Fibrinogen-to-albumin ratio predicts mortality in COVID-19 patients admitted to the intensive care unit

Introduction: Coronavirus disease 2019 (COVID-19) is an inflammatory disease, and serum albumin and fibrinogen are two important factors in systemic inflammation. We aimed to investigate the relationship between the fibrinogen-to-albumin ratio (FAR) and in-hospital mortality in COVID-19 patients admitted to the intensive care unit (ICU).Material and methods: Patients diagnosed with COVID-19 admitted to the Adiyaman Training and Research Hospital from August to November 2020 were enrolled in this retrospective cohort study. They were divided into 2 groups based on in-hospital mortality: a survivor group (n = 188) and a non-survivor group (n = 198). FAR was calculated by dividing the fibrinogen value by the albumin value. Mortality outcomes were followed up until December 15, 2020.Results: The average age of the patients was 71.2 ± 12.9 years, and 54% were male. On multivariate logistic analysis, diabetes mellitus (OR: 1.806; 95% CI: 1.142–2.856; p = 0.011), troponin I levels (OR: 1.776; 95% CI: 1.031–3.061; p = 0.038), and FAR (OR: 1.004; 95% CI: 1.004–1.007; p = 0.010) at ICU admission were independent predictors of in-hospital mortality in patients with COVID-19.Conclusions: The FAR at admission was associated with mortality in patients infected with SARS-CoV-2 in the ICU

Intoxications in Intensive Care: Cost and Bed Occupancy According to Glasgow Coma Scale

Objective:Intensive care units (ICU) are the units in which critical patient care and follow-up are conducted. About 3.7-40% of ICU beds are used for intoxications. In ICU, intoxications may be mortal or can be discharged only by observation without any complication. The necessity of hospitalization of all these patients to the ICU is controversial in terms of bed occupancy and cost. In our study, it was aimed to determine the necessity and cost of hospitalization of ICU patients who were admitted to ICU with diagnosis of intoxication.Materials and Methods:This study was conducted by investigating the files of 205 intoxication patients who underwent more than 24 hours of follow-up and treatment at second and third level ICU. While patients were admitted to ICU, they were divided into two groups according to Glasgow Coma score (GCS) 15 (group=15) and below 15 (group <15). The patients’ age, gender, GCS, cause of poisoning, number of days stayed in the ICU and the need for mechanical ventilation (MV) were recorded, and the ICU costs of the groups were calculated. In addition, the cost that would be generated if the patients in group=15 were followed in the service environment rather than in the ICU was calculated.Results:Of the 205 patients examined, 145 had GCS of 15, while the GCS of 60 patients were below 15. The number of patients with GCS=15 and the intoxication case with suicide intent were higher in female gender. While the number of intoxications with cardiovascular system drugs and analgesic drugs was greater in group=15, the number of intoxications with carbon monoxide and drug substances was greater in group <15. The number of days stayed in ICU, MV requirement and ICU costs were higher in group <15. If the patients in group=15 had been followed up in the service environment, the cost would have been lower than the cost in ICU.Conclusion:GCS; it can be used to determine the necessity of hospitalization of intoxication cases into ICU due to its specificity and easy applicability. It is common belief that intoxications leading to life threatening and organ failure should be followed in second and third level ICUs. The fact that ICU beds in our country are not used according to the criteria is a big problem, which may increase the cost of use and also cause an increase in mortality. Adhering to the criteria for admitting patients to high cost units which require specialist and technological equipment such as ICUs will prevent unnecessary bed occupancy and ensure proper use of resources. According to our study, close follow-up of patients, who admitted to ICU with GCS=15, in an equipped service may reduce cost and bed occupancy