Search

Aim: The aim of this study is to develop and explain an easy-to-use severity score calculation tool to predict severe COVID-19 cases that would need intensive care unit (ICU) follow-up.Material method: The study was carried out in patients with laboratory-confirmed COVID-19 hospitalized in Ankara City Hospital between March 15, 2020, and June 15, 2020. The outcome was severe illness that required ICU follow-up. Univariate and binary logistic regression were used to create a prediction model by using potential predictive parameters obtained on the day of hospitalization. Youden’s J index was calculated with receiver-operator characteristic curves analysis in order to evaluate cut-off points, and predicted probability was calculated. The accuracy of the prediction model was tested by calculating the area under curve (AUC). Results: Of the total of 1022 patients, 152 had a severe illness and required ICU follow-up. Among 68 variables, 20 parameters met the potential predictive factor condition for severe illness and were included in the development process for ANKARA CITY HOSPITAL COVID-19 SEVERITY SCORE (ACCSES). The ACCSES calculation tool was created by the final 9 parameters (sex, oxygen saturation, hemoglobin, platelet count, glomerular filtration rate, aspartate transaminase, procalcitonin, ferritin, and D-dimer). AUC was 0.96 (95% CI, 0.95-0.98).Conclusion: We developed a simple, accessible, easy to use calculation tool, ACCSES, with good distinctive power for a severe illness that required ICU follow-up. The clinician can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up simply using available clinical and laboratory values of patients upon admission.

Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Background Appropriate antimicrobial therapy and sometimes urgent surgery are life-saving in intra-abdominal infections (IAI). Methods We performed a retrospective case control study to evaluate the efficacy of ceftriaxone, ceftriaxone plus metronidazole, tigecycline, and ertapenem regimens in IAI. Patients aged >18 years and diagnosed with IAI between 2015 and 2017 are included in the study. Definitions are based on IDSA IAI guideline. Significant resolution of all signs and symptoms of IAI with no further need for antimicrobial therapy or surgical intervention for infection is accepted as clinical response (CR). Microbiological response (MR) is assessed among patients with positive culture and defined as documented or presumptive microbiological eradication of pathogen. Results 659 patients are included in the study. Mean age was 56 years. Source control was maintained in 45.5% of patients. Among 54 patients with available culture specimen, E.coli was the most isolated pathogen (81% ESBL +). Comparisons of antibiotics in all patients and in complicated IAI are shown in Table 1 and 2, respectively. Conclusion Ertapenem, and especially tigecycline are good options in IAI in the era of high antimicrobial resistance. Table 1. Comparison of antibiotic regimens in all patients (n (%), n ± SD) Ceftriaxone (343) Ceftriaxone/ Metronidazole (230) Tigecycline (27) Ertapenem (59) P APACHE II ≥15, 5 (1.5) 14 (6) 2 (7.4) 10 (16.9)