Factors to consider when assessing the severity of COVID-19

Background: Analysis and evaluation of the multitude of parameters that impact and mirror clinical evolution of COVID-19 infection. Narrative literature review type of study. Bibliographic search of the PubMed database, applying the keywords: ”SARS-CoV-2”, ”COVID-19”, ”risk score”, ”laboratory parameters”, ”pathophysiology”, ”cytokine storm”, ”imaging evaluation”, “outcomes”, “clinical evolution”, which were combined with each other. There were selected English-language publications, in extenso, published in recognized journals from March 2020. Priority in the analysis was given to articles of critical synthesis of literature, randomized studies, those with large samples of patients. One of the clinically important symptoms that reflects severe or critical clinical evolution is persistent fever during the time. The presence of comorbidities, especially associated with obesity, represents a high risk of severe evolution. Proinflammatory, prothrombotic and systemic endothelial damage processes are represented by changes in platelet count, lymphocytes, neutrophil / lymphocyte ratio, C-reactive protein, D-dimers, fibrinogen, procalcitonin, urea, creatinine, ALS, AST, interleukin-6 and serum ferritin. Bacterial and fungal infections negatively influence clinical evolution. Common prediction scores have low value in COVID-19 patients and need adaptation. Imaging evaluation identifies the type of lung injury and correlates with the severity degree and outcome. Conclusions: COVID-19 disease caused by SARS-CoV-2 virus includes a multitude of pathophysiological changes that through its mechanism represent a systemic nosology. The complete analysis of all the factors and parameters that can influence its clinical evolution is a basic component of the decisionmaking steps and treatment approach

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

IMSP Institutul de Medicină Urgentă Centrul Naţional Ştiinţifico-Practic de Medicină Urgentă, Chişinău, MoldovaRezumat În pofida progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50, p<0,0011). De asemenea, a fost identifi cat un grad mediu de corelare dintre consumul intra-anestezic total de fentanil şi intensitatea durerii postoperatorii (r=0,34; p<0,013). Despite advances in postoperative pain management field, the prevalence of patients with severe postoperative pain is still high, 24-46%. For a better result, the postoperative pain management should take into consideration some specific risk factors for severe postoperative pain. Early identification of the factors in patients at risk of postoperative pain will allow a more effective intervention and a better management. For this aim, in our study were included 92, in which were evaluated the risk factor capacity of the following entities: pain catastrofizing, depression, preoperative pain, duration of the surgical operation, anxiety, redux, intra-anesthetic fentanil consumption. In our study, anxiety and high intra-anesthetic fentanyl doses were the most common predictors for severe postoperative pain. Also, was found a moderate degree of correlation between the total intra-anesthetic fentanil consumption and postoperative pain intensity. Несмотря на прогресс в лечении послеоперационной боли, распространенность сильной острой послеоперационной боли (СЩПБ) у пациентов остается высокой, 24-46%. Для улучшения качества послеоперационного обезболивания, нужно принять во внимание специфические факторы риска. С этой целью, мы про- вели исследование на 92 пациентах, дабы оценить являются ли факторами риска следующие: катастрофизм боли, депрессия, предоперационная боль, продолжительность операции, тревожности, операций проводимые на существующих уже послеоперационных шрамах, интра-операционное потребление фентанила. В результате исследования мы смогли доказать что тревожности является фактором риска (OR = 5,1, CI95 = 1,44 до 18,50, р <0,0011). Также была определена средняя степень корреляции между потреблением фентанила во время анестезий и послеоперационной интенсивностью боли (р = 0,34, р <0,013)

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

În pofi da progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50,

Prognostic value of D-dimers in patients with COVID-19: narrative synthesis

Introduction. Contemporary researchers have suggested and demonstrated the hypothesis that the elevated level of D-dimers, which is a valuable marker of coagulation and fibrinolysis activation, can predict the severity of COVID-19, pulmonary complications, and thromboembolic events before they occur. Material and methods. The bibliographic resources were analyzed and selected from databases such as PubMed, Hinari, SpringerLink, and Google Search using keywords such as “COVID-19,” “SARS-CoV-2,” “coronavirus,” “D-dimers,” “biomarkers,” and “severity prediction,” which were used in various combinations to maximize search efficiency. Therefore, the manuscript contains 51 representative articles for the purpose of this synthesis article. Results. The D-dimer levels are significantly higher in patients with severe forms of COVID-19 compared to those with non-severe forms, in patients with acute respiratory distress syndrome compared to those without acute respiratory distress syndrome, and in deceased patients compared to those who have survived. D-dimers positively correlate with the degree of severity and the increased risk of progression to severe disease, inversely proportional to the survival rate. They can predict prognosis, determine therapeutic strategies, prevent complications, positively influence the disease’s course, and monitor the prognosis. Conclusions. D-dimers should be used as a pre-radiographic screening tool as early as possible after admission and as an indicator for risk stratification of venous thromboembolism in hospitalized patients with COVID-19. Based on the increase in D-dimer levels, adjusting therapeutic doses of anticoagulants is more beneficial for patients compared to administering prophylactic doses

IDENTIFICATION OF RISK FACTORS FOR POSTOPERATIVE ACUTE SEVERE PAIN IN ABDOMINAL SURGERY.

Culegere de Rezumate Stiinţifice a Congresului SRATI 2012: AL 38-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 6-LEA CONGRES ROMÂNO - FRANCEZ DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 4-LEA SIMPOZION ROMÂNO - ISRAELIAN DE ACTUALITĂŢI ÎN ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 11-LEA CONGRES AL ASISTENŢILOR DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 10-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE SEPSISIntroducere: În pofida măsurilor luate, prevalenţa durerii postoperatorii acute intense, DPOI (≥5/10 pe SVN) rămâne înaltă (24- 46% – în Europa de Vest şi 64% – în Republica Moldova). Strategiile preventive pentru DPOI trebuie să ia în consideraţie şi factorii de risc. Scopul lucrării: Identificarea factorilor de risc pentru DPOI după intervenţii pe abdomen (herniorafie, apendectomie, colecistectomie) prin screening-ul unor condiţii pre- şi intraoperatorii suspecte. Introduction: Despite recent acivements, the prevalence of postoperative acute severe pain, PASP (≥5/10, VNS) is high (24-46% – in West European countries and 64% – in Republic of Moldova). Prevention strategies for PASP should take into account the risk factors. Goal of the Study: Identification of risk factors for PASP after abdominal surgery (hernioplasty, appendectomy, cholecystectomy) via screening of some intra- and postoperative suspected conditions

Anxiety, but not pain catastrophizing, represents a risk factor for severe acute postoperative pain: a prospective, observational, cohort study

State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova National Scientific and Practical Centre of Emergency Medicine, Chisinau, Republic of MoldovaAbstract Introduction: The prevalence of severe acute postoperative pain (SAPP), i.e. pain intensity > 5/10 measured with Numeric Rating Scale (NRS), is still high, 24-46% in Western European countries and 64% in Republic of Moldova. Objective of the study: We tested the hypothesis that anxiety and pain catastrophizing perception (interpreted as hypervigilance) represent risk factors for SAPP. Materials and methods: 176 patients scheduled for abdominal surgery under general anaesthesia were enrolled in this study, after approval by the University’s Research Ethics Committee and after obtaining patient written informed consent. Preoperatively, all patients filled a Pain Catastrophizing Scale (PCS) questionnaire and self-assessed the anxiety level on a numeric rating scale that was bounded by 0 (denoting no anxiety) and 10 (denoting maximal imaginable anxiety). Duration of surgery, intraoperative administration of fentanyl and pain intensity at 24 hours postoperatively on NRS was also recorded. Statistical analysis comprised the following tests: odds ratio (OR), relative risk (RR), positive and negative predictive values (PPV and NPV, respectively), likelihood ratio, receiver operating characteristic (ROC) curves, and Pearson correlation test. Results: “Hypervigilant” patients did not show an increased risk for SAPP based on histogram calculations (OR = 1.51 [95CI = 0.62-3.65], p = 0.39). However, based on ROC curve calculations (OR = 2.34 [1.13- 4.83], p = 0.0029), these patients showed a risk for SAPP. On average, anxiety determined a fivefold increase of the SAPP risk (OR = 5.1 [95CI = 1.44-18.50], p = 0.011). Intraoperative fentanyl consumption had a weak but significant correlation with pain intensity at 24 h postoperatively (Pearson r = 0.26; p = 0.0008). Surgery duration did not correlate with pain intensity (Pearson r = -0.10; p = 0.46). Conclusion: Anxiety, but not pain catastrophizing, represents a risk factor for SAPP. Intraoperative fentanyl consumption had a weak correlation with postoperative pain intensit

Predictable severity biomarkers in Covid-19

Introduction: The recorded studies suggest that there is clear evidence-based association between various laboratory biomarkers and COVID-19 disease severity. These marker levels reflect the intensity of the cytokine-mediated hyperinflammatory response, which is strongly associated with a poor outcome of SARS-CoV-2 infection. Conclusions: C-reactive protein is not only a systemic inflammatory marker, but also an important regulator of inflammatory processes. The level of this protein is positively correlated and can be widely used to predict the severity, prognosis and mortality in COVID-19 patients, additionally to vital signs monitoring, supportive care, oxygen therapy, ventilation and circulatory support. Procalcitonin is an indicator of disease severity, which can facilitate timely clinical decision-making, and determination of procalcitonin levels during COVID-19 patients’ follow-up, as well as being used in assessing risk, predicting prognosis, and improving patient survival. The assessment of hematological laboratory parameters upon admission, which help in differentiating between severe and non-severe cases, high-risk and low-risk cases of mortality, allows raising awareness, monitoring and timely treatment of patients with COVID-19, as well as their early improvement of clinical condition. Inflammatory biochemical and hemocytometric measures are feasible, easily interpretable, and widely available biomarkers in most healthcare settings, favorable for being used in treatment and severity determination, in predicting clinical outcomes, and in the prognosis of patients with COVID-19. However, the assessment of the accuracy of these biomarkers needs to be determined in further more relevant worldwide studies, showing a more precise design, more accurate performance, and having larger sample sizes

Identificarea unor factori de risc pentru durerea postoperatorie acută intensă

IMSP Institutul de Medicină Urgentă Centrul Naţional Ştiinţifico-Practic de Medicină Urgentă, Chişinău, MoldovaRezumat În pofida progresului în managementul durerii postoperatorii, prevalenţa pacienţilor cu durere postoperatorie intensă (DPOI) rămâne înaltă, de 24-46%. Pentru o calitate mai bună a managementului durerii postoperatorii, anumiţi factori de risc specifi ci trebuie luaţi în consideraţie. În acest scop, studiul nostru, efectuat pe 92 de pacienţi, a apreciat calitatea de factor de risc pentru următoarele entităţi: catastrofi smul durerii, depresia, durere preoperatorie, durata intervenţiei, anxietatea, intervenţie pe cicatrice preexistentă, consumul intranestezic de fentanil. În studiul nostru, calitatea de factor de risc a fost confi rmată doar pentru anxietate (OR=5,1; CI95=1,44-18,50, p<0,0011). De asemenea, a fost identifi cat un grad mediu de corelare dintre consumul intra-anestezic total de fentanil şi intensitatea durerii postoperatorii (r=0,34; p<0,013). Despite advances in postoperative pain management field, the prevalence of patients with severe postoperative pain is still high, 24-46%. For a better result, the postoperative pain management should take into consideration some specific risk factors for severe postoperative pain. Early identification of the factors in patients at risk of postoperative pain will allow a more effective intervention and a better management. For this aim, in our study were included 92, in which were evaluated the risk factor capacity of the following entities: pain catastrofizing, depression, preoperative pain, duration of the surgical operation, anxiety, redux, intra-anesthetic fentanil consumption. In our study, anxiety and high intra-anesthetic fentanyl doses were the most common predictors for severe postoperative pain. Also, was found a moderate degree of correlation between the total intra-anesthetic fentanil consumption and postoperative pain intensity. Несмотря на прогресс в лечении послеоперационной боли, распространенность сильной острой послеоперационной боли (СЩПБ) у пациентов остается высокой, 24-46%. Для улучшения качества послеоперационного обезболивания, нужно принять во внимание специфические факторы риска. С этой целью, мы про- вели исследование на 92 пациентах, дабы оценить являются ли факторами риска следующие: катастрофизм боли, депрессия, предоперационная боль, продолжительность операции, тревожности, операций проводимые на существующих уже послеоперационных шрамах, интра-операционное потребление фентанила. В результате исследования мы смогли доказать что тревожности является фактором риска (OR = 5,1, CI95 = 1,44 до 18,50, р <0,0011). Также была определена средняя степень корреляции между потреблением фентанила во время анестезий и послеоперационной интенсивностью боли (р = 0,34, р <0,013)

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended