Introduction: The sociodemographic factors have a substantial impact on COVID 19 and understanding the characteristics and clinical presentation of COVID-19 is essential for diagnosis, management, prevention, and targeting clinical care and allocating resources. Objectives: To determine the socio-clinical profile, hospital outcomes and predictors of mortality of patients with COVID19 in Perpetual Succour Hospital from March to September 2020. Study Design: Retrospective observational study Materials and Methods: The population consisted of 368 COVID 19 admitted patients in a tertiary hospital in Cebu City from March to September 2020. Data collection was done by reviewing the charts of the patients and analyzing for descriptive statistics. Results: The COVID 19 patients were predominantly elderly males, smokers, with hypertension and diabetes. Smoking had a significant association with the mortalities. Cough, fever and dyspnea were the common manifestations. Intubated patients had a high mortality. Age, APACHE II and SOFA score, CRP level showed significant association with mortality. Acute kidney injury was the prevalent complication and respiratory failure was the primary cause of death. Majority of the admitted patients were classified as moderate and were discharged alive. Conclusion COVID 19 has a high recovery rate but poses a risk for the elderly, smokers and those with comorbidities. The manifestations mimic those of a respiratory infection and clinical parameters would usually be typical. Furthermore, acute kidney injury is common for infected patients, with respiratory failure and the need for intubation leading to increased morbidity and mortality.
COVID-19 ; Mortality

Background: The prevalence of confirmed cases of COVID-19 is high and tends to continue to increase in Indonesia. Based on data, the Province of South Kalimantan, Indonesia in early mid-2021 experienced a high spike in cases, resulting in a large number of deaths, especially in Banjar Regency. Active COVID-19 cases in South Kalimantan in July 2021 were recorded at 5,279 (12.41%) out of 42,527 positive cases. Data compiled from the COVID-19 Task Force (Satgas) showed that Banjar Regency was the third highest area of the cumulative number of deaths, with as many as 47 people dying in one day. The results of many research on risk factors for COVID-19 cases vary widely. People with comorbidities are a very vulnerable group. Objective: This study aims to identify the relationship between comorbid conditions and death based on data from COVID-19 admission in the Wetland Environment community in Banjar Regency, South Kalimantan, Indonesia in the years 2020-2021. Methods: This is a retrospective analytical observational study which used purposive sampling. The data were collected from the case form report (CFR). The dependent variable in this study was inpatients at Ratu Zaleha Hospital who died and were diagnosed as positive for COVID-19, while the independent variables were age (productive/non-productive), tuberculosis, hypertension, diabetes mellitus, asthma, pneumonia, heart disease, COPD (lung disease), HIV/AIDS, chronic kidney disease (CKD), and stroke (CVA). Data were analyzed by univariate, bivariate, and multivariate analyses with logistic regression method to obtain adjusted OR. Results: Out of 700 patients with confirmed COVID-19 infection, 273 (39%) had no comorbidity while 427 (61%) had at least one comorbid condition. There were 330 (47.1%) male patients and 370 (52.9%) female patients. There were 565 (80.7%) patients who belong in the productive age and 135 (19.35%) in the nonproductive age. Results showed that age (p=0.002), asthma (p=0.026), chronic kidney disease (p=0.000), and heart disease (p=0.002) are significant risk factors of COVID-19 death in Banjar Regency. Conclusion Based on our analysis of COVID-19-related deaths in Banjar Regency in Ratu Zaleha Hospital on the year 2020-2021, diabetes, pneumonia, kidney failure, and COPD were associated with increased mortality.
COVID-19 ; Comorbidity ; Mortality

BACKGROUND

Remdesivir is an intravenously administered antiviral drug that inhibits RNA-dependent RNA polymerase. In vitro studies have shown that remdesivir can inhibit the growth of the COVID-19 virus in infected Vero cells and can inhibit infection in human cell lines.

To determine the efficacy and safety of remdesivir in treating patients with COVID-19 infection.

A systematic search of electronic medical literature databases was done from inception until September 4, 2022. Search for ongoing studies and preprints was also done. Risk of bias assessment was done using Cochrane risk of bias tool version 2.0. Measures of effect used were relative risk (RR) and 95% confidence interval (CI). Subgroup analysis by disease severity was preplanned. The estimates for efficacy and safety of remdesivir was calculated using Review Manager 5.4 software.

Nine randomized controlled trials with 13,085 participants were identified. Eight of the included studies recruited confirmed COVID-19 patients needing hospitalization, while one study limited recruitment to nonhospitalized patients. Remdesivir showed significant benefit for outpatients with mild to moderate disease with at least one risk factor for disease progression in terms of COVID 19-related hospitalization (RR 0.13 95% CI 0.03 to 0.59), all-cause hospitalization (RR 0.28, 95% CI 0.10 to 0.75), and need for medically-attended visits (RR 0.19, 95% CI 0.07 to 0.56). For hospitalized patients, remdesivir had a slight benefit in reducing all-cause mortality at day 28 (RR 0.90, 95% CI 0.83 to 0.98). Subgroup analysis by disease severity showed a trend towards reduction in mortality among those with severe disease (RR 0.61, 95% CI 0.35 to 1.07), with no effect on those with critical disease (RR 0.96, 95% CI 0.87 to 1.04), and inconclusive effect for those with mild-moderate disease (RR 0.74, 95% CI 0.49 to 1.11). Remdesivir showed benefit in decreasing clinical deterioration (RR 0.75, 95% CI 0.61 to 0.89), improving recovery rate (RR 1.07, 95% CI 1.01 to 1.13), and reducing the need for mechanical ventilation (RR 0.68, 95% CI 0.51 to 0.90). There was inconclusive effect on the need for ICU admission (RR 0.98, 95% CI 0.43 to 2.22). No increased risk of adverse events (RR 0.98, 95% CI 0.91 to 1.06), including serious adverse events (RR 0.77, 95% CI 0.57 to 1.03), was seen.

Based on the available evidence, remdesivir shows benefit in the treatment for patients with mild, moderate, and severe COVID-19 infection. However, there was no benefit in mortality noted among those with critical disease requiring mechanical ventilation. Remdesivir demonstrated a good safety profile, with no increased risk of adverse events compared to control. These results are consistent with the international agencies’ recommendations for the use of remdesivir among patients with mild, moderate or severe COVID-19 infection, but not for those with critical infection.

Current evidence supports the use of remdesivir as treatment for selected patients with COVID-19.

BACKGROUND

The coronavirus disease (COVID-19) is a global pandemic that caused millions of deaths worldwide. There is no standard risk stratification score for COVID 19 pneumonia. This study aims to determine the accuracy of the MuLBSTA score in predicting the risk of mortality in COVID-19 confirmed moderate to critical pneumonia cases.

A total of 168 COVID-19-confirmed moderate to critical pneumonia patients admitted at Cardinal Santos Medical Center from January 1, 2021 to April 30, 2021 were included by chart review. The MuLBSTA score was determined for each patient using the following information: age, smoking history, co-morbidities, complete blood count, sputum culture, blood culture, chest xray and chest CT scan. All clinical outcomes were based on patient status by the end of the hospital stay (survival versus death). Thereafter, logistic regression was done using the MuLBSTA score and mortality to determine any correlation. In addition, modified regression was used to find any correlation with the MuLBSTAscore and patient co-morbidities as predictors of mortality. Chi-square tests of independence were conducted to assess the specific cut-off values of the MuLBSTAscore in predicting mortality.

The MuLBSTAscore is a significant predictor of mortality (73.08%) and survivability (66.67%). It was determined that the MuLBSTA score's accuracy in predicting mortality increases with diabetics [b = .26, p < .05]. In addition, the intervention of hemoperfusion can skew the predictive accuracy of the scoring [b = -.45, p <.01]. The study showed that a MuLBSTA score of 8 as a cut-off value to delineate high risk patients was more accurate in COVID-19 pneumonia patients compared to the previously established score cut-off of 12 in viral pneumonia [1].

The MuLBSTA score may be used for risk stratification in predicting mortality in COVID-19 pneumonia, especially among diabetic patients. A MuLBSTA score of 8 proves to be the more accurate cut-off in assessing risk of mortality in COVID-19. However, hemoperfusion makes the MulBSTAscore inapplicable.

Objective: This study determined the association of SARS-CoV-2 RT-PCR cycle threshold (Ct) value with disease severity and mortality among hospitalized pediatric COVID-19 patients. Methodology: This is a retrospective cohort study of patients aged 0-18 years with SARS-CoV-2 RT-PCR-confirmed COVID-19 from 1-September-2020 to 31-August-2022. The cohort was divided into those with high (>30), medium (> 20) and low (mortality was determined using logistic regression. Results: There were 236 patients included with male predominance. Median age was 7 years. Most belonged to the 0-5 years age group. Most were severe to critical COVID-19 cases. Median day of illness on swab collection was 4 days. Majority presented with symptoms such as fever (54%), cough (22%) and dyspnea (22%). Eighty-four percent had co-morbidities, of which majority were cancer and neurologic diseases. Median Ct value was 30.81. Fifty-four percent had high Ct values. The median age of patients with a high Ct value was significantly lower than other cohorts. The median day of illness of patients with low Ct value was significantly shorter than other cohorts. There was no significant difference across the terciles in terms of presence of co-morbidities. Majority of patients for each cohort had high Ct values. There was no significant association between Ct value and COVID-19 disease severity on admission. Nearly fifty percent had critical disease and the all-cause mortality rate was 21.61%. There was no significant association between Ct value and mortality. Conclusions Ct value was not associated with disease severity and all-cause mortality after controlling for confounders. A look into medical interventions, emergence of variants, and other factors that may affect the clinical presentation, disease course, severity and outcome are recommended in future studies.
COVID-19 ; Mortality

Objective: To assess the performance of prognostic models in predicting mortality or clinical deterioration among patients with COVID-19, both hospitalized and non-hospitalized Methods: We conducted a systematic review of the literature until March 8, 2021. We included models for the prediction of mortality or clinical deterioration in COVID-19 with external validation. We used the Prediction model Risk Of Bias ASsessment Tool (PROBAST) and the GRADEpro Guideline Development Tool (GDT) to assess the evidence obtained. Results: We reviewed 33 cohort studies. Two studies had a low risk of bias, four unclear risks, and 27 with a high risk of bias due to participant selection and analysis. For the outcome of mortality, the QCOVID model had excellent prediction with high certainty of evidence but was specific for use in England. The COVID Outcome Prediction in the Emergency Department (COPE) model, the 4C Mortality Score, the Age, BUN, number of comorbidities, CRP, SpO2/FiO2 ratio, platelet count, heart rate (ABC2-SPH) risk score, the Confusion Urea Respiration Blood Pressure (CURB-65) severity score, the Rapid Emergency Medicine Score (REMS), and the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) score had fair to good prediction of death among inpatients, while the quick Sepsis-related Organ Failure Assessment (qSOFA) score had poor to fair prediction. The certainty of evidence for these models was very low to low. For the outcome of clinical deterioration, the 4C Deterioration Score had fair prediction, the National Early Warning Score 2 (NEWS2) score poor to good, and the Modified Early Warning Score (MEWS) had poor prediction. The certainty of evidence for these three models was also very low to low. None of these models had been validated in the Philippine setting. Conclusion The QCOVID, COPE, ABC2-SPH, 4C, CURB-65, REMS, RISE-UP models for prediction of mortality and the 4C Deterioration and NEWS2 models for prediction of clinical deterioration are potentially useful but need to be validated among patients with COVID-19 of varying severity in the Philippine setting.
COVID-19 ; Mortality ; Clinical Deterioration

INTRODUCTION: Coronavirus disease 2019 (COVID-19) cases are increasing rapidly worldwide. Similar to Middle East respiratory syndrome where cardiovascular diseases were present in nearly 30% of cases, the increased presence of cardiovascular comorbidities remains true for COVID-19 as well. The mechanism of this association remains unclear at this time. Therefore, we reviewed the available literature and tried to find the probable association between cardiovascular disease with disease severity and mortality in COVID-19 patients. METHODS: We searched Medline (via PubMed) and Cochrane Central Register of Controlled Trials for articles published until Sept 5, 2020. Nineteen articles were included involving 6,872 COVID-19 patients. RESULTS: The random-effect meta-analysis showed that cardiovascular disease was significantly associated with severity and mortality for COVID-19: odds ratio (OR) 2.89, 95% confidence interval (CI) 1.98-4.21 for severity and OR 3.00, 95% CI 1.67-5.39 for mortality, respectively. Risk of COVID-19 severity was higher in patients having diabetes, hypertension, chronic obstructive pulmonary disease, malignancy, cerebrovascular disease and chronic kidney disease. Similarly, patients with diabetes, hypertension, chronic liver disease, cerebrovascular disease and chronic kidney disease were at higher risk of mortality. CONCLUSION Our findings showed that cardiovascular disease has a negative effect on health status of COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid cardiovascular disease are urgently needed to understand the extent of these concerning comorbidities.
COVID-19/mortality* ; Cardiovascular Diseases/virology* ; Humans

Introduction: Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival. We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at home, in-hospital, or mixed home/in-hospital use. Objectives: This study aimed to determine an association between metformin use and mortality among patients with type 2 diabetes mellitus hospitalized for COVID-19 infection. Methodology: This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin non-users. Results: We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000 mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017). Conclusion Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose of ≥1000 mg to <2000 mg.
Metformin ; Diabetes Mellitus ; COVID-19 ; Mortality

INTRODUCTION COVID-19 (coronavirus disease 2019), which is caused by the human severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), has reached a pandemic level. As a novel disease, local epidemiologic data are important to determine high-risk age groups, as well as risk factors that contribute to mortality. This study is a retrospective cohort study of 182 COVID-19–positive patients confirmed by real-time polymerase chain reaction. Baseline demographics and data on the preexisting cardiovascular comorbidities of 182 COVID-19 patients were collected by chart review and underwent statistical analysis using STATA 14 software (StataCorp, College Station, Texas). In the study, the majority of COVID-19 patients were 61 years or older (44.5%), with a higher prevalence of individuals 61 years or older among those who died (68.4%) compared with survivors (38.2%) (P = 0.005). In terms of gender, half of the patients were male (57.7%). In terms of cardiovascular disease, the most prevalent was hypertension (48.3%), followed by diabetes (28.0%). The prevalence of coronary artery disease (CAD) was significantly higher among patients who died (15.8%) compared with survivors (2.8%) (P = 0.022). In the univariate logistic regression analysis, older age was significantly associated with increased odds for mortality (odds ratio, 1.06; 95% confidence interval, 1.03–1.09). In terms of comorbidities, having CAD was significantly associated with increased odds for mortality (odds ratio, 6.6; 95% confidence interval, 1.7–24.6). Other variables were not significantly associated with mortality. In our study, advanced age and the presence of underlying CAD have been associated with an increased risk of in-hospital mortality among COVID-19 patients.
Cardiovascular Diseases ; COVID-19 ; mortality ; Sex

OBJECTIVES

The study aimed to determine the association of electrocardiographic (ECG) abnormalities and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) infection admitted in a tertiary care hospital in the Philippines.

We conducted a retrospective study of confirmed COVID-19–infected patients. Demographic and clinical characteristics and clinical outcomes were extracted from the medical records. Electrocardiographic analysis was derived from the 12-lead electrocardiogram recorded upon admission. The frequencies and distributions of various clinical characteristics were described, and the ECG abnormalities associated with in-hospital mortality were investigated.

A total of 163 patients were included in the study; most were female (52.7%) with a median age of 55 years. Sinus rhythm with any ECG abnormality (65%), nonspecific ST and T-wave changes (35%), and sinus tachycardia (22%) were the frequently reported ECG findings. The presence of any ECG abnormality was detected in 78.5% of patients, and it was significantly associated with in-hospital mortality (P = 0.038). The analysis revealed a statistically significant association between in-hospital mortality and having atrial fibrillation or flutter (P = 0.002), supraventricular tachycardia (P = 0.011), ventricular tachycardia (P = 0.011), third-degree atrioventricular block (P = 0.011), T-wave inversion (P = 0.005), and right ventricular hypertrophy (P = 0.011).

The presence of any ECG abnormality in patients with COVID-19 infection was associated with in-hospital mortality. Electrocardiographic abnormalities that were associated with mortality were atrial fibrillation or flutter, supraventricular tachycardia, ventricular tachycardia, third-degree atrioventricular block, T-wave inversion, and right ventricular hypertrophy.