APACHE II score was calculated during the first 24 h of admission to ICU-LC. Indicators for disease severity were the MELD-Na score (40 points total), APACHE II score (71 points total), SOFA score (24 points total), and invasive mechanical ventilation during hospitalization. The CCI predicts a 10-year survival rate based on a comorbidity burden out of 37 points. Comorbidities included history of alcohol abuse (former or current), obesity (body mass index ≥30.0 kg/m 2), and Charlson Comorbidity Index (CCI), which includes a range of comorbid conditions of age, diabetes mellitus, renal disease, chronic obstructive pulmonary disease, history of myocardial infarction, heart failure, peripheral vascular disease, cerebrovascular accident, dementia, solid tumor, leukemia, lymphoma, AIDS status, connective tissue disease, peptic ulcer disease, and chronic liver disease. This manuscript adheres to the STROBE guideline.ĭemographic variables were age (years), sex (male and female), and race/ethnicity (Caucasian, African American, Hispanic and/or Latino, Asian, South Asian, and Other). All patients completed their hospital course as either discharged alive or deceased. Patients who did not have liver injury were excluded from the study. ICU-LC was defined by supplemental oxygen requirement with fraction of inspired oxygen >55% (with or without invasive mechanical ventilation) or use of vasopressor medications (e.g., norepinephrine, phenylephrine, epinephrine, vasopressin, dobutamine, and dopamine). Liver injury was defined by the presence of elevated levels alanine transaminase 1.5-times normal range (above 60 U/L) or elevated total bilirubin above 1.1 mg/dL. COVID-19-positive status was confirmed by a positive nasopharyngeal sample of real-time reverse transcription–polymerase chain reaction result for SARS-CoV-2. Ethical approval was received from the hospital institutional review board. This is a retrospective study with the inclusion criteria of (1) adults of age 18 years or greater, (2) confirmed COVID-19 infection, and (3) admitted to ICU-LC at a safety-net institution in a suburban New York City hospital from March 1, 2020, to May 15, 2020. We study the association of the APACHE II, SOFA, and MELD-Na scores for mortality and length of stay (LOS) in critically ill COVID-19 patients with liver injury. Liver injury patients have high mortality, and it is important to have readily available tools for risk stratification. These scores have not been studied in critically ill COVID-19 patients with liver injury. There are limited data for the APACHE II, SOFA, and MELD-Na scores for COVID-19 disease. A study among general COVID-19 patients found that the MELD-Na score predicted mortality from renal failure however, literature on MELD-Na predicting mortality for liver injury in COVID-19 patients is lacking. The Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) score is a prognostic tool for patients awaiting liver transplant that is also commonly applied to estimate mortality in acute liver failure patients. Increased APACHE II score in critically ill COVID-19 patients and increased SOFA in all hospitalized COVID-19 patients predicted increased mortality. The Acute Physiologic and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA) scores are commonly used to assess disease severity and estimate mortality for critical illnesses. Liver injury incidence in critically ill patients with COVID-19 disease is as high as 80%. Although the underlying mechanism is not fully understood, it has been proposed that liver injury might be caused by either direct SARS-CoV-2 viral damage, or treatment toxicity, or severe systemic inflammatory and sepsis response. In critically ill COVID-19 patients, extrapulmonary organ involvement including liver injury is reported. The association of substance abuse, including alcohol abuse, with mortality in critically ill COVID-19 patients with liver injury has not been studied. Some report substance abuse increases the risk for COVID-19 infection. Reported risk factors associated with critical illness for COVID-19 are older age male gender and comorbidities of hypertension, diabetes mellitus, morbid obesity, and chronic lung disease. ICU-LC for COVID-19 has high mortality rates ranging up to 35%. Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious viral pathogen with 9%–46% of patients having critical illness requiring intensive care unit level of care (ICU-LC).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |