Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3855
S. Nguyen, M. Gupta, G. Manek, D. Datta
Rationale: Novel coronavirus-19 (COVID-19) has been observed to cause multi-organ failure and death. Lactic acid has been shown to predict worse outcomes in patients with multi-organ failure in various disease processes. During episodes of acute hypoxia there is increased conversion of pyruvate to lactic acid. In COVID-19 patients, the dysregulated inflammatory response, also known as the cytokine storm, has been known to cause acute respiratory distress syndrome (ARDS) causing refractory hypoxemia and worsening lactic acidosis. Various inflammatory markers have been studied to predict outcomes in COVID-19 patients. The objective of this study was to identify whether lactic acid at admission correlated with mortality in patients with acute respiratory failure due to COVID-19. Methods: Seventy-one patients admitted to our hospital with acute respiratory failure due to COVID-19 were studied. Medical records were reviewed to obtain demographics including age, gender, body mass index (BMI), outcome (survivor or non-survivor) and admission lactic acid levels. Pearson's correlation analysis was performed to evaluate the correlation between admission lactic acid levels and mortality. Independent t-test was performed to determine the impact of this parameter on mortality. p < 0.05 was deemed statistically significant. Results: Of the seventy-one (71) patients, admission lactic acid levels were obtained in sixty-four (64) patients. Mean age was 47.7 + 16.7 years, 73% were male, and mean BMI was 32.27 + 2.73 kg/m2. Twelve patients (18.75%) did not survive. The mean admission lactic acid for non-survivors was 2.05 + 1.032 mmol/L and for survivors was 1.16 + 0.85 mmol/L (p = 0.002, independent t-test) [Figure 1]. Pearson's correlation analysis showed a significant correlation between admission lactic acid levels and mortality (r = -0.372, p = 0.002). Conclusions: A lactic acid at admission has a significant correlation with mortality in COVID-19 patients with acute respiratory failure. Further studies are required to assess this correlation and of rise in lactic acid to risk of mortality in patients. In addition, more studies are also needed to determine if there is a specific value of lactic acid that would predict mortality in patients.
{"title":"Admission Serum Lactate as a Predictor of Mortality in COVID-19 Pneumonia with Acute Respiratory Failure","authors":"S. Nguyen, M. Gupta, G. Manek, D. Datta","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3855","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3855","url":null,"abstract":"Rationale: Novel coronavirus-19 (COVID-19) has been observed to cause multi-organ failure and death. Lactic acid has been shown to predict worse outcomes in patients with multi-organ failure in various disease processes. During episodes of acute hypoxia there is increased conversion of pyruvate to lactic acid. In COVID-19 patients, the dysregulated inflammatory response, also known as the cytokine storm, has been known to cause acute respiratory distress syndrome (ARDS) causing refractory hypoxemia and worsening lactic acidosis. Various inflammatory markers have been studied to predict outcomes in COVID-19 patients. The objective of this study was to identify whether lactic acid at admission correlated with mortality in patients with acute respiratory failure due to COVID-19. Methods: Seventy-one patients admitted to our hospital with acute respiratory failure due to COVID-19 were studied. Medical records were reviewed to obtain demographics including age, gender, body mass index (BMI), outcome (survivor or non-survivor) and admission lactic acid levels. Pearson's correlation analysis was performed to evaluate the correlation between admission lactic acid levels and mortality. Independent t-test was performed to determine the impact of this parameter on mortality. p < 0.05 was deemed statistically significant. Results: Of the seventy-one (71) patients, admission lactic acid levels were obtained in sixty-four (64) patients. Mean age was 47.7 + 16.7 years, 73% were male, and mean BMI was 32.27 + 2.73 kg/m2. Twelve patients (18.75%) did not survive. The mean admission lactic acid for non-survivors was 2.05 + 1.032 mmol/L and for survivors was 1.16 + 0.85 mmol/L (p = 0.002, independent t-test) [Figure 1]. Pearson's correlation analysis showed a significant correlation between admission lactic acid levels and mortality (r = -0.372, p = 0.002). Conclusions: A lactic acid at admission has a significant correlation with mortality in COVID-19 patients with acute respiratory failure. Further studies are required to assess this correlation and of rise in lactic acid to risk of mortality in patients. In addition, more studies are also needed to determine if there is a specific value of lactic acid that would predict mortality in patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91462216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3819
