Early predictors of intensive care unit admission among COVID-19 patients in Qatar

BackgroundCOVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19.MethodsThis was a case–control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29–May 29, 2020. For each case enrolled, one control was matched by age and gender.ResultsA total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16–2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08–2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03–2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80–4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53–4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40–2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81–5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77–3.54, p < 0.001).ConclusionHaving cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19

Performance improvements of imaging-based screening tests

Endoscopic and radiologic tests appear to be more accurate than stool-tests in detecting advanced neoplasia because of direct visualisation of colorectal mucosa. Further technological advances are expected to improve the performance and acceptability of these tests. Several attempts at increasing the adenoma detection rate of colonoscopy have been tested, and in vivo histologic differentiation between neoplastic and hyperplastic polyps may lead to substantial saving in economic and medical resources. Low-volume and non-cathartic bowel preparations may improve CT colonography acceptability, whilst computer-aided detection and low-dose protocols may result in a higher accuracy and safety of this procedure. Despite the lack of ionising radiation, significant drawbacks will likely to limit the role of MR colonography in screening programs. Colon capsule endoscopy appears to be a safe and technically feasible procedure. The suboptimal accuracy of the first generation seems to be substantially improved by the second generation of this device

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population