Fulminant onset COVID-19: predictors and outcome.

Autor:	Sathiavageesan S; Nephrology, Sundaram Hospital, Tiruchirapalli, Tamil Nadu, India.; Global Clinical Scholar Research Training, Harvard Medical School, Boston, Massachusetts, USA., Sundaram V; Internal Medicine, Sundaram Hospital, Trichy, Tamil Nadu, India., Sundaram N; Emergency Medicine, Sundaram Hospital, Trichy, Tamilnadu, India., Shanmugam VB; Cardiology, Sundaram Hospital, Trichy, Tamilnadu, India., Selvaraj J; Internal Medicine, Sundaram Hospital, Trichy, Tamil Nadu, India., Vivek N; Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India., Ravi GK; Nephrology, Sundaram Hospital, Tiruchirapalli, Tamil Nadu, India., Velan M; Internal Medicine, Sundaram Hospital, Trichy, Tamil Nadu, India., Palaniappan C; Nephrology, Sundaram Hospital, Tiruchirapalli, Tamil Nadu, India., Singaravelu V; Internal Medicine, Sundaram Hospital, Trichy, Tamil Nadu, India., Shanmugam MP; Internal Medicine, Sundaram Hospital, Trichy, Tamil Nadu, India.
Jazyk:	angličtina
Zdroj:	Postgraduate medical journal [Postgrad Med J] 2022 Oct 01; Vol. 98 (1164), pp. 742-749.
DOI:	10.1136/postgradmedj-2022-141724
Abstrakt:	Purpose: During COVID-19 infection, organ dysfunction such as respiratory failure tends to occur towards the second week of illness; however, in a subset, there may be rapid onset of organ dysfunction as early as symptom onset. We define fulminant onset COVID-19 as rapid onset of organ dysfunction such as acute respiratory failure, acute kidney injury, acute encephalopathy or shock within 4 days of symptom onset. Fulminant onset COVID-19 has not yet been systematically studied. We aimed to identify predictors and prognosis of fulminant onset COVID-19. Methods: This retrospective study was carried out on patients admitted to a single referral hospital in South India between June 2020 and January 2022. Patients were categorised into fulminant and non-fulminant onset COVID-19. Candidate predictors for fulminant onset were chosen by an intuitive approach and analysed using logistic regression. Then, the outcome of fulminant onset COVID-19 at 30 days was studied. Results: Out of 2016 patients with confirmed COVID-19, 653 (32.4%) had fulminant onset COVID-19. Age>60 years (a-OR 1.57, 95% CI 1.30 to 1.90, p<0.001), hypertension (a-OR 1.29, 95% CI 1.03 to 1.61, p=0.03) and immune-suppressed state (a-OR 5.62, 95% CI 1.7 to 18.7, p=0.005) were significant predictors of fulminant onset COVID-19. Complete vaccination lowered the odds of fulminant onset COVID-19 significantly (a-OR 0.61, 95% CI 0.43 to 0.85, p=0.004). At 30 days, the fulminant onset COVID-19 group had higher odds of mortality and need for organ support. Conclusion: Fulminant onset COVID-19 is not uncommon and it carries poor prognosis and deserves recognition as a distinct phenotype of COVID-19. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu