TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19最新文献

{"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}

{"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}

{"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}

{"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}