新型冠状病毒肺炎患者肺部超声特征

目的 评价新型冠状病毒肺炎(COVID-19)患者肺部超声特征,并探讨其临床应用价值.方法 回顾性分析2020年1月23日～2月25日成都市公共卫生临床医疗中心收治的26例COVID-19患者入院第1天的床旁肺超声及其相关临床资料,分析患者双肺10个扫查区域的"B线"、实变和"白肺"等病理性肺超声特征.依据国家卫生健康...     

床旁肺部超声评估对心脏术后早期肺实变和肺不张的诊断准确性研究

目的探讨床旁肺部超声对心脏术后早期肺实变和肺不张的诊断准确性。方法选取2014年9月至2015年8月四川大学华西医院心脏大血管外科行心脏大血管手术(包括冠状动脉旁路移植术、瓣膜置换术等)后1周之内出现呼吸衰竭的49例患者,其中男24例、女25例,年龄(54.4±13.2)岁。收集患者术后床旁肺部超声及胸部CT检查结果,进行对照、分析、总结。结果在肺实变和肺不张的诊断中,胸部CT诊断47例(95.9%)患者为阳性,肺部超声评估方案(BLUE方案)诊断45例(91.8%)患者为阳性,床旁肺部超声与胸部CT诊断一致率为95.9%。结论床旁肺部超声可作为筛查肺实变和肺不张的方法。     

急诊床边肺部超声改良方案对新型冠状病毒肺炎患者肺部病灶的评估价值

目的以胸部CT影像学为依据,探讨急诊床边肺部超声改良方案(BLUE-plus)评估新型冠状病毒肺炎(COVID-19)肺部病变的临床价值。方法对西安市COVID-19定点医院西安市胸科医院2020年1~2月收治的22例COVID-19确诊病例按BLUE-plus行肺部超声动态检查,并与胸部CT进行对比,分别采用Kappa检验和ROC曲线分析其一致性和诊断准确性。结果22例COVID-19确诊病例按照BLUE-plus进行肺超声检查可见病灶多分布于后蓝点、下蓝点垂直向后与同侧腋后线的交点(PLAPS点),BLUE-plus与胸部CT检查的一致性Kappa值为0.73(95%CI:0.442~1.018、P<0.001)。BLUE-plus发现肺部病变的灵敏度为94.7%,特异度为83.3%,准确度为93.2%。患者在COVID-19进展期超声图像特征为B线逐步变为小斑片状肺实变,逐渐加重为大片状实变,且实变病灶内支气管充气征逐渐减少。患者于COVID-19恢复期超声图像特征与进展期相反。结论BLUE-plus可用于评估COVID-19患者的肺部病变及动态变化,为临床判断患者病情进展与恢复提供动态信息。     

肺超声在不同临床分型新型冠状病毒肺炎中的应用

目的 探讨不同临床分型新型冠状病毒肺炎(COVID-19)的肺部超声声像图特点,为临床诊断与疗效评估提供参考.方法 回顾性分析2020年3月至7月首都医科大学附属北京地坛医院收治经临床确诊的COVID-19患者共39例,其中普通型13例、重型15例、危重型11例,均于入院时行床旁肺超声检查,观察入组患者肺部超声声像图特...     

武汉胸外科医护人员及手术患者新型冠状病毒感染防治临床实践

目的总结武汉市大型三甲医院胸外科防治新型冠状病毒(2019-nCoV,SARS-CoV-2)肺炎(COVID-19)的临床经验,提供可行的临床实践策略。方法回顾性分析2019年12月15日至2020年2月15日武汉市7家大型三甲医院胸外科确诊COVID-1941例患者的临床资料,其中手术患者20例,男10例、女10例,年龄(54.35±10.80)岁;医护人员21例,男7例、女14例,年龄(30.38±6.23)岁。结果COVID-19患者临床表现主要为发热(70.73%)和咳嗽(53.66%)。COVID-19患者外周血白细胞总数正常或减少,淋巴细胞计数减少,部分患者可出现C反应蛋白增高。COVID-19患者胸部CT早期呈现局限性磨玻璃影改变,以肺外带明显,进而发展为双肺多发浸润影,严重者出现肺实变。确诊时医护人员多为磨玻璃影及单侧病变,甚至肺部无明显异常。COVID-19确诊患者均及时转入隔离病房按国家卫生健康委员会《新型冠状病毒肺炎诊疗方案》规范治疗。随访截至2020年2月20日,手术患者出院7例(35.00%),死亡7例(35.00%),医护人员出院13例(61.90%),无死亡。结论武汉市医院胸外科COVID-19患者中,手术患者重症比例及死亡率明显高于普通人群。医护人员易院内感染。早期氧疗及呼吸支持有可能改善预后。COVID-19疫情期间应推迟择期或限期手术。严格把握急诊手术指征。急诊手术应按三级防护处理。胸外科有专科特殊性,若有确诊患者,全科人员应积极排查。早发现、早隔离、早诊断、早治疗是改善COVID-19预后的最佳防治措施。     

