Introduction
New Approach for ITP
Asymptomatic Hyperuricemia - Update
THE EFFECT OF OBLIGATORY PADUA PREDICTION SCORING IN HOSPITALIZED MEDICALLY ILL PATIENTS: A RETROSPECTIVE COHORT STUDY
Abstract
Background and Aims
Venous thromboembolism (VTE) is considered a preventable cause of mortality. The administration of routine VTE prophylaxis in medical patients is recommended in guidelines. Since 2014, the Israeli Ministry of Health instructed all hospitals to assess hospitalized patients in internal medicine wards for the risk for VTE using the Padua Prediction Score. Administration of prophylactic anticoagulants was not mandatory. The aim of the study is to evaluate the effect of filling the Padua score on patients’ outcomes
Methods
Data were collected from the electronic medical records at Rabin Medical Center in Israel during the years 2014-2017. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and major bleeding. A propensity-weighted logistic multivariate analysis was performed.
Results
18,890 patients were included in the study. VTE prophylaxis was administered in 2662/14392 (18%) of patients in the Padua group vs 544/4498 (12%) in the group without the score, OR 1.66 (95% CI 1.49-1.84). Filling the Padua score was not associated with reduction in mortality OR 1.13 (95% CI 0.97-1.31). VTE events occurred in 112 patients in the Padua group (0.8%) vs 30 events (0.7%) in the group without the score. Padua filling was not associated with reduction in VTE, OR 1.22 (95% CI 0.79-1.8). Major bleeding events were not statistically different between the two groups with OR of 1.22 (95% CI 0.96-1.56)
Conclusions
Padua score usage for assessment of VTE risk in medical wards was not associated with any beneficial outcome. Its usage should be reassessed as a performance measure.
PULMONARY ASPERGILLOSIS ASSOCIATED WITH COVID-19: EXPERIENCE OF A SECOND LEVEL HOSPITAL
Abstract
Background and Aims
COVID-19 associated pulmonary aspergillosis (CAPA) is a very serious complication among patients with severe COVID-19. The aim of our study is to retrospectively identify characteristics of patients with COVID-19 and aspergillosis in our center.
Methods
Retrospective analysis of a cohort of COVID-19 patients admitted to a second level hospital in Andalusia with isolation of Aspergillus spp. in respiratory microbiological samples between March 2020 and 2021.
Results
19 patients were included, all of them admitted to the ICU. Among ICU COVID-19 patients, the prevalence of CAPA was 4.04%. Most isolations were made in bronchial aspirate (59.7%). 15 patients met “possible” CAPA criteria, and 4 were colonized. Aspergillus fumigatus was the most common pathogen, isolated in 73.7%. Serum galactomannan was positive in 3 of 7 samples. Cardiovascular risk factors and the presence of a central venous catheter were the most prevalent characteristics. Most patients were on mechanical ventilation. 94.7% had received corticosteroids, with a cumulative median dose of 678.8 equivalent milligrams of prednisone. 21.1% received tocilizumab. The most used antifungal was voriconazole (52.6%). 10 patients died (52.6%), all diagnosed with CAPA (66.6% mortality among them).
Conclusions
Pulmonary aspergillosis is an important complication among patients with COVID-19 admitted to the ICU. High dose of corticosteroids and mechanical ventilation may be risk factors associated with it. It carries a high mortality and an ominous forecast, so prevention, early diagnosis and even prophylactic therapy must be our priorities. This study identifies the characteristics of patients with CAPA and may help to achieve these objectives.