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Background: Mortality predictors are often used for analyzing disease progression as a guide for disease management strategy. The sequential organ failure assessment (SOFA) score is a predictor tool used to analyze organ dysfunction in critically ill patients. This study aimed to validate the SOFA score in predicting 28-day mortality in critically ill Coronavirus disease 2019 (COVID-19) patients. Methods: Subjects included in this study were critically ill, confirmed COVID-19 cases admitted to the intensive care unit (ICU) between March and August 2020. Demographic data, clinical characteristics, and laboratory findings within the first 24 hours of ICU admission were obtained from medical records to compute the SOFA score. The 28-day outcome was recorded as alive or deceased. Validity was analyzed using the area under the curve (AUC), Hosmer-Lemeshow goodness of fit, and bivariate logistic regression. The optimal cut-off point was determined statistically. Result: From the total of 88 subjects in this study, the mortality rate was 39.8%. AUC was 0.971 (confidence interval [CI] 95% 0.943-0.999), and the goodness of fit test by using Hosmer-Lemeshow showed p=0.782. An optimal cut-off point of SOFA score was 6, with a sensitivity of 87% and specificity of 90%. Discussion: SOFA score demonstrated very strong discrimination and good calibration in predicting 28-day mortality on the critical case of COVID-19. Conclusion: The SOFA score is valid for predicting 28-day mortality in the critical case of COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: Eighty-six percent of patients administrated with intravenous fluid resuscitation had positive fluid accumulation. This resulted in fluid overload in 35% of all ICU patients in 2009-2012. Then, the worst consequence is multi-organs failures. Thus, one of the treatments is pharmacological diuresis to solve physiological problems. Despite of its adverse effects and fluid balance decrement on the hypoperfused organ, the organ failure resolution of furosemide usage has not been proven through any research. Hence, a research which analyzed the correlation of organ system failure status based on modified sequential organ failure assessment (MSOFA) score with furosemide usage on intensive care patient and their demographics data has been conducted. Material and Methods: The research design was a retrospective cohort which analyzed 194 subjects through ICU medical records selected by consecutive sampling method. Data of furosemide usage and MSOFA score changes were recorded. Thereafter, Chi-square test was conducted to analyze the data. Moreover, characteristics of subjects were also recorded and analyzed in this study. Results: Based on the characteristics of subjects analysis, significant factors on furosemide usage (P < 0.05) included total fluid changes, total fluid after therapy, organ system dysfunctions before therapy (including the respiratory and central nervous system), organ system dysfunction after therapy (cardiovascular), and MSOFA score before therapy. Very significant factors (P < 0.001) include total fluid before therapy, organ system dysfunction after therapy (central nervous system), and MSOFA score after therapy. There was a significant association between worsening organ system failure with furosemide usage on critically ill patients, especially in the cardiovascular and central nervous system. The relative risk result reported that furosemide usage resulted in higher MSOFA score 1.271 times more than those patients with no furosemide diuresis usage (95% CI 1.108-1.458). Furosemide usage in this research worsens organ dysfunction, especially in cardiovascular and central nervous systems. Conclusion: The furosemide usage worsens the organ failure based on MSOFA score. Furosemide therapy should be individually adjusted, especially in those who have respiration, cardiovascular, and central nervous system dysfunction. [ABSTRACT FROM AUTHOR]

Background: The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients. Objective: Our study aimed to assess factors associated with early IFD in critically ill patients. Materials and Methods: This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5-7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P < 0.25 in bivariate analysis. Results: Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18-79), mean Leon's score was 3 (score range 2-5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135-3.803) was found as an independent factor associated with early IFD critically ill patients. Conclusion: DM is a significant factor for the incidence of early IFD in critically ill patients. [ABSTRACT FROM AUTHOR]

BACKGROUND Severe COVID-19 patients may become critically ill and require treatment in the intensive care unit (ICU). As intensive care resources are limited, mortality predictors should be used to guide resource allocation. This study aimed to validate the Charlson comorbidity index (CCI) as the mortality predictor of critical COVID-19 patients in the ICU. METHODS A retrospective cohort study was done in adult patients admitted to the ICU with severe COVID-19 at Cipto Mangunkusumo Hospital and Universitas Indonesia Hospital from March to August 2020. We extracted the subject's CCI score from the medical records and the 28-day mortality after ICU admission. The CCI score was validated by the Hosmer-Lemeshow calibration test, determination of area under the curve (AUC), and optimal cut-off point for the critical patients in the ICU. We used the chi-square test to examine the association of comorbidities with mortality. RESULTS Mortality was higher in CCI scores >4 (odds ratio [OR]: 8.83; 95% confidence interval [CI] = 1.81-43.01). The CCI score had moderate discrimination ability (AUC 76.1%; 95% CI = 0.661-0.881). Chronic kidney disease (CKD) (OR: 18.00, 95% CI = 2.19-147.51), congestive heart failure (CHF) (OR: 4.25, 95% CI = 1.23-14.75), and uncontrolled diabetes mellitus (DM) (OR: 18.429, 95% CI = 2.19-155.21) increased the risk of 28-day mortality. CONCLUSIONS The CCI score could predict the 28-day mortality of critical COVID-19 patients. The coexistence of CKD, CHF, DM, peripheral vascular disease, and peptic ulcer in COVID-19 patients should be considered for patient management. [ABSTRACT FROM AUTHOR]