S. Thakur, A. Pajak, P. Gandhi, B. Berg, J. Liou, T. Al-Mohamad, I. Slabý, H. Arsenault, A. Deitchman, D. Valentino
Rationale: Obese patients represent a vulnerable population at risk of developing severe COVID-19 infections. Patients with COVID-19 pneumonia are at increased risk for developing acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Prone positioning has long been studied as a measure to improve hypoxemia in ARDS. We hypothesize that the critically ill obese patient may represent a unique subset of the population when considering their innate respiratory mechanic variations and distinctive physiology who may benefit most from prone positioning as an adjunctive measure to improve oxygenation in COVID-19 pneumonia. Methods: We conducted a retrospective, dual-hospital, single institution cohort analysis of confirmed diagnosed COVID-19 infection patients admitted to our 1227-bed tertiary care center. The data pool was subdivided into obese and non-obese adult patients, defined by body mass index ≥ 30 kg/m2. Proning was defined by at least 4 hours a day spent fully pronated. The primary outcome was in-hospital mortality. Secondary outcomes included the requirement of mechanical ventilation (MV) and ICU length of stay (LOS). Results: Between February and August 2020, 55% (144/259) of the total study population patients admitted to our ICU for AHRF secondary to COVID-19 pneumonia were obese. Of these obese patients, 25% (36/144) were proned and 75% (108/144) were not proned. In-hospital mortality was 11.11% in the proned/obese patients compared to 30.55% in the non-proned/obese patients (p=0.0207). In comparison, 26% (30/115) of the non-obese patients were proned and 74% (85/115) were not proned. In-hospital mortality was 36.66% in the proned/nonobese patients compared to 34.11% in the non-proned/non-obese patients (p=0.8010). A total of 43.05% (62/144) of obese versus 43.47% (50/115) of the non-obese patients required mechanical ventilation (MV) at some point in their ICU stay. In the obese population, 41.66% of proned/obese patients compared to 43.51% of the non-proned/obese patients required MV (p=0.8459). While in the non-obese population 46.66% of proned/non-obese patients compared to 42.35% of the non-proned/non-obese patients required MV (p=0.6819). The average ICU LOS was 8.17 days in non-proned compared to 6.77 days in proned obese patients. Conclusion: In regards to obese patients, there was a clinically significant improvement in mortality between patients that were proned versus non-proned patients. There was no clinically significant difference in the effect of proning on non-obese patients in terms of mortality. There was also no clinically significant difference in the effects of proning in obese and non-obese patients in regards to the requirement of mechanical ventilation.
{"title":"Clinical Outcomes in Proning Critically Ill Obese Patients Infected with COVID-19 Pneumonia - The PROSECOVA Trial","authors":"S. Thakur, A. Pajak, P. Gandhi, B. Berg, J. Liou, T. Al-Mohamad, I. Slabý, H. Arsenault, A. Deitchman, D. Valentino","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3819","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3819","url":null,"abstract":"Rationale: Obese patients represent a vulnerable population at risk of developing severe COVID-19 infections. Patients with COVID-19 pneumonia are at increased risk for developing acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Prone positioning has long been studied as a measure to improve hypoxemia in ARDS. We hypothesize that the critically ill obese patient may represent a unique subset of the population when considering their innate respiratory mechanic variations and distinctive physiology who may benefit most from prone positioning as an adjunctive measure to improve oxygenation in COVID-19 pneumonia. Methods: We conducted a retrospective, dual-hospital, single institution cohort analysis of confirmed diagnosed COVID-19 infection patients admitted to