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Background and Aims: Major head neck surgeries are often associated with major blood loss requiring blood transfusion. However, in spite of transfusion, patients usually suffer adverse postoperative outcomes. Biomarkers can help in identifying such events early. This observational study was conducted to compare blood lactate and bicarbonate levels as predictors of adverse postoperative outcomes. Materials and Methods: Forty-eight adult American Society of Anesthesiologists Physical Status I–III patients met the inclusion criteria. Intraoperative blood loss was managed with stored blood transfusion as per transfusion trigger. Blood lactate and bicarbonate levels were measured preoperatively (Tbas), at the immediate postoperative period (T0), and at 8 h (T8), 16 h (T16), and 24 h (T24) postoperatively. Outcomes such as need for intensive care unit (ICU) admission, length of ICU stay, intraoperative blood transfusion, re-exploration rate, and mortality were recorded. Results: Blood transfusions and ICU admissions were required in 19 (39.6%) and 24 (50%) patients, respectively. Lactate levels of patients requiring blood transfusion and admission to ICU rose significantly from their baseline (1.30 ± 0.41 mmol/l) to 2.80 ± 1.14 mmol/l at the immediate postoperative period, which fell to 2.06 ± 0.78 mmol/l at 24 h postoperatively, compared to other patients who did not require transfusion and ICU admission (P < 0.001). The bicarbonate value did not show any significant change from its baseline (22.68 ± 1.83 mEq/l) at all time points (P = 0.8). In addition, no significant difference was noted regarding ICU admissions (P = 0.659) or blood transfusions (P = 0.788). Conclusions: Following major head and neck surgeries, blood lactate level is a good predictor, but bicarbonate is a poor predictor of the need for blood transfusions and ICU admission. Intraoperative blood transfusion failed to prevent rise in blood lactate level, which is taken as a surrogate marker of tissue hypoxia. [ABSTRACT FROM AUTHOR]

The growing population of nonagenarians has led to increased intensive care unit (ICU) admissions among elderly patients. However, evidence on their outcomes and optimal management strategies remains limited and fragmented. This scoping review aimed to explore mortality outcomes, factors associated with mortality, and treatment intensity in nonagenarians, comparing them to younger patients. A systematic search of MEDLINE and Embase from 1946 to September 2024 identified studies reporting ICU, in-hospital, and long-term mortality in nonagenarians. Twenty-nine studies involving 21,420 nonagenarians and 244,323 younger patients were included. ICU mortality among nonagenarians ranged from 1.42% to 66.7%, with an overall rate of 17.05% (2,738/16,062). In-hospital mortality ranged from 5.6% to 47%, with an overall rate of 26.54% (5,563/20,962). Long-term (oneyear) mortality varied from 19% to 77%, with an overall rate of 53.45% (7,020/13,134). Key predictors of mortality included comorbidities, high severity scores (APACHE II, SAPS II), and less aggressive treatment. Despite these factors, nonagenarians had comparable mortality rates to younger patients when adjusted for illness severity. Nonagenarians in ICUs display variable but acceptable mortality rates, suggesting that age alone should not determine care intensity. Their heightened vulnerability after discharge calls for more effective and personalized post-ICU and post-hospital discharge care plans to better address their ongoing risks. [ABSTRACT FROM AUTHOR]

Objective: Placenta accreta spectrum (PAS) is a complex disorder of uterine wall disruption with significant morbidity and mortality, particularly at time of delivery. Both physician and physical hospital resource allocation/utilization remains a challenge in PAS cases including intensive care unit (ICU) beds. The primary objective of the present study was to identify preoperative risk factors for ICU admission and create an ICU admission prediction model for patient counseling and resource utilization decision making in an evidence‐based manner. Methods: This was a case–control study of 145 patients at our PAS referral center undergoing cesarean hysterectomy for PAS. Final confirmation by histopathology was required for inclusion. Patient disposition after surgery (ICU vs post‐anesthesia care unit) was our primary outcome and pre‐/intra‐/postoperative variables were obtained via electronic medical records with an emphasis on the predictive capabilities of the preoperative variables. Uni‐ and multivariate analysis was performed to identify independent predictive factors for ICU admission. Results: In this large cohort of 145 patients who underwent cesarean hysterectomy for PAS, with histopathologic confirmation, 63 (43%) were admitted to the ICU following delivery. These patients were more likely to be delivered at an earlier gestational age (34 vs 35 weeks, P < 0.001), have had >2 episodes of vaginal bleeding and emergent delivery compared to patients admitted to patients with routine recovery care (44% vs 18.3%, P = 0.009). Uni‐ and multivariate logistic regression showed an area under the curve of 0.73 (95% CI: [0.63, 0.81], P < 0.001) for prediction of ICU admission with these three variables. Patients with all three predictors had 100% ICU admission rate. Conclusion: Resource prediction, utilization and allocation remains a challenge in PAS management. By identifying patients with preoperative risk factors for ICU admission, not only can patients be counseled but this resource can be requested preoperatively for staffing and utilization purposes. Synopsis: Maternal ICU admission after cesarean hysterectomy for placenta accreta spectrum may be predicted by vaginal bleeding, gestational age and emergent delivery. [ABSTRACT FROM AUTHOR]

Background: To determine the optimal fluid resuscitation volume in septic patients with acutely decompensated heart failure (ADHF). Methods: Septic patients with ADHF were identified from a tertiary urban medical center. The generalized additive models were used to explore the association between fluid resuscitation volume and endpoints, and the initial 3 h fluid resuscitation volume was divided into four groups according to this model: < 10 mL/kg group, ≥ 10 to ≤ 15 mL/kg group, > 15 to ≤ 20 mL/kg group, and > 20 mL/kg group. Logistic and Cox regression models were employed to explore the association between resuscitation volume and primary endpoint, in-hospital mortality, as well as secondary endpoints including 30-day mortality, 1-year mortality, invasive ventilation, and ICU admission. Results: A total of 598 septic patients with a well-documented history of HF were enrolled in the study; 405 patients (68.8%) had sepsis-induced hypoperfusion. Patients with NYHA functional class III and IV were 494 (83.9%) and 22 (3.74%), respectively. Resuscitation volumes above 20 mL/kg (OR 3.19, 95% CI 1.31–8.15) or below 10 mL/kg (OR 2.33, 95% CI 1.14–5.20) significantly increased the risk of in-hospital mortality in septic patients, while resuscitation volumes between 15 and 20 mL/kg were not associated with the risk of in-hospital death in septic patients (OR 1.79, 95% CI 0.68–4.81). In the multivariable Cox models, the effect of resuscitation volume on 30-day and 1-year mortality in septic patients was similar to the effect on in-hospital mortality. Resuscitation volume exceeds 15 mL/kg significantly increased the risk of tracheal intubation, while fluid resuscitation volume was not associated with ICU admission in the septic patients. In septic patients with hypoperfusion, these fluid resuscitation volumes have similar effects on patient outcomes. This association was consistent across the three subgroups with worsened cardiac function, as well as in sensitivity analyses. Conclusions: Our study observed that an initial fluid resuscitation volume of 10–15 mL/kg in the first 3 h was optimal for early resuscitation in septic patients with ADHF, particularly those with worsened cardiac function. These results need to be confirmed in randomized controlled trials with larger sample sizes. [ABSTRACT FROM AUTHOR]