肺超声评分鉴别急性胰腺炎病情危重程度及预后评估

目的观察肺超声评分(LUS)鉴别急性胰腺炎(AP)病情危重程度及预后评估。方法前瞻性纳入2021年8月至2023年4月郑州大学第二附属医院重症医学科54例AP患者, 根据严重程度将其分为中度急性胰腺炎(MAP)组和重症急性胰腺炎(SAP)组。根据SAP组出院时预后情况将患者分为预后良好组与预后不良组, 于入院24 h内行肺部超声检查及实验室检查, 观察各指标组间差异, 绘制受试者工作特征(ROC)曲线, 采用DeLong检验比较曲线下面积(AUC), 检验LUS对AP患者病情严重程度及预后的评估价值。结果 MAP组LUS低于SAP组[(10.23±2.29)分比(15.15±3.18)分, t=-7.414, P<0.05];MAP组APACHE Ⅱ评分低于SAP组[(5.80±1.63)分比(10.71±3.28)分, t=-7.183, P<0.05];MAP组PCT低于SAP组[(1.24±0.51) ng/ml比(15.35±13.98) ng/ml, t=-5.539, P<0.05];MAP组Lac低于SAP组[(1.10±0.59) mmol/L比(6....     

肺超声评分评价肺保护性通气策略对老年开腹手术患者肺损伤的影响

目的通过肺超声评分探讨肺保护性通气策略减轻老年开腹手术患者肺损伤的作用。方法选择2019年8月至2020年6月择期开腹手术患者50例,男33例,女17例,年龄65～80岁,BMI 18～25 kg/m~2,ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:对照组(C组)和肺保护性通气组(P组),每组25例。所有患者常规麻醉诱导,采用容量控制的通气模式。C组设置V_T 8 ml/kg,不使用呼气末正压(PEEP);P组设置V_T 6 ml/kg, PEEP 6 cmH_2O,每间隔30 min给予手法肺复张。采用床旁超声评估患者双侧共12个区域的肺部超声,各区域分数累积为肺超声评分(LUS)。记录入室时(T_0)、麻醉诱导气管插管后5 min(T_1)、手术开始后2 h(T_2)、手术结束时(T_3)、气管导管拔除后15 min(T_4)、2 h(T_5)、术后1 d(T_6)的LUS评分、HR、MAP、SpO_2、PaO_2和PaCO_2。记录T_1—T_3时的氧合指数(PaO_2/FiO_2)、气道峰压(Ppeak)、吸气末平台压(Pplat)和驱动压力(ΔP)。记录术后7 d内肺部并发症(PPCs)的发生情况。结果与T_0时比较,T_1—T_5时C组和P组LUS评分明显升高(P0.05)。与T_1时比较,T_2—T_3时C组PaO_2/FiO_2明显降低(P0.05),P组ΔP明显降低(P0.05)。与C组比较,P组T_2—T_5时LUS评分明显降低(P0.05),T_2—T_3时PaO_2/FiO_2明显升高(P0.05)、ΔP明显降低(P0.05)。C组术后7 d内PPCs发生率为20%,P组未发生PPCs(P0.05)。结论床旁肺超声监测下,老年开腹手术患者在全麻期间和术后早期LUS评分升高,肺通气丢失。肺保护性通气策略可降低患者围术期的肺超声评分,减少肺通气损失,降低术后7 d的肺部并发症发生率。     

床旁肺部超声对胃肠癌根治术患者术后肺部并发症的预测价值

目的评价床旁肺部超声对胃肠癌根治术患者术后肺部并发症(PPCs)的预测价值。方法选取择期全身麻醉下行胃肠癌根治术患者108例, 性别不限, 年龄>18岁。于术前(T1 )、术后2、4和7 d(T2-4 )时行肺部超声检查, 记录肺部超声评分(LUS)、B线评分, 测定血清降钙素原(PCT)浓度, 并行血常规检查, 计算全身免疫炎症指数(SII)。于术前、术后7 d内行胸部CT检查, 以胸部CT及临床诊断结果为诊断PPCs的金标准。记录术后7 d内PPCs的发生情况。根据患者是否发生PPCs分为PPCs组和非PPCs组。采用Spearman相关分析评价B线评分、LUS与PPCs、SII、血清PCT浓度的相关性。绘制受试者工作特征(ROC)曲线评价LUS预测PPCs的准确性。结果最终纳103例患者, PPCs组45例, 非PPCs组58例, PPCs发生率为43.7%。T1时B线评分、LUS与PPCs呈正相关(P<0.001) , T2-4时B线评分、LUS均与PCT、SII呈正相关(P<0.001)。术前B线评分、LUB预测PPCs的曲线下面积(95%可信区间)分别为0...     