our 1227-bed tertiary care center. The data pool was subdivided into obese and non-obese adult patients, defined by body mass index ≥ 30 kg/m2. Proning was defined by at least 4 hours a day spent fully pronated. The primary outcome was in-hospital mortality. Secondary outcomes included the requirement of mechanical ventilation (MV) and ICU length of stay (LOS). Results: Between February and August 2020, 55% (144/259) of the total study population patients admitted to our ICU for AHRF secondary to COVID-19 pneumonia were obese. Of these obese patients, 25% (36/144) were proned and 75% (108/144) were not proned. In-hospital mortality was 11.11% in the proned/obese patients compared to 30.55% in the non-proned/obese patients (p=0.0207). In comparison, 26% (30/115) of the non-obese patients were proned and 74% (85/115) were not proned. In-hospital mortality was 36.66% in the proned/nonobese patients compared to 34.11% in the non-proned/non-obese patients (p=0.8010). A total of 43.05% (62/144) of obese versus 43.47% (50/115) of the non-obese patients required mechanical ventilation (MV) at some point in their ICU stay. In the obese population, 41.66% of proned/obese patients compared to 43.51% of the non-proned/obese patients required MV (p=0.8459). While in the non-obese population 46.66% of proned/non-obese patients compared to 42.35% of the non-proned/non-obese patients required MV (p=0.6819). The average ICU LOS was 8.17 days in non-proned compared to 6.77 days in proned obese patients. Conclusion: In regards to obese patients, there was a clinically significant improvement in mortality between patients that were proned versus non-proned patients. There was no clinically significant difference in the effect of proning on non-obese patients in terms of mortality. There was also no clinically significant difference in the effects of proning in obese and non-obese patients in regards to the requirement of mechanical ventilation.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72703871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3839
M.A. Garcia, S. Johnson, E. Sisson, C. Sheldrick, V.K. Kumar, K. Boman, S. Bolesta, V. Bansal, M. Bogojobic, J. Domecq, A. Lal, O. Gajic, R. Kashyap, A. Walkey
RATIONALE: In the absence of effective therapies at the start of the Coronavirus disease of 2019 (COVID-19) pandemic, anti-viral and antiinflammatory medications were used for management of COVID-19 without robust evidence of their benefit. The patterns of use, implementation, and de-implementation of these medications is unclear. METHODS: We performed a retrospective, observational study on an international cohort of adult patients hospitalized from March 2020 to November 2020 with laboratory confirmed COVID-19 infection, receiving supplemental oxygen, and enrolled in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry. The primary outcome of interest was to describe the hospital-level variation in the most commonly used medications repurposed for empiric management of patients hospitalized with COVID-19 (hydroxychloroquine, remdesivir, corticosteroids, and anti-IL-6 therapies). Secondary outcomes included geographic and temporal variation in medication use. RESULTS: Among 6,621 patients with COVID-19 across 86 hospitals (predominantly USbased [88%]), 1,373 (20.7%, hospital usage rates range 0%-96.4%) received corticosteroids, 1,302 (19.7%, range 0%-100%) received hydroxychloroquine, 602 (9.1%, range: 0%-65.7%) received remdesivir, and 405 (6.1%, range 0%-87.5%) received an anti-IL6 medication. USbased hospitals vs non-US hospitals showed differences in medication use with 9.9% vs. 0.8% use of remdesivir, 19.5% vs 33.2% use of corticosteroids, 18.7% vs 29.6% use of hydroxychloroquine and 6.3% vs. 3.9% use of anti-IL6 medications. Comparing use prior to July 2020 with use after July 2020, prescription of remdesivir increased from 6.5% to 20.5%, corticosteroid use increased from 17.5% to 35.0%, hydroxychloroquine use decreased from 23.9% to 1.1% and anti-IL6 use decreased from 7.0% to 2.4%. CONCLUSIONS: Hospital-level variation and geographic variation in use of repurposed anti-viral and anti-inflammatory medications for the management of COVID-19 infection was large. Coinciding with accrual of scientific evidence, the use of remdesivir and corticosteroids increased over time, while the use of hydroxychloroquine and anti-IL6 medications decreased over time. Further studies are needed to evaluate the drivers of hospital variation and impact on clinical outcomes.
理由:在2019年冠状病毒病(COVID-19)大流行开始时缺乏有效的治疗方法，在没有强有力证据证明其益处的情况下，使用了抗病毒和抗炎药物来治疗COVID-19。这些药物的使用、实施和取消实施的模式尚不清楚。方法:我们对2020年3月至2020年11月住院的实验室确诊COVID-19感染的成人患者进行了一项回顾性观察性研究，接受了补充氧气，并登记在重症监护医学发现学会病毒感染和呼吸系统疾病通用研究(病毒)登记处。本研究的主要结局是描述医院水平上对COVID-19住院患者的经验管理中最常用药物(羟氯喹、瑞德西韦、皮质类固醇和抗il -6治疗)的变化。次要结局包括药物使用的地理和时间差异。结果:86家医院(主要是美国的[88%])的6621例COVID-19患者中，1,373例(20.7%，医院使用率范围为0%-96.4%)使用皮质类固醇，1,302例(19.7%，范围为0%-100%)使用羟氯喹，602例(9.1%，范围为0%-65.7%)使用瑞德西韦，405例(6.1%，范围为0%-87.5%)使用抗il -6药物。美国医院与非美国医院在药物使用方面存在差异，瑞德西韦使用率为9.9% vs 0.8%，皮质类固醇使用率为19.5% vs 33.2%，羟氯喹使用率为18.7% vs 29.6%，抗il - 6药物使用率为6.3% vs 3.9%。与2020年7月前和2020年7月后的使用情况相比，瑞德西韦的处方从6.5%增加到20.5%，皮质类固醇的使用率从17.5%增加到35.0%，羟氯喹的使用率从23.9%下降到1.1%，抗il - 6的使用率从7.0%下降到2.4%。结论:在COVID-19感染管理中，重新使用抗病毒和抗炎药物的医院水平和地理差异很大。随着科学证据的积累，瑞德西韦和皮质类固醇的使用随着时间的推移而增加，而羟氯喹和抗il - 6药物的使用随着时间的推移而减少。需要进一步的研究来评估医院变化的驱动因素及其对临床结果的影响。
{"title":"Variation in Use of Anti-Viral and Anti-Inflammatory Medications in Patients Hospitalized with COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)","authors":"M.A. Garcia, S. Johnson, E. Sisson, C. Sheldrick, V.K. Kumar, K. Boman, S. Bolesta, V. Bansal, M. Bogojobic, J. Domecq, A. Lal, O. Gajic, R. Kashyap, A. Walkey","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3839","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3839","url":null,"abstract":"RATIONALE: In the absence of effective therapies at the start of the Coronavirus disease of 2019 (COVID-19) pandemic, anti-viral and antiinflammatory medications were used for management of COVID-19 without robust evidence of their benefit. The patterns of use, implementation, and de-implementation of these medications is unclear. METHODS: We performed a retrospective, observational study on an international cohort of adult patients hospitalized from March 2020 to November 2020 with laboratory confirmed COVID-19 infection, receiving supplemental oxygen, and enrolled in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry. The primary outcome of interest was to describe the hospital-level variation in the most commonly used medications repurposed for empiric management of patients hospitalized with COVID-19 (hydroxychloroquine, remdesivir, corticosteroids, and anti-IL-6 therapies). Secondary outcomes included geographic and temporal variation in medication use. RESULTS: Among 6,621 patients with COVID-19 across 86 hospitals (predominantly USbased [88%]), 1,373 (20.7%, hospital usage rates range 0%-96.4%) received corticosteroids, 1,302 (19.7%, range 0%-100%) received hydroxychloroquine, 602 (9.1%, range: 0%-65.7%) received remdesivir, and 405 (6.1%, range 0%-87.5%) received an anti-IL6 medication. USbased hospitals vs non-US hospitals showed differences in medication use with 9.9% vs. 0.8% use of remdesivir, 19.5% vs 33.2% use of corticosteroids, 18.7% vs 29.6% use of hydroxychloroquine and 6.3% vs. 3.9% use of anti-IL6 medications. Comparing use prior to July 2020 with use after July 2020, prescription of remdesivir increased from 6.5% to 20.5%, corticosteroid use increased from 17.5% to 35.0%, hydroxychloroquine use decreased from 23.9% to 1.1% and anti-IL6 use decreased from 7.0% to 2.4%. CONCLUSIONS: Hospital-level variation and geographic variation in use of repurposed anti-viral and anti-inflammatory medications for the management of COVID-19 infection was large. Coinciding with accrual of scientific evidence, the use of remdesivir and corticosteroids increased over time, while the use of hydroxychloroquine and anti-IL6 medications decreased over time. Further studies are needed to evaluate the drivers of hospital variation and impact on clinical outcomes.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83762170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3811
S. Bansal, H. Kalpakam, S. Bysani, A. Varsha, R. Mehta
{"title":"A Shorter Symptom Onset to Remdesivir Treatment (SORT) Interval Is Associated with a Lower Mortality in Moderate to Severe COVID-19: A Real-World Analysis","authors":"S. Bansal, H. Kalpakam, S. Bysani, A. Varsha, R. Mehta","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3811","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3811","url":null,"abstract":"","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82459633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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