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Objective: Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID-19 infection. Methods: We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders. Results: This analysis included 94,114 COVID-19 hospitalizations, of which 9391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% vs. 9.6%, p <.001), prolonged length of stay (40.0% vs. 27.1%, p <.001), vasopressor use (4.4% vs. 1.9%, p <.001), mechanical ventilation (19.0% vs. 9.1%, p <.001), and ICU admission (18.4% vs. 8.8%, p <.001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality adjusted odds ratio [OR], 2.04, 95% CI: 1.92–2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31–1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86–2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72–2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88–2.15). Conclusion: COVID-19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF. PLAIN LANGUAGE SUMMARY: Atrial fibrillation (AF) is a common heart rhythm disorder, especially in patients with high cardiovascular risk. This study aimed to investigate the hospital outcomes for patients admitted with both AF and COVID-19. We used data from the California State Inpatient Database for the year 2020, focusing on COVID-19 hospitalizations of adults aged 18 and older. The main outcomes studied were in-hospital death, extended hospital stays, use of vasopressor medications that raise blood pressure, need for mechanical ventilation, and admission to the intensive care unit (ICU). Our results showed that patients with both COVID-19 and AF had significantly worse outcomes compared to those without AF. Specifically, these patients had higher rates of death, extended hospital stays, vasopressor medication use, mechanical ventilation, and ICU admission, even after accounting for other health conditions. The study concludes that hospitalized COVID-19 patients with underlying AF are at a greater risk for severe complications and death. This highlights the need for increased attention and care for COVID-19 patients with AF to improve their hospital outcomes. [ABSTRACT FROM AUTHOR]

Aim: To develop and internally validate risk prediction models for subsequent clinical deterioration, unplanned ICU admission and death among ward patients following medical emergency team (MET) review. Design: A retrospective cohort study of 1500 patients who remained on a general ward following MET review at an Australian quaternary hospital. Method: Logistic regression was used to model (1) subsequent MET review within 48 h, (2) unplanned ICU admission within 48 h and (3) hospital mortality. Models included demographic, clinical and illness severity variables. Model performance was evaluated using discrimination and calibration with optimism‐corrected bootstrapped estimates. Findings are reported using the TRIPOD guideline for multivariable prediction models for prognosis or diagnosis. There was no patient or public involvement in the development and conduct of this study. Results: Within 48 h of index MET review, 8.3% (n = 125) of patients had a subsequent MET review, 7.2% (n = 108) had an unplanned ICU admission and in‐hospital mortality was 16% (n = 240). From clinically preselected predictors, models retained age, sex, comorbidity, resuscitation limitation, acuity‐dependency profile, MET activation triggers and whether the patient was within 24 h of hospital admission, ICU discharge or surgery. Models for subsequent MET review, unplanned ICU admission, and death had adequate accuracy in development and bootstrapped validation samples. Conclusion: Patients requiring MET review demonstrate complex clinical characteristics and the majority remain on the ward after review for deterioration. A risk score could be used to identify patients at risk of poor outcomes after MET review and support general ward clinical decision‐making. Relevance to clinical practice: Our risk calculator estimates risk for patient outcomes following MET review using clinical data available at the bedside. Future validation and implementation could support evidence‐informed team communication and patient placement decisions. [ABSTRACT FROM AUTHOR]

Background Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients. Methods A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Results Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC = 0.983) and mortality (AUC = 0.999). Conclusion The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning. [ABSTRACT FROM AUTHOR]

Background: An effective referral system is key to access timely emergency obstetric care in order to prevent maternal and perinatal mortality. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study was conducted with an objective to document the patterns, primary reasons of obstetric case referral and the maternal and perinatal outcome of the referred cases in Government Medical College, Mahasamund in rural Chhattisgarh. As a systematic monitoring of referrals majorly helps to identify current gaps and timeliness of referral in providing essential obstetric care. Methods: The study is based on the health records and details on referral forms from referral center and peripheral health facilities. This follow-up study was conducted in between July 2022 and June 2023 (12 months). All referred patients for obstetrics indications above 20 weeks and patients with postpartum indications were included. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes. Results: According to our study, out of a total of 5,962 delivered patients, 1,281 (20.5%) cases were referred patients. Maximum cases, i.e., 567 (44.2%) were in the age-group of 24-29 years. The major reasons for referring patient were hypertensive disorders of pregnancy (11.2%), previous cesarean section (9.8%), and PPH (9.5%). There were six maternal deaths (0.5%) and discharge rate was 96.2%. Conclusion: The present study showed that illiteracy and ignorance of female regarding healthcare requirements and poor infrastructure came out to be a major contributor of poor pregnancy outcome. Timely referral is crucial for a satisfactory maternal and fetal outcome. To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, healthcare workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality. [ABSTRACT FROM AUTHOR]

IntroductionEarly prediction of multiple organ dysfunction syndrome (MODS) secondary to severe heat stroke (SHS) is crucial for improving patient outcomes. This study aims to develop and validate a risk prediction model for those patients based on immediate assessment indicators on ICU admission.MethodsTwo hundred eighty-four cases with SHS in our hospital between July 2009 and April 2024 were retrospectively reviewed, and categorized into non-MODS and MODS groups. Logistic regression analyses were performed to identify risk factors for MODS, and then to construct a risk prediction model, which was visualized by a nomogram. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow (HL) test, calibration curve, and decision curve analysis (DCA). Finally, the AUCs of the prediction model was compared with other scoring systems.ResultsAcute gastrointestinal injury (AGI), heart rate (HR) >100 bpm, a decreased Glasgow Coma Scale (GCS) score, and elevated total bilirubin (TBil) within the first 24 h of ICU admission are identified as independent risk factors for the development of MODS in SHS patients. The model demonstrated good discriminative ability, and the AUC was 0.910 (95% CI: 0.856–0.965). Applying the predictive model to the internal validation dataset demonstrated good discrimination with an AUC of 0.933 (95% CI: 0.880–0.985) and good fit and calibration. The DCA of this model showed a superior clinical net benefit.DiscussionThe risk prediction model based on AGI, HR, GCS, and TBil shows robust predictive performance and clinical utility, which could serve as a reference for assessing and screening the risk of MODS in SHS patients.

