Tag Archives: COVID-19

Positive fluid balance is associated with earlier acute kidney injury in COVID-19 patients

Rezwan Munshi1, Sandra Gomez-Paz2, Salman Bhutta3, Joshua Fogel4, James Pellegrini1, Narois Nehru1, Eric Lam5, Sofia Rubinstein1

1 Nassau University Medical Center, East Meadow, NY, USA
2 Brody School of Medicine, East Carolina University, Greenville, NC, USA
3 Northwell Health, New Hyde Park, NY, USA
4 Brooklyn College, Brooklyn, NY, USA
5 Rutgers New Jersey Medical School, Newark, NJ, USA

DOI: 10.2478/jccm-2026-0016

Introduction: Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops.
Aim of the study: We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality.
Material and Methods: Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred.
Results: AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS.
Conclusions: Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.

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Inhaled sevoflurane in critically ill COVID-19 patients: A retrospective cohort study

Jose J. Zaragoza1, Marco A. Baez-Garcia2,3, Jose M. Lomeli-Teran2,4, Daniela Anzures-Diaz2, Paola Zamudio-Cantellano2,4, Job H. Rodriguez-Guillen2,4

1 Hospital H+ Queretaro, Santiago de Querétaro, Mexico
2 Critical Care Department, Hospital H+ Queretaro, Queretaro, Mexico
3 Universidad Anahuac Queretaro, Queretaro, Mexico
4 Colegio Mexicano de Medicina Crítica, Benito Juárez, Mexico

DOI: 10.2478/jccm-2026-0011

Background: Managing sedation in critically ill COVID-19 patients is challenging due to high sedative requirements and organ dysfunction that alters drug metabolism. Inhaled sevoflurane offers a lung-eliminated alternative that may mitigate drug accumulation.
Methods: This single-center, retrospective cohort study analyzed 43 mechanically ventilated COVID-19 patients (March–November 2020). Patients received inhaled sevoflurane adjunctive to IV sedation (n=30) or IV sedation alone (n=13). The primary outcome was the cumulative dose of IV sedatives over 7 days. Secondary outcomes included time to extubation and antipsychotic use.
Results: There was no significant difference in the cumulative dose of IV sedatives between groups. However, the sevoflurane group had a significantly longer median duration of mechanical ventilation (206 [IQR 144-356] vs 144 [IQR 115-156] hours, p=0.005) and a higher requirement for antipsychotic medication (66.6% vs 15.3%, OR 18.6, p=0.011). Daily doses of propofol were lower in the sevoflurane group on specific days, but overall burden was unchanged.
Conclusions: In this cohort, adjunctive inhaled sevoflurane did not significantly reduce the cumulative burden of IV sedatives and was associated with delayed extubation and increased antipsychotic use. While sevoflurane is a feasible alternative, these findings suggest caution regarding weaning and delirium management in COVID-19 patients.

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Admission biomarkers and COVID-19 mortality: A retrospective study during Vietnam’s pandemic peak

Uyen Thi Bich Nguyen1, Hau Phuc Le2,3, Vu Hoang Anh Nguyen4, Ai-Thanh Tran-Nguyen4,5

1 Department of Nephrology and Hemodialysis, Le Van Viet Hospital, Ho Chi Minh City, Vietnam
2 Outpatient Clinic for HIV-AIDS Patients, Chau Thanh District Medical Center, Tra Vinh Province, Vietnam
3 Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
4 Department of Psychosomatic Medicine, Thu Duc City Hospital, Ho Chi Minh City, Vietnam
5 Thu Duc City Hospital, Ho Chi Minh City, Vietnam

DOI: 10.2478/jccm-2026-0012

Background: This study aimed to evaluate the prognostic value of key admission biomarkers in predicting mortality among hospitalized COVID-19 patients and to establish optimal cut-off thresholds for clinical decision-making.
Methods: Retrospective cohort study included 269 COVID-19 patients treated at Thu Duc City Hospital, Vietnam, during the peak of the fourth pandemic wave in 2021. Logistic regression identified independent predictors of mortality, and receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of biomarkers. The area under the ROC curve (AUROC), Sensitivity, Specificity and Accuracy Index were used to determine optimal cut-off values.
Results: Among the 269 patients, 53 (19.7%) died and 216 (80.3%) survived. Non-survivors exhibited elevated D-dimer (4.48 μg/mL vs 0.93 μg/mL, p < 0.0001), neutrophil counts (6.8 × 10⁹/L vs 3.5 × 10⁹/L, p < 0.0001) and white blood cell counts (11.68 × 10⁹/L vs. 7.87 × 10⁹/L, p < 0.0001). Lymphocyte counts and fibrinogen levels were significantly lower in non-survivors (p < 0.05). Logistic regression identified D-dimer (OR = 1.05, 95% CI: 1.02–1.09, p = 0.001), neutrophil counts (OR = 1.32, 95% CI: 1.10–1.63, p = 0.005) and lymphocyte counts (OR = 0.51, 95% CI: 0.26–0.92, p = 0.033) as significant predictors of mortality. ROC analysis revealed that D-dimer (AUROC = 0.809) and neutrophil counts (AUROC = 0.726) demonstrated strong discriminatory power, with cut-off values of ≥1.126 μg/mL (sensitivity = 90.57%, specificity = 60.19%) and ≥6.715 × 10⁹/L (sensitivity = 52.83%, specificity = 82.87%), respectively.
Conclusion: These findings support the use of admission biomarkers to guide early interventions and improve patient outcomes in severe COVID-19 cases. Further studies are warranted to validate these results and explore their applicability in other settings.

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Severe acute respiratory syndrome coronavirus 2 infection and West Nile encephalitis in a patient with chronic kidney disease

Vince Akos Andrejkovits1, Alexandra Ioana Asztalos2, Nina Ioana Bodnar1, Erzsebet Iringo Zaharia-Kezdi1, Anca Meda Vasiesiu1

1 George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Romania
2 Mures County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0040

Objective: We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management.
Case report: We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs.
Conclusions: Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.

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Comparative analysis of COVID-19 critically ill patients across four pandemic waves in Greece

Stelios Kokkoris1, Aikaterini Goufa2, Dimitrios Tsilivarakis1, Fotios Kavallieratos1, Georgia Minatsi1, Despoina Papadaki1, Aikaterini Pranti1, Spyros Zakynthinos1, Anastasia Kotanidou1, Christina Routsi1

1 National and Kapodistrian University of Athens, Medical School, First Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece
2 National and Kapodistrian University of Athens, First Department of Medicine, Laiko General Hospital, Athens, Greece

DOI: 10.2478/jccm-2025-0036

Introduction: There is limited information about trends in mortality of intensive care unit (ICU) patients with Coronavirus Disease-2019 (COVID-19) throughout the entire pandemic period.
Aim: We compared the ICU mortality among the four consecutive waves of the pandemic, according to the virus variant predominance.
Methods: This is a retrospective study of prospectively collected data extracted from our COVID-19 clinical database. All adult patients with confirmed SARS-CoV-2 infection, consecutively admitted to our ICU from March 2020 through April 2022, were included. For the analysis we used the dates of the four periods of the pandemic, according to the predominance of different SARS-CoV-2 variants in Greece. Kaplan-Meier and Cox proportional hazards analyses were used.
Results: In total, 805 patients [median (IQR) age 67 (56-76) years, 68% males] were included. APACHE II, Charlson, and SOFA scores were 14 (11-19), 3 (2-5) and 7 (4-9), respectively; 674 (84%) patients required invasive mechanical ventilation. ICU length of stay was 15 (8-29) days, and mechanical ventilation duration was 11 (4-24) days. ICU and hospital mortality was 48% and 54%, respectively. Kaplan-Meier survival curves revealed no significant differences in ICU mortality among the four waves. Age, malignancy, chronic pulmonary disease and SOFA score were independent predictors of ICU mortality, but the pandemic waves themselves were not. Age had a significant impact on ICU mortality across all waves.
Conclusion: The effect of COVID-19 wave (and consequently of the SARS- CoV-2 variant) on ICU mortality seems to be trivial, and therefore our focus should be shifted to other risk factors, such as age and comorbidities. These findings along with those of other studies could be useful for modelling the evolution of future outbreaks.

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Artificial intelligence algorithms based approach in evaluating COVID-19 patients and management

Ioana Hălmaciu1, Anca Meda Văsieșiu2, Andrei Manea1,3, Andrei Dragomir3, Ioana Tripon4, Vlad Vunvulea5, Cristian Boeriu6, Andrea Rus7, Minodora Dobreanu8,9

1 Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2 Department of Infectious Diseases, George Emil Palade University of Medicine Pharmacy Science, and Technology of Targu Mures, Targu Mures, Romania
3 Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
4 Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5 Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
6 Department of Emergency Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
7 Department of Radiology, Clinical Emergency County Hospital of Targu Mureș, Targu Mures, Romania
8 Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
9 Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0032

