after percutaneous coronary intervention (PCI) were enrolled. The probable outcomes were a composite of re-infarction, acute LVF, recurrent ischemia, repeat revascularization, bleeding, stroke or death at 30 days. Results: Male were predominating (74%vs26%). Left anterior descending artery was the commonest infarct related artery in both groups (p=0.114). Cardiac markers, Cardiogenic shock, Acute left ventricular failure (LVF) and ventilator requirement were significantly higher (p=0.007, p=0.060, p=0.009, p=0.002) and mean duration of hospital stay was longer (p <0.001) in delayed intervention group. At 30 days follow-up improvement of chest pain, LVF and ejection fraction were achieved significantly in patient undergoing early intervention (p <0.001, p=0.016, 54.7±7.4 vs. 48.4±6.9; p <0.001). Adverse outcome like acute LVF (7% vs. 21%; p=0.004), re-infarction (0% vs. 7%; p=0.007), acute kidney injury (AKI) (5% vs. 17%; p=0.007), bleeding (11% vs. 18%; p=0.160), stroke (3% vs. 9%; p=0.074), repeat revascularization (1% vs. 7%; p=0.032), death (0% vs. 5%; p=0.030) was higher in delayed invasive intervention group (p=0.001). Conclusion: Acute LVF, ventilator requirement and duration of hospital stay were significantly predominating in delayed intervention group. Early invasive strategy in ACS patient associated with lower rates of acute LVF, acute kidney injury, re-infarction, stroke, bleeding, repeat revascularization and death compared with delayed invasive strategy at 30 days of follow-up. Cardiovasc. j. 2019; 11(2): 129-138

Evaluation of Clinical and Radiological Factors Determining the Need of Post-operative Ventilator Requirement in Patients of Esophageal Atresia

Objective: Ventilator requirement is an important constituent of post-operative care of patients of esophageal atresia (EA). In contrast to the developed world, the situation is very different in developing countries where the resources are limited, and ventilator may not be available to all patients of EA. This study was conducted to assess whether there are certain criteria, which may predict the possibility of non- requirement of ventilator for patients of EA in the post-operative period. Design: This study was a retrospective observational study. Setting: This study was conducted at a tertiary care teaching hospital. Duration: This study was conducted from 5 years and 6 months. Materials and Methods: We used certain parameters to assess the requirement of ventilators for the patients in the post-operative period. These included the presentation of patients before or after 3 days of life and birth weight (BW) of more or <2.5 kg. Presence of respiratory distress (RD) was analyzed. The presence of consolidation on X-ray was also evaluated. Results: The total number of patients was 175. In univariate analysis, the need of ventilator was significantly higher in patients presenting after 3 days of life, weight <2.5 kg, presence of RD, and pneumatic patch. In multivariate analysis, the age of presentation, weight, RD, and consolidation were found to independent factor for the ventilator requirement. Conclusion: On the basis of clinical and radiological features, namely, age, sex, BW, RD, and consolidation, we may prioritize these patients of EA, who may not be requiring the ventilator in the post-operative period. Further prospective studies on the basis of these factors may substantiate our efforts.

Carotid Endarterectomy in Patients With Thrombocytopenia: Analysis of the National Surgical Quality Improvement Program Registry

BACKGROUND: Carotid endarterectomy (CEA) is infrequently performed in patients with mild to moderate thrombocytopenia.OBJECTIVE: To determine whether preoperative thrombocytopenia is associated with a higher rate of complications after CEA.METHODS: We analyzed patient characteristics, comorbid conditions, operative details, and 30-day postoperative outcomes for patients who underwent CEA in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program Registry. Thrombocytopenia was defined based on the preprocedure platelet count of ≤150 000 platelets/μL. The odds ratios (ORs) for selected outcomes were calculated using logistic regression with stepwise forward selection with age, sex, symptomatic status, and high-risk individuals as potential confounders.RESULTS: Thrombocytopenia was present in 896 of 8658 patients (10.3%) who underwent CEA: mild (100 000-149 000 platelets/μL) and moderate (50 000-99 000 platelets/μL) in 805 patients (89.8%) and 91 patients (10.2%), respectively. The adjusted rates of myocardial infarction/arrhythmia (3.7% vs 1.8%; OR: 1.9; 95% confidence interval [CI]: 1.3-2.8; P = .001), unplanned intubations (2.6% vs 1.2%; OR: 2.2; 95% CI: 1.4-3.5; P = .001), ventilator requirement &gt;48 hours (1.5% vs 0.7%; OR: 2.1; 95% CI: 1.1-3.8; P = .02), deep venous thrombosis/thrombophlebitis (0.7% vs 0.2%; OR: 3.7; 95% CI: 1.4-9.7; P = .01), and surgical deep incisional infections (0.3% vs 0.1%; OR: 4.3; 95% CI: 1.1-17.4; P = .04) post-CEA were higher among patients with thrombocytopenia compared with those without thrombocytopenia. Thrombocytopenia did not significantly contribute to 1-month mortality or stroke.CONCLUSION: The higher rate of postprocedure complications in patients with preoperative thrombocytopenia needs to be recognized for adequate risk stratification before CEA.