Background: The unique physiological changes during pregnancy present challenges in understanding the full scope and effects of COVID-19 on pregnant women, adding complexity to their medical management. Given the significant changes in the immune, circulatory, respiratory, and hormonal systems during the progression of the pregnancy, and the specific factors with higher risk of COVID-19, like metabolic, vascular, and endothelial factors, typically also associated with maternal and neonatal unfavorable outcomes, the full understanding of how COVID-19 affects pregnant women is not clarified yet. Methods: In this study, anonymous data from medical records of pregnant women with lab-confirmed COVID‐19 in Astana, Kazakhstan from May 1, 2021, to July 14, 2021, were collected retrospectively. A multivariate regression model was built to identify factors associated with the risk of ICU admission. Cluster analysis was performed to identify distinct groups among women admitted to the ICU based on their blood parameters, coagulation profiles, and oxygenation saturation levels. Results: 10.7 % of pregnant women were admitted to ICU. Among them, 4.36 % were in the 2nd trimester and 13.58 % in the 3rd trimester. No women in the 1st trimester were admitted to ICU. A multivariate regression model demonstrates that gestational diabetes, leukocytes, CRP, and saturation were the factors significantly associated with a higher risk of ICU admission. Three clusters of pregnant women were segmented, and preterm birth was frequent in clusters 1 (serious systemic conditions affecting multiple organs) and 3 (women with hypertension and preeclampsia), whereas cluster 2 represents women who can also be characterized as suffering from infections with a possible autoimmune component. Neutrophil to lymphocyte ratio was frequent in clusters 1 and 3. Conclusion: In this study, multivariable analysis identified factors with a risk of ICU admission, and clustering analysis helped to identify groups of COVID-19-infected pregnant women admitted to ICU with similar risk profiles. Differences in clusters can help to explain discrepancies in COVID-19 outcomes and suggest biochemical and molecular mechanisms involved in COVID-19 and outline a more personalized approach to understanding, diagnosing, and treating women.

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p

Background: The intensive care unit (ICU) is a scarce resource in all health care systems, necessitating a well-defined utilization. Therefore, benchmarks are essential; and yet, they are limited due to heterogenous definitions of what an ICU is. This study analyzed the case distribution, patient characteristics, and hospital course and outcomes of 6,204,093 patients in the German Helios Hospital Group according to 10 derived ICU definitions. We aimed to set a baseline for the development of a nationwide, uniform ICU definition. Methods: We analyzed ten different ICU definitions: seven derived from the German administrative data set of claims data according to the German Hospital Remuneration Act, three definitions were taken from the Helios Hospital Group's own bed classification. For each ICU definition, the size of the respective ICU population was analyzed. Due to similar patient characteristics for all ten definitions, we selected three indicator definitions to additionally test statistically against IQM. Results: We analyzed a total of 5,980,702 completed hospital cases, out of which 913,402 referred to an ICU criterion (14.7% of all cases). A key finding is the significant variability in ICU population size, depending on definitions. The most restrictive definition of only mechanical ventilation (DOV definition) resulted in 111,966 (1.9%) cases; mechanical ventilation plus typical intensive care procedure codes (IQM definition) resulted in 210,147 (3.5%) cases; defining each single bed individually as ICU or IMC (ICUᴧIMC definition) resulted in 411,681 (6.9%) cases; and defining any coded length of stay at ICU (LOSi definition) resulted in 721,293 (12.1%) cases. Further testing results for indicator definitions are reported. Conclusions: The size of the population, utilization rates, outcomes, and capacity assumptions clearly depend on the definition of ICU. Therefore, the underlying ICU definition should be stated when making any comparisons. From previous studies, we anticipated that 25–30% of all ICU patients should be mechanically ventilated, and therefore, we conclude that the ICUᴧIMC definition is the most plausible approximation. We suggest a mandatory application of a clearly defined ICU term for all hospitals nationwide for improved benchmarking and data analysis. [ABSTRACT FROM AUTHOR]

Background: The therapeutic effects of vitamin D supplementation on Coronavirus disease 2019 (COVID-19) aggravation remain controversial and inconclusive. To probe into this contentious issue, we performed the present meta-analysis of randomized controlled trials (RCTs). Methods: Literature published up to June 2023 was retrieved from Cochrane Library, PubMed, Web of Science and Embase. RCTs assessing mortality, intensive care unit (ICU) admission, mechanical ventilation (MV), length of hospitalization (LOH), and inflammatory markers containing C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), lactate dehydrogenase (LDH) were included. 19 RCTs were involved in the analysis and were conducted subgroup analyses on the baseline COVID-19 severity and vitamin D administration. Results: In the severity subgroup, statistically significant effects in moderate to severe group were observed in ICU admission (OR 0.43, 95% CI 0.23, 0.80; p = 0.008), MV (OR 0.44, 95% CI 0.27, 0.72; p = 0.001) and LOH (SMD –0.49, 95% CI –0.92, −0.06; p = 0.027). In the administration subgroup, effects of ICU admission (OR 0.39, 95% CI 0.16, 0.97; p = 0.044), MV (OR 0.18, 95% CI 0.07, 0.46; p = 0.000) and LOH (SMD –0.50, 95% CI –0.96, −0.04; p = 0.034) were more pronounced in patients supplied with multiple-dose vitamin D than single-dose. Although the result of mortality showed no statistically significant effect, it indicated a reduced trend (OR 0.87, 95% CI 0.63, 1.12; p > 0.05). The results of inflammatory markers reached no statistical differences. Conclusion: This meta-analysis revealed that moderate to severe COVID-19 patients supplied with multiple doses of vitamin D were less apt to need ICU admission, mechanical ventilation and have shorter hospital stays. [ABSTRACT FROM AUTHOR]

Background: The global pandemic, known as the coronavirus disease 2019 (COVID-19) and caused by the severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2), poses a significant threat, particularly to individuals with comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), diabetes, HIV, cardiovascular disease (CVD), and cancer. Methods: This descriptive retrospective study investigates the impact of comorbidities on COVID-19-positive patients. The study includes individuals that were tested positive for SARS-CoV-2 via polymerase chain reaction at the Security Forces Hospital, Makkah, KSA, between February, 2022, and June, 2022. A total of 208 patients (107 males, 101 females) were examined, and the laboratory results revealed normal parameters. Results: An analysis indicates that 86.5% of the patients were discharged, 2.9% remained hospitalized, and 10.6% succumbed to the disease, indicating a 10.6% mortality rate among comorbid COVID-19-positive patients. Notably, the study identifies specific comorbidities (chronic kidney disease, diabetes mellitus, hypertension) and changes in laboratory parameters (red blood cells, hemoglobin, C-reactive protein, white blood cells, ferritin, Ddimer, ALT, troponin, LDH, neutrophils) associated with ICU admission during hospitalization. Conclusions: This study underscores the critical impact of comorbidities, such as chronic kidney disease, diabetes, and hypertension, on the clinical outcomes of COVID-19-positive patients. The identification of specific laboratory parameters linked with ICU admission provides valuable insights for risk stratification and tailored management strategies. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to investigate the role of the pre- and postoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting intensive care unit (ICU) admission and postoperative length of stay (LOS) in bariatric surgery. Materials and Methods: We retrospectively analysed 96 patients who underwent bariatric surgery at our institution. The NLR and PLR were calculated in the pre- and postoperative stages. Changes in pre- and postoperative hematological ratios were compared using the Wilcoxon signed-rank test. The optimal cutoff values and area under the curve (AUC) for each ratio were calculated using receiver operating characteristic (ROC) analysis. Multivariate linear regression analysis was used to assess the relationship between each ratio and the postoperative LOS after adjusting for age, sex, and American Society of Anesthesiologists (ASA) score. Results: The median age of our patients was 35.50 years, and 54.2% were male. The preoperative NLR showed a significant increase from 1.44 to 6.38 postoperatively (p < 0.001). The PLR increased from 107.08 preoperatively to 183.58 postoperatively, p < 0.001). ROC analysis showed that the postoperative NLR was a moderate to high predictor of ICU admission (AUC = 0.700, optimal cutoff point = 5.987). The postoperative PLR had less predictive power for ICU admission (AUC = 0.641, optimal cutoff point = 170.950). Ratios that had a statistically significant relationship with the postoperative LOS were the preoperative NLR (standardized β [95% CI]: 0.296 [0.115–0.598]), postoperative NLR (0.311 [0.034–0.161]), and postoperative PLR (0.236 [0.000–0.005]). Conclusions: The NLR and PLR demonstrated an independent relationship with the postoperative LOS after bariatric surgery and the predictive ability of ICU admission. Both ratios might be useful as simple markers to predict patient outcome after surgery. [ABSTRACT FROM AUTHOR]

Background: As the global battle against the COVID-19 pandemic endures, the spread of the Delta variant has introduced nuanced challenges, prompting a nuanced examination. Materials and Methods: We performed a multilevel logistic regression analysis encompassing 197 patients, comprising 44 vaccinated individuals (V group) and 153 unvaccinated counterparts (UV). These patients, afflicted with the Delta variant of SARS-CoV-2, were hospitalized between October 2021 and February 2022 at the COVID-19 department of a University Centre in Cluj-Napoca, Romania. We compared patient characteristics, CT lung involvement, Padua score, oxygen saturation (O2 saturation), ventilation requirements, dynamics of arterial blood gas (ABG) parameters, ICU admission rates, and mortality rates between the two groups. Results: The UV group exhibited a statistically significant (p < 0.05) proclivity toward developing a more severe form of infection, marked by elevated rates of lung involvement, oxygen requirement, ICU admission, and mortality. Conclusion: Our findings underscore the substantial efficacy of the vaccine in diminishing the incidence of severe disease, lowering the rates of ICU admissions, and mitigating mortality among hospitalized patients. [ABSTRACT FROM AUTHOR]

It has been suggested that dipeptidyl peptidase 4 (DPP4) overexpression is associated with COVID-19 severity. We aimed to evaluate the clinical outcomes in people with COVID-19 infections and type 2 diabetes (T2DM) treated with DPP4 inhibitors in order to explore the impact of treatment with DPP4 inhibitors on adverse in-hospital outcomes. This retrospective multi-center study included 400 hospitalized people with T2DM and confirmed COVID-19 infection. The composite outcomes, including ICU admission, invasive ventilation and in-hospital mortality, were compared between patients who received DPP4 inhibitors before admission and those treated by other glucose-lowering drugs (GLDs), applying regression models. A total of 54 (13.5%) patients were treated with DPP4 inhibitors. Considering the potential confounders, the odds of the composite outcome of intensive care unit (ICU) admission, invasive ventilation, and death were significantly lower in patients treated with DPP4 inhibitors compared to their counterpart group (OR: 2.52, (1.05-6.01), P=0.04). Previous treatment with DPP4 inhibitors lowers the risk of adverse in-hospital outcomes in people with T2DM and COVID-19 infection. [ABSTRACT FROM AUTHOR]

Introduction: To elucidate factors associated with severe disease in patients with coronavirus disease 2019 (COVID-19) pneumonia complicated with diabetes mellitus. Methods: Among patients with COVID-19 pneumonia hospitalized from January to September 2021, 100 patients with diabetes were included in the study. Patients in the intensive care unit admission or in-hospital death category were defined as the severe group (26 patients), and the other patients as the moderate group (74 patients). Comparisons were made between the two groups. Medical histories were extracted from the medical records, and statistical analysis was performed. Results: Patients were 62.1 ± 13.0 years of age, 70 % male, 48 % aged 65 years and more, and HbA1c was 7.72 ± 1.51 %. The severe group had significantly higher blood glucose level, CRP, WBC, and LDH on admission. Serum albumin level was significantly lower in the severe group and was significantly negatively correlated with number of days on oxygen administration (r = 0.447) and maximal oxygen concentration (r = 0.561). Multiple logistic regression analysis with severity of illness as the objective variable showed that high CRP and low albumin levels on admission, and older age were independently associated. Conclusions: Low albumin levels on admission may be an indicator of severe disease in patients with diabetes.

Xiao-Yu Xu,1,&ast; Yang Gao,2,&ast; Chuang-Shi Yue,3,&ast; Yu-Jia Tang,4,&ast; Zhao-Jin Zhang,5 Feng-Jie Xie,6 Hong Zhang,6 Yu-Cheng Zhu,7 Yan Zhang,7 Qi-Qi Lai,4 Xin-Tong Wang,4 Jia-Xi Xu,4 Jia-Ning Zhang,4 Bo-Wen Liu,4 Jian-Nan Zhang,4 Kai Kang4 1Department of Critical Care Medicine, The Second People’s Hospital of Beihai, Beihai, People’s Republic of China; 2Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 3Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China; 4Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 5Department of Critical Care Medicine, The Yichun Central Hospital, Yichun, People’s Republic of China; 6Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, People’s Republic of China; 7Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian-Nan Zhang; Kai Kang, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang, 150001, People’s Republic of China, Tel +86-13836119816 ; +86-13904618016, Email zhangjiannan@hrbmu.edu.cn; janekk79@126.comPurpose: In this study, our objective was to investigate the potential utility of lymphocyte-C-reactive protein ratio (LCR) as a predictor of disease progression and a screening tool for intensive care unit (ICU) admission in adult patients with acute pancreatitis (AP).Methods: We included a total of 217 adult patients with AP who were admitted to the First Affiliated Hospital of Harbin Medical University between July 2019 and June 2022. These patients were categorized into three groups: mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), based on the presence and duration of organ dysfunction. Various demographic and clinical data were collected and compared among different disease severity groups.Results: Height, diabetes, lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet count (PLT), D-Dimer, albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), glucose (GLU), calcium ion (Ca2+), C-reactive protein (CRP), procalcitonin (PCT), hospitalization duration, ICU admission, need for BP, LCR, sequential organ failure assessment (SOFA) score, bedside index for severity in AP (BISAP) score, and modified Marshall score showed significant differences across different disease severity groups upon hospitalization. Notably, there were significant differences in LCR between the MAP group and the MSAP and SAP combined group, and the MAP and MSAP combined group and the SAP group, and adult AP patients with ICU admission and those without ICU admission upon hospitalization.Conclusion: In summary, LCR upon hospitalization can be utilized as a simple and reliable predictor of disease progression and a screening tool for ICU admission in adult patients with AP.Keywords: lymphocyte-C-reactive protein ratio, acute pancreatitis, lymphocyte count, C-reaction protein, disease progression, ICU admission, screening tool

Abstract Background In-hospital cardiac arrest/periarrest is a recognised trigger for consideration of admission to the intensive care unit (ICU). We aimed to investigate the rates of ICU admission following in-hospital cardiac arrest/periarrest, evaluate the outcomes of such patients and assess whether anticipatory care planning had taken place prior to the adult resuscitation team being called. Methods Analysis of all referrals to the ICU page-holder within our district general hospital is between 1st November 2018 and 31st May 2019. From this, the frequency of adult resuscitation team calls was determined. Case notes were then reviewed to determine details of the events, patient outcomes and the use of anticipatory care planning tools on wards. Results Of the 506 referrals to the ICU page-holder, 141 (27.9%) were adult resuscitation team calls (114 periarrests and 27 cardiac arrests). Twelve patients were excluded due to health records being unavailable. Admission rates to ICU were low — 17.4% for cardiac arrests (4/23 patients), 5.7% (6/106) following periarrest. The primary reason for not admitting to ICU was patients being “too well” at the time of review (78/129 — 60.5%). Prior to adult resuscitation team call, treatment escalation plans had been completed in 27.9% (36/129) with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms present in 15.5% of cases (20/129). Four cardiac arrest calls were made in the presence of a valid DNACPR form, frequently due to a lack of awareness of the patient’s resuscitation status. Conclusions This study highlights the significant workload for the ICU page-holder brought about by adult resuscitation team calls. There is a low admission rate from these calls, and, at the time of resuscitation team call, anticipatory planning is frequently either incomplete or poorly communicated. Addressing these issues requires a collaborative approach between ICU and non-ICU physicians and highlights the need for larger studies to develop scoring systems to aid objective admission decision-making.

Abdullah A Alqarni,1,2 Omaima I Badr,3,4 Abdulelah M Aldhahir,5 Jaber S Alqahtani,6 Rayan A Siraj,7 Abdallah Y Naser,8 Abdulrhman S Alghamdi,9 Mansour Majrshi,10,11 Saeed M Alghamdi,12 Mohammed M Alyami,13 Sara A Alghamdi,14 Hassan Alwafi15 1Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 2Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 3Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, Saudi Arabia; 5Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 7Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia; 8Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 9Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 10National Heart and Lung Institute, Imperial College London, London, UK; 11Respiratory Medicine, Royal Brompton Hospital, London, UK; 12Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 13Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia; 14Respiratory Care Department, AlSalama Hospital, Jeddah, Saudi Arabia; 15Department of Clinical Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Hassan Alwafi, Department of Clinical Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, Email hhwafi@uqu.edu.saBackground: Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity’s impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD.Methods: In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities.Results: A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively).Conclusion: Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration.Keywords: COPD, obesity, ICU admission, spirometry parameters, comorbidities

Background/Objectives: Respiratory illnesses frequently lead to hospitalization in adults aged 60 and older, especially due to respiratory viral infectious (RVI). This study investigates hospitalization patterns and characteristics of RVI at HM Hospitals from October 2023 to March 2024; Methods: We retrospectively explored hospitalizations of patients aged 60 years and older with RVIs, gathering data on demographics, clinical profiles, comorbidities, and treatments. Outcomes included hospitalization, ICU admissions, and mortality, and independent factors associated with outcomes were identified using a multi-state model; Results: From October 2023 to March 2024, from a total of 3258 hospitalizations, 1933 (59.3%) were identified as positive for RVIs. Overall, SARS-CoV-2 was the most prevalent (52.6%), followed by influenza (32.7%), and RSV (11.8%). Most RVI involved single infections (88.2%). Hospitalization rates increased with age for SARS-CoV-2 (333.4 [95% CI: 295.0–375.2] to 651.6 [95% CI: 532.1–788.4]), influenza (169.8 [95% CI: 142.6–200.7] to 518.6 [95% CI: 412.1–643.1]), and RSV (69.2 [95% CI: 52.2–90.0] to 246.0 [95% CI: 173.8–337.5]), with SARS-CoV-2 showing the highest rate, followed by influenza and RSV. In the multi-state model, RSV infection significantly increased ICU admission risk (HR: 2.1, 95%, p = 0.037). Age on admission (HR: 1.1, 95%, p < 0.001) and Charlson score (HR: 1.4, 95%, p = 0.001) were associated with transitioning from admission to death. ICU to death risks included age at admission (HR: 1.7, 95%, p < 0.001); Conclusions: RVI in adults 60 years and older are associated with high hospitalization and mortality rates, primarily driven by influenza and SARS-CoV-2, followed by RSV. Age and comorbidities significantly impact disease severity, emphasizing the need for targeted prevention and management strategies for RSV in this vulnerable population.

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retro-prospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Abstract Objectives This study aimed to explore the value of the Charlson comorbidity index (CCI) in predicting ICU admission in patients with aortic aneurysm (AA). Methods The clinical data of patients were obtained from the Medical Information Mart for Intensive Care-IV database. The association between CCI and ICU admission was explored by restricted cubic spline (RCS), threshold effect analysis, generalized linear model, logistic regression, interaction, and mediation analyses. Its clinical value was evaluated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), DeLong's test, and net reclassification index (NRI) analyses. Results The ICU admission was significantly associated with the thoracic AA (TAA), unruptured status, and surgery status. Therefore, 288 candidate patients with unruptured TAA who received surgery were enrolled in the further analysis. We found that CCI was independently associated with the ICU admission of candidates (P = 0.005). Further, their nonlinear relationship was observed (adjusted P = 0.008), and a significant turning point of 6 was identified. The CCI had a favorable performance in predicting ICU admission (area under curve = 0.728) and achieved a better clinical net benefit. New models based on CCI significantly improved the accuracy of prediction. Besides the importance of CCI in ICU admission, CCI also exerted important interaction effect (rather than mediating effects) on the association of other variables (such as age and blood variables) with ICU admission requirements (all P

Abstract Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused significant economic damage and forced a slew of limitations to be placed by regulatory bodies worldwide. As the SARS-CoV-2 virus continuously mutates over time, it’s crucial to understand how well the vaccines are effective against a new variant. Objectives To measure COVID-19 vaccine effectiveness against ICU admission with the Omicron variant in Saudi Arabia regions. Methods and materials A retrospective cohort study was conducted of vaccinated and non-vaccinated individuals who tested positive during Omicron dominant period (Jan 1, 2020- Jun 11, 2022). We used a Cox proportional hazards model based on calendar time to assess the vaccine’s effectiveness while controlling for age and gender. Results A total of 14103 individuals who were divided into fully vaccinated included 8388 (59.5%) individuals, partially vaccinated included 1851 (13.5%) individuals, and un-vaccinated included 3864 (27.4%) individuals. Higher age was associated with a higher risk of ICU admission (HR = 1.03, 95% CI: 1.02, 1.04). Three doses are associated with a lower risk of ICU admission compared to the single dose (HR = 0.09, 95% CI: 0.04, 0.20). By studying the distribution of Omicron infection among different regions, Al-Madinah Al-Monawarah had the highest proportion at 60.23 per 100,000 population (95% CI: 57.05, 63.53). In contrast, Al-jouf had the lowest proportion at 4.51 per 100,000 population (95%CI: 2.891, 6.713). The vaccination status was significantly different in different regions, as the highest proportion of fully vaccinated participants inhabited in Tabouk region, with 71.8% of its cases. Out of all regions, Najran had the highest proportion of ICU admission among Omicron cases with 20% (95% CI: 9.94%, 34.22%). While the lowest rates existed in Riyadh with 0.86% (95%CI: 0.61%, 1.17%). Conclusion We found that a booster significantly enhanced protection against severe COVID-19. The partially vaccinated and unvaccinated participants were at significantly higher risk of ICU admission when compared to the fully vaccinated participants. Furthermore, in future, it is worth investigating the effectiveness of a booster when other potential factors (e.g., region, comorbidities, etc.) are included, particularly among future variants of COVID-19.

To compare risk factors, biochemical parameters, maternal and fetal health parameters of Early onset preeclampsia and Late onset preeclampsia in Central India at tertiary care centre. Methods: At a tertiary care institute in Central India, a prospective study was conducted. 75 women in each, EOP and LOP, were studied based on development of preeclampsia before and after 34 weeks of gestation respectively. Risk factors, biochemical parameters, maternal and perinatal outcomes were compared between the groups to get a better idea in understanding etiopathogenesis and its implications on Indian Population. Results: The results concluded that Mean Gestational age in EOP was 31.8 weeks than 37.9 in LOP. 50.67% and 37.3% ICU admissions were seen in EOP and LOP respectively due to more incidence of maternal morbidities in EOP. In EOP and LOP still births were 21.3% and 9.3% respectively. More number of NICU admissions were seen in EOP than LOP; 30.7% and 8% respectively. Conclusion: The results concluded that Early onset preeclampsia is comparatively associated with more severe maternal and perinatal outcomes, which was statistically significant. Biochemical parameters were more deranged in Early onset preeclampsia. Inconclusive results were found on comparison of known risk factors of preeclampsia between both groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac injury in COVID-19 patients confers a worse prognosis. The interpretation of electrocardiography can be beneficial in the early diagnosis of probable cardiac involvement. After adjusting for other variables, we sought to determine if the initial ECG on admission could add additional prognostic value. METHODS: In this single-center cross-sectional study, 1165 patients with a positive COVID-19 PCR between Feb 2020 and Nov 2021 were enrolled in our study. Patients were grouped according to their admitted units, and survivors to hospital discharge or non-survivors. Predictors of ICU admission and in-hospital mortality were determined using univariate analysis and a logistic regression model. RESULTS: The mean age was 55.6 ± 16.2 years and 52% were male. Out of 1165 patients, 149 deaths (12.8%) were recorded during hospitalization. Sinus tachycardia was the most common dysrhythmia, followed by premature atrial and ventricular beats, sinus bradycardia, and atrial fibrillation (28.6%, 5.6%, 3.9%, and 2.1%, respectively). Age (p<0.001), sex (p=0.006), history of diabetes mellitus (p=0.002), hypertension (p=0.018), ischemic heart disease (p=0.004), and cancer (p<0.001) were more frequent among non-survivors. Among ECG findings, tachycardia, low voltage QRS, ST-T changes, and dysrhythmia were related to an increased mortality risk. However, in regression analysis, only sex (OR 1.89, 95% CI 1.2 to 2.9, p=0.004), age (OR 1.03, 95% CI 1.02 to 1.05, p<0.001), and initial tachycardia (OR 1.02, 95% CI 1.01 to 1.03, p<0.001) were independent predictors of in-hospital mortality. CONCLUSION: Our data suggest that initial electrocardiographic findings could be helpful in distinguishing patients with an increased risk for ICU admission or in-hospital death. [ABSTRACT FROM AUTHOR]

Background:YKL-40 is a new marker that plays a role in tissue remodeling and airway inflammatory processes. Objective: The objective wasevaluatingYKL-40 serum levels in children with bronchial asthma, its predictive value for asthma exacerbation, and its correlation with other inflammatory parameters. Patients and Methods: 84 patients with bronchial asthma (34 acute, 50 stable) and 60 healthy children as controls were recruited. YKL-40 levels were measured using an ELISA kit, analyzing correlations with inflammatory parameters. Results:Serum YKL-40 levels in asthmatic patients were significantly higher than in non-asthmatic individuals (p < 0.001), demonstrating excellent diagnostic accuracy; the area under the curve (AUC) was 1. At a cutoff of 11.9 ng/mL, YKL-40 exhibited 100% sensitivity and 98% specificity. Higher levels were observed in patients with exacerbations (p < 0.001) and a history of hospitalizations or intensive care unit (ICU) admissions (p = 0.03, p < 0.001 respectively). Positive correlations were found with ICU admissions (r = 0.34, p < 0.001) and inverse correlations with asthma control test (ACT) score (r = -0.62, p < 0.001). YKL-40 was also associated with inflammatory markers and predicted exacerbations (AUC = 0.73, p < 0.001) at a cutoff of 20.2 ng/mL (sensitivity 79%, specificity 65%). Conclusion:YKL-40 could serve as a potential biomarker for asthma exacerbation prediction and may provide valuable insights into disease severity and inflammation. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) in COVID‐19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta‐analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID‐19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel‐Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg‐Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID‐19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID‐19 across studies was 2.10% (95% CI, 1.23–3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID‐19 patients with UGIB was 55% (95% CI, 37.01–72.68), 29% (95% CI, 19.26–40.20) and 12.7% (95% CI, 7.88–18.42) respectively. Further, UGIB in COVID‐19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80–6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33–3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta‐analysis. The results of our study indicate that UGIB in individuals with COVID‐19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re‐bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID‐19 cases and emphasise the importance of timely clinical assessment and proper treatment. [ABSTRACT FROM AUTHOR]

Background: In-hospital cardiac arrest/periarrest is a recognised trigger for consideration of admission to the intensive care unit (ICU). We aimed to investigate the rates of ICU admission following in-hospital cardiac arrest/periarrest, evaluate the outcomes of such patients and assess whether anticipatory care planning had taken place prior to the adult resuscitation team being called. Methods: Analysis of all referrals to the ICU page-holder within our district general hospital is between 1st November 2018 and 31st May 2019. From this, the frequency of adult resuscitation team calls was determined. Case notes were then reviewed to determine details of the events, patient outcomes and the use of anticipatory care planning tools on wards. Results: Of the 506 referrals to the ICU page-holder, 141 (27.9%) were adult resuscitation team calls (114 periarrests and 27 cardiac arrests). Twelve patients were excluded due to health records being unavailable. Admission rates to ICU were low — 17.4% for cardiac arrests (4/23 patients), 5.7% (6/106) following periarrest. The primary reason for not admitting to ICU was patients being "too well" at the time of review (78/129 — 60.5%). Prior to adult resuscitation team call, treatment escalation plans had been completed in 27.9% (36/129) with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms present in 15.5% of cases (20/129). Four cardiac arrest calls were made in the presence of a valid DNACPR form, frequently due to a lack of awareness of the patient's resuscitation status. Conclusions: This study highlights the significant workload for the ICU page-holder brought about by adult resuscitation team calls. There is a low admission rate from these calls, and, at the time of resuscitation team call, anticipatory planning is frequently either incomplete or poorly communicated. Addressing these issues requires a collaborative approach between ICU and non-ICU physicians and highlights the need for larger studies to develop scoring systems to aid objective admission decision-making. [ABSTRACT FROM AUTHOR]

Abstract Background The trend in postoperative care for free flap patients is to deescalate from routine ICU admission into a specialty recovery unit. This study aims to investigate the predictive parameters in a routine perioperative clinical assessment that are expected to be directly correlated with prolonged ICU length of stay in at-risk patients who received oral reconstructive surgery for squamous cell carcinoma (OSCC). Methods All patients who underwent ablative surgery for OSCC with free flap reconstruction and were managed in the ICU were included in this study. The primary outcome was ICU-length of stay. Perioperative, operative and postoperative parameters were analyzed using single test ( t-test, ANOVA analysis, correlation coefficients, effect size) and multivariate regression test. The P-value was set as

Background. With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation. Objective. To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU. Methods. A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients’ demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross- referenced to the outcome of the ICU consultation. Data were descriptively analysed. Results. Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data. Conclusion. Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes.

Background: In 2022/2023, Influenza A and Respiratory Syncytial Virus (RSV) reappeared in hospitalized patients, which was in parallel to ongoing SARS-CoV-2 infections. The aim of our study was to compare the characteristics and outcomes of these infections during the same time. Methods: We included patients of all ages with a positive polymerase chain reaction (PCR) test for Influenza A/B, RSV, or SARS-CoV-2 virus hospitalized in the neurological, internal or paediatric units of the RoMed Hospital Rosenheim, Germany, between October 1st 2022 and February 28th 2023. Results: A total of 906 patients were included (45.6% female; median age 68.0 years; 21.9% Influenza A, 48.2% SARS-CoV-2, 28.3% RSV). Influenza B (0.2%) and co-infections (1.5%) played a minor role. In patients aged ≥ 18 years (n = 637, 71%), Influenza A, SARS-CoV-2 and RSV groups differed in age (median 72, 79, 76 years, respectively; p < 0.001). Comorbidities, particularly asthma and COPD, were most prevalent for RSV. 103 patients were admitted to the intensive care unit (ICU) (16.3% Influenza A, 15.3% SARS-CoV-2, 19.2% RSV; p = 0.649), 56 died (6.8% Influenza A, 9% SARS-CoV-2, 11.1% RSV; p = 0.496). RSV showed the highest frequencies of low-flow oxygen supplementation for admission and stay. Differences in the length of stay were minor (median 7 days). Conversely, in patients aged < 18 years (n = 261, 28,8%), 19.5%, 17.6% and 60.2% were in the Influenza A, SARS-CoV-2 and RSV groups, respectively; 0.4% showed Influenza B and 2.3% co-infections. 17 patients were admitted to ICU (3.9% Influenza A, 9.6% RSV, 0% SARS-CoV-2); none died. RSV showed the highest frequencies of high- and low-flow oxygen supplementation, SARS-CoV-2 the lowest. Conclusion: When comparing infections with Influenza, SARS-CoV-2 and RSV in the winter 2022/2023 in hospitalized adult patients, rates of ICU admission and mortality were similar. RSV showed the highest frequencies of obstructive airway diseases, and of oxygen supplementation. The latter was also true in children/adolescents, in whom RSV dominated. Thus, in the situation of declining importance of SARS-CoV-2, RSV showed a disease burden that was relatively higher than that from Influenza and SARS-CoV-2 across ages, and this might be relevant for the seasons coming. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the value of the Charlson comorbidity index (CCI) in predicting ICU admission in patients with aortic aneurysm (AA). Methods: The clinical data of patients were obtained from the Medical Information Mart for Intensive Care-IV database. The association between CCI and ICU admission was explored by restricted cubic spline (RCS), threshold effect analysis, generalized linear model, logistic regression, interaction, and mediation analyses. Its clinical value was evaluated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), DeLong's test, and net reclassification index (NRI) analyses. Results: The ICU admission was significantly associated with the thoracic AA (TAA), unruptured status, and surgery status. Therefore, 288 candidate patients with unruptured TAA who received surgery were enrolled in the further analysis. We found that CCI was independently associated with the ICU admission of candidates (P = 0.005). Further, their nonlinear relationship was observed (adjusted P = 0.008), and a significant turning point of 6 was identified. The CCI had a favorable performance in predicting ICU admission (area under curve = 0.728) and achieved a better clinical net benefit. New models based on CCI significantly improved the accuracy of prediction. Besides the importance of CCI in ICU admission, CCI also exerted important interaction effect (rather than mediating effects) on the association of other variables (such as age and blood variables) with ICU admission requirements (all P < 0.05). Conclusions: The CCI is an important predictor of ICU admission after surgery in patients with unruptured TAA. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused significant economic damage and forced a slew of limitations to be placed by regulatory bodies worldwide. As the SARS-CoV-2 virus continuously mutates over time, it's crucial to understand how well the vaccines are effective against a new variant. Objectives: To measure COVID-19 vaccine effectiveness against ICU admission with the Omicron variant in Saudi Arabia regions. Methods and materials: A retrospective cohort study was conducted of vaccinated and non-vaccinated individuals who tested positive during Omicron dominant period (Jan 1, 2020- Jun 11, 2022). We used a Cox proportional hazards model based on calendar time to assess the vaccine's effectiveness while controlling for age and gender. Results: A total of 14103 individuals who were divided into fully vaccinated included 8388 (59.5%) individuals, partially vaccinated included 1851 (13.5%) individuals, and un-vaccinated included 3864 (27.4%) individuals. Higher age was associated with a higher risk of ICU admission (HR = 1.03, 95% CI: 1.02, 1.04). Three doses are associated with a lower risk of ICU admission compared to the single dose (HR = 0.09, 95% CI: 0.04, 0.20). By studying the distribution of Omicron infection among different regions, Al-Madinah Al-Monawarah had the highest proportion at 60.23 per 100,000 population (95% CI: 57.05, 63.53). In contrast, Al-jouf had the lowest proportion at 4.51 per 100,000 population (95%CI: 2.891, 6.713). The vaccination status was significantly different in different regions, as the highest proportion of fully vaccinated participants inhabited in Tabouk region, with 71.8% of its cases. Out of all regions, Najran had the highest proportion of ICU admission among Omicron cases with 20% (95% CI: 9.94%, 34.22%). While the lowest rates existed in Riyadh with 0.86% (95%CI: 0.61%, 1.17%). Conclusion: We found that a booster significantly enhanced protection against severe COVID-19. The partially vaccinated and unvaccinated participants were at significantly higher risk of ICU admission when compared to the fully vaccinated participants. Furthermore, in future, it is worth investigating the effectiveness of a booster when other potential factors (e.g., region, comorbidities, etc.) are included, particularly among future variants of COVID-19. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, cancer patients were among the most vulnerable patient groups to the SARS-CoV-2 infection effects. This paper aimed to conduct an umbrella review and meta-meta-analysis to determine the severity of disease in cancer patients affected by COVID-19. The umbrella review and meta-meta-analysis were undertaken according to the PRISMA and MOOSE guidelines. The PubMed/Medline, Web of Science, and Scopus databases were searched for published papers from the start of the pandemic through July 18, 2022. The pooled effect sizes (ES) and odds ratios (ORs) were calculated using a random effect model in the 95% confidence interval (CI) for ICU (Intensive Care Unit) admissions and mortality in cancer patients infected with SARS-CoV-2. Egger's linear regression test, schematic illustrations of funnel plots, and Begg and Mazumdar's rank correlation tests were used to quantify the possibility of publication bias. The pooled ES was calculated based on 1,031,783 participants, and mortality was significantly increased in cancer patients affected by COVID-19 (OR = 2.02, %95 CI: 1.74–2.35, p < 0.001). The pooled ES for ICU admission was also significantly increased in cancer patients infected with SARS-CoV-2 (OR = 1.84, %95 CI: 1.44–2.34, p < 0.001). As a result, this synthesis of systematic reviews and meta-analyses by the meta-meta-analysis method revealed that disease severity is higher in cancer patients affected by COVID-19. Since cancer patients are a more sensitive and specific patient group, they should be evaluated more carefully, especially during the COVID-19 pandemic and other pandemics that may occur in the future. [ABSTRACT FROM AUTHOR]

Objective: Diabetic ketoacidosis is one of the most common causes of admission to the intensive care unit in Saudi Arabia. This study aimed to investigate the rate of diabetic ketoacidosis-related intensive care unit admission and related risk factors and to determine the rate of intensive care unit readmission and mortality in a single tertiary health care center. Methods: This retrospective record review study was based on diabetic ketoacidosis patients aged ≥15 years admitted to the intensive care unit of King Abdulaziz University Hospital from 2018 to 2020. Associations between variables such as patient demographics, precipitating factors, biochemical data, intensive care unit stay details, complications within the study period, and history of readmission to intensive care unit were performed. Statistical analysis was done using RStudio program. Factors associated with the primary outcome variables were further entered in a multivariate binary logistic regression analysis to assess the independent relationships. Results: Of all diabetic ketoacidosis-related admissions, 28.4% of the admissions matched the study criteria. In 50% of cases, the precipitating cause for diabetic ketoacidosis which leads to intensive care unit admission was medication nonadherence, followed by infectious disease and severe diabetic ketoacidosis. Based on the multivariate regression analysis using patients' age and medication incompliance as independent variables, being an older adult (>60 years) was the sole risk factor for death among patients under study (odds ratio = 23.3, 95% confidence interval, 3.0-65.3, P = .005). Conclusion: Our findings highlight that the intensive care unit admission rate of diabetic ketoacidosis remains a significant health problem. Significant independent associated factors for intensive care unit admission were old age and medication nonadherence. [ABSTRACT FROM AUTHOR]

Historically, the admission of hematological patients in the ICU shortly after the start of a critical illness is associated with better survival rates. Early intensive interventions administered by MET could play a role in the management of hematological critically ill patients, eventually reducing the ICU admission rate. In this retrospective and monocentric study, we evaluate the safety and effectiveness of intensive treatments administered by the MET in a medical ward frame. The administered interventions were mainly helmet CPAP and pharmacological cardiovascular support. Frequent reassessment by the MET at least every 8 to 12 h was guaranteed. We analyzed data from 133 hematological patients who required MET intervention. In-hospital mortality was 38%; mortality does not increase in patients not immediately transferred to the ICU. Only three patients died without a former admission to the ICU; in these cases, mortality was not related to the acute illness. Moreover, 37% of patients overcame the critical episode in the hematological ward. Higher SOFA and MEWS scores were associated with a worse survival rate, while neutropenia and pharmacological immunosuppression were not. The MET approach seems to be safe and effective. SOFA and MEWS were confirmed to be effective tools for prognostication. [ABSTRACT FROM AUTHOR]

Objectives The appropriate anesthesia method in patients requiring surgical treatment with confirmed or suspected new coronavirus disease (COVID-19) is unclear. This study aimed to compare regional anesthesia (RA) with general anesthesia (GA) in patients with COVID-19 infection in terms of admission to intensive care unit (ICU), rate of pulmonary complications, and mortality. Materials and Methods We reviewed medical records between March 2020 and December 2021 added patients with COVID-19 that operated under RA or GA in the study. The patients were assigned into two groups: 1. patients operated under RA and 2. patients operated under GA. Primary outcomes were admission rates to the ICU, acute pulmonary, renal, and hepatic complications, and perioperative mortality rates. Results We included 123 patients in the study. Regional anesthesia was significantly higher in the cohort. 97 (78.9 %) patients were operated under RA and 26 (21.1 %) patients under GA. The admission rate to ICU was 8.2 %in the RA group and 11.5 %in the GA group. The difference was not significant (p=0.422). Pulmonary complications were seen in 6 (6.2 %) patients in the RA group and 2 (7.7 %) patients in the GA group without a significant difference (p=0.535). Perioperative mortality rates were comparable between groups (5.2 %in the RA group vs. 7.7 %in the GA group) (p=0.535). Conclusion Pulmonary complications, ICU admission, and perioperative mortality rates were lower in COVID-19 patients operated under regional anesthesia; however, the differences were not significant.