Introduction: COVID-19 pneumonia manifests with a wide range of clinical symptoms, from minor flu-like signs to multi-organ failure. Chest computed tomography (CT) is the most effective imaging method for assessing the extent of the pulmonary lesions and correlates with disease severity. Increased workloads during the COVID-19 pandemic led to the development of various artificial intelligence tools to enable quicker diagnoses and quantitative evaluations of the lesions.
Aim of the study: This study aims to analyse the correlation between lung lesions identified on CT scans and the biological inflammatory markers assessed, to establish the survival rate among patients.
Methods: This retrospective study included 120 patients diagnosed with moderate to severe COVID-19 pneumonia who were admitted to the intensive care unit and the internal medicine department between September 2020 and October 2021. Each patient underwent a chest CT scan, which was subsequently analysed by two radiologists and an AI post-processing software. On the same day, blood was collected from the patients to determine inflammatory markers. The markers analysed in this study include the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammatory index, systemic inflammation response index, systemic inflammation index, and serum interleukin-6 value.
Results: There were strong and very strong correlations between the derived inflammatory markers, interleukin-6, and the CT severity scores obtained by the AI algorithm (r=0.851, p<0.001 in the case of NLR). Higher values of the inflammatory markers and high lung opacity scores correlated with a decreased survival rate. Crazy paving was also associated with an increased risk of mortality (OR=2.89, p=0.006).
Conclusions: AI-based chest CT analysis plays a crucial role in assessing patients with COVID-19 pneumonia. When combined with inflammatory markers, it provides a reliable and objective method for evaluating COVID-19 pneumonia, enhancing the accuracy of diagnosis.

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Hyperglycemia, diabetes, and de novo diabetes in patients hospitalized in intensive care units for COVID-19 in Colombia: Results from a longitudinal cohort study

John Jaime Sprockel1,2, Ana Maria Perez2, Maria Camila Chamorro2, Jose Alejandro Vergel2, Ximena Espinosa1, Juan Carlos Vargas1, Carlos Angarita1, Jhon Edinson Parra1

1 El Tunal Hospital, Bogota, Cundinamarca, Colombia
2 Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia

DOI: 10.2478/jccm-2025-0026

Introduction: Hyperglycemia and diabetes have been identified as risk factors for severe COVID-19 and death, with a high rate of reported de novo diabetes. We evaluated their incidence and relationship with adverse outcomes in critically ill COVID-19 patients.
Methods: Prospective single-center longitudinal cohort study in adults hospitalized in intensive care units for confirmed COVID-19. ROC curves for serum glucose and glycated hemoglobin were plotted in relation to 60-day mortality. A Cox proportional hazards model was used to assess the association of diabetes and de novo diabetes with 60-day mortality.
Results: 547 patients were included, with a mean age of 59.8 years; 133 (24.3%) had a history of diabetes, and 67 (12.2%) had de novo diabetes. At 60 days, 317 (57.9%) had died. For mortality, the AUC for glucose at admission was 0.55 (95% CI: 0.48 – 0.62) and 0.51 (95% CI: 0.41 – 0.62) for glycated hemoglobin. In the Cox model, diabetes had an HR of 0.888 (95% CI: 0.695 – 1.135, p: 0.344), history of DM had an HR of 0.881 (95% CI: 0.668 – 1.163, p: 0.371), and de novo diabetes had an HR of 0.963 (95% CI: 0.672 – 1.378, p: 0.835).
Conclusion: There was a high incidence of de novo diabetes in patients hospitalized in intensive care for COVID-19. Neither hyperglycemia, history of diabetes, nor de novo diabetes were associated with the development of complications or 60-day mortality.

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Use of prone position in spontaneous breathing in patients with COVID-19

Rodrigo Cerqueira Borges1, Isadora Salvador Rocco2, Camila Botana Alves Ferreira1, Mauricio Kenzo Tobara1, Cristiane Helena Papacidero1, Vanessa Chaves Barreto Ferreira1, Andrey Wirgues Sousa1

1 Hospital Samaritano Higienópolis, São Paulo, Brazil
2 Universidade Federal de Sao Paulo, Brazil

DOI: 10.2478/jccm-2025-0015

Objective: To investigate if awake prone position (PP) reduces the rate of endotracheal intubation and mortality in patients with COVID-19 admitted to the intensive care unit (ICU).
Methods: This was a retrospective cohort study of 726 patients who were admitted to the ICU with acute hypoxic respiratory failure secondary to COVID-19. The protocol of the institution recommended the use of awake PP in patients with nasal catheter with an oxygen flow ≥ 5 L/min and SpO2 ≤ 90% or a high-flow nasal catheter (HFNC) with FiO2 ≥ 50% and SpO2 ≤ 90%. The following data were collected: age, comorbidities, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, duration of invasive and noninvasive MV, HFNC therapy, nitric oxide therapy, hemodialysis and PP while spontaneously breathing.
Results: There was a higher mortality rate in the supine position group (27.1%) than in the awake PP group (13.9%). There was no significant difference in the time on MV or number of patients on MV (p>0.05). The variables with p < 0.05 in the bivariate analysis were entered into the Cox regression model. The model was adjusted for awake PP, sex, age, SAPS-3 score, onset of symptoms, the degree of pulmonary involvement, chronic arterial disease, and noninvasive ventilation. The only variable associated with lower mortality over time was awake PP (hazard ratio: 0.55; 95% confidence interval: 0.33-0.92).
Conclusion: Awake prone position has been shown to be a safe and effective therapy that reduced mortality but not the risk of intubation in patients with COVID-19.

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Poor clinical outcomes among hospitalized obese patients with COVID-19 are related to inflammation and not respiratory mechanics

Jordan N Edwards, Tomas Ganz, Elizabeta Nemeth, Emily J Martin, Nicholas J Jackson, Airie Kim

David Geffen School of Medicine, University of California Los Angeles, CA, USA

DOI: 10.2478/jccm-2025-0012

Introduction: The coronavirus disease 2019 (COVID-19) has infected millions of people worldwide resulting in high morbidity and mortality. Obesity is known to cause metabolic derangements and precipitate worse outcomes from viral pneumonia, potentially secondary to increased inflammation and/or altered respiratory mechanics.
Aim of the Study: Our study’s aim was to examine the relationships among BMI, systemic inflammation, and respiratory mechanics in determining clinical outcomes.
Materials and Methods: This retrospective, observational cohort study included 199 adult patients with confirmed COVID-19 who were hospitalized at a quaternary-referral academic health system. Data were manually extracted from electronic medical records, including baseline demographics and clinical profiles, inflammatory markers, measures of respiratory mechanics, and clinical outcomes. We used the rank-sum test to compare the distributions of BMI and inflammatory markers between those with and without specific clinical outcomes, and the Pearson correlation to measure the correlations between BMI and inflammatory markers or respiratory mechanics.
Results: Higher BMI was associated with worse clinical outcomes, including the need for Intensive Care Unit (ICU) admission, invasive mechanical ventilation (IMV), neuromuscular blockade, and prone positioning, particularly in male patients. Inflammation, as measured by C-reactive protein, lactate dehydrogenase (LDH), ferritin, and D-Dimer, was also increased in both male and female patients who required ICU admission, IMV, neuromuscular blockade, and prone positioning. However, only male patients had a positive correlation of LDH and D-Dimer levels with BMI. There was no correlation between BMI and respiratory mechanics, as measured by static compliance and the response to prone positioning.
Conclusions: Our findings suggest that the metabolic dysfunction and systemic inflammation seen in obesity, and not dysfunctional respiratory physiology, drive the negative clinical outcomes seen in this cohort of hospitalized COVID-19 patients.

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Risk factors and outcomes of critically ill pregnant COVID-19 patients: Experience from the first and second waves of the pandemic

Dita Aditianingsih1,2, Noor Hafidz1,2, Aino Nindya Auerkari1,2, Zarah Tin Cahyaningrum1,
El Nissi Leonard1, Chrisella Annabelle1

1 Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
2 Department of Anesthesiology and Intensive Care, Universitas Indonesia Hospital, Indonesia

DOI: 10.2478/jccm-2025-0008

Introduction: Understanding the association between risk factors and clinical outcomes of COVID-19 can lead to identifying suitable management strategies for reducing the mortality rate among maternal COVID-19 patients in the ICU.
Aim of the Study: This study aims to investigate the clinical outcomes and risk factors associated with pregnant and postpartum women diagnosed with COVID-19 and admitted to the intensive care unit (ICU) between May 2020 and September 2021.
Materials and Methods: This retrospective cohort study was conducted at the Universitas Indonesia Hospital. Secondary data was collected from the medical records to include all pregnant and postpartum women diagnosed with confirmed COVID-19 admitted to the hospital during the research period.
Results: The study included 113 patients and found that admission to the ICU, age, and gestational age significantly influenced clinical outcomes, with a mortality rate of 42.11% among ICU-admitted patients. Pre-existing comorbidities such as type-2 diabetes mellitus, congestive heart failure, and coronary artery disease were associated with ICU admission. Having at least one comorbidity was found to increase the mortality rate by six-fold.
Conclusions: The study emphasizes the importance of monitoring and evaluating maternal and fetal complications during COVID-19 infection, highlighting the need for multidisciplinary management involving intensivists, obstetricians, anesthesiologists, and infectious disease specialists. The findings underscore the significance of baseline health status in treatment planning and the potential for evidence-based interventions to improve maternal outcomes and pregnancy preservation. Further research is warranted to validate these results and enhance understanding of the underlying pathophysiology.

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