肺部超声在先天性心脏病手术超快通道麻醉中优化作用的随机对照研究北大核心CSCD

目的探讨肺部超声在先天性心脏病(先心病)手术超快通道麻醉中对肺部并发症的影响。方法选取2019年深圳市儿童医院先心病手术行超快通道麻醉的患者60例,其中男34例、女26例,年龄1个月至6岁。将患者随机分为常规组(N组,30例)和肺部超声优化组(L组,30例)。两组均采用相同的麻醉方法和麻醉药配伍。N组按超快通道麻醉,术后拔管送心外监护室(CCU);L组手术完毕,根据手术前、后肺部超声检查对比,发现B线融合、肺不张、肺支气管充气征等情况导致肺部超声评分(LUS)增加的患者,进行有针对性的优化处理,包括气管导管内吸痰、纤维支气管镜肺泡灌洗、手控膨肺吸痰、超声引导下肺复张等,再经肺部超声评估后拔管,送CCU。比较两组患者肺部并发症发生情况、LUS、氧合指数(OI)、拔管时间等。结果两组患者手术麻醉诱导前与术后拔管1 h后比较,肺部并发症发生率L组低于N组[18例(60.0%)vs.26例(86.7%),χ^(2)=4.17,P=0.040],L组LUS降低的患者比例高于N组[15例(50.0%)vs.7例(23.3%),χ^(2)=4.59,P=0.032]。所有患者各个时间点的LUS评分与OI值的相关性分析显示呈负相关(P<0.05)。L组拔管时间长于N组[(18.70±5.42)min vs.(13.47±4.73)min,P=0.001]。结论先心病超快通道麻醉通过肺部超声检查在拔管前进行相应的优化处理,可以显著降低术后肺部并发症发生率,改善术后肺部影像学表现,有助于患者术后康复,具有临床应用价值。     

肺部超声检查在围手术期麻醉管理中的应用进展

肺部超声(lung ultrasound, LUS)检查是一种重要的影像学检查, 它便捷、无辐射、准确性高、重复性好, 可以用于围手术期麻醉管理, 减少术后肺部并发症(postoperative pulmonary complications, PPC)。文章就近年来LUS在围手术期麻醉管理中的应用进行综述, 包括LUS对常见肺部疾病(如肺不张、胸腔积液、气胸和肺水肿)的评估, 利用肺部超声指导的液体管理(fluid administration limited by lung sonography, FALLS)方案、反FALLS方案来指导补液及利尿治疗, 在LUS下进行肺复张及呼气末正压(positive end-expiratory pressure, PEEP)滴定, 利用人工智能(artificial intelligence, AI)分析LUS图像。关于LUS的临床应用还需要进一步研究和探索, 以充分发挥其巨大的医学价值。     

Risk factors for infection and mortality among hemodialysis patients during COVID-19 pandemic

Purpose

The aim of this study was to evaluate risk factors for COVID-19 infection and mortality and to document if any relation exists between 25 (OH) Vitamin D and COVID-19 infection.

Methods

This retrospective study evaluated 151 HD patients. Patients infected with COVID-19 were compared to patients without the infection. Risk factors for intensive care unit (ICU) stay and mortality were analyzed. Deceased infected patients were also compared to patients who died due to other causes.

Results

The mean age of all HD patients was 57.15?±?15.73 years and 51.7% were male. The mean 25 (OH) Vitamin D level of all patients was 16.48?±?8.45 ng/ml. Thirty-five infected patients were significantly older, had a higher Charlson comorbidity index (CCI) score. They also had a higher number of patients with diabetic nephropathy, cerebrovascular accident (CVA) and coronary heart disease (CHD). Patients who needed to stay in ICU had higher CCI score, a higher number of patients with diabetic nephropathy, pulmonary diseases and had statistically significantly higher CRP levels. Deceased infected patients were significantly older, had higher CCI scores and lower PTH than survived infected patients. Deceased infected patients had lower PTH, but had significantly lower leukocyte, lymphocyte counts and urea levels at admission when compared to patients who died due to other causes. Patients with poor prognosis had lower neutrophil and lymphocyte counts before infection and at admission; respectively. 25 (OH) Vitamin D level was not related to the risk of COVID-19 infection, ICU stay or mortality.

Conclusion

Older age, higher CCI scores, diabetic nephropathy, CHD, CVA, pulmonary diseases, and lower neutrophil and lymphocyte counts were found as poor prognostic factors. The comparisons yielded no significant finding for 25 (OH) Vitamin D, acetylsalicylic acid, erythropoietin, intravenous iron, ACEI, ARBs, and dialysis adequacy parameters.

     

Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan,China

BackgroundPrevious studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations.ObjectiveTo evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients.Design, setting, and participantsA total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group.InterventionImmunosuppressant reduction and low-dose methylprednisolone therapy.Outcome measurements and statistical analysisThe clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis.Results and limitationsThe clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure.ConclusionsKidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations.Patient summaryImmunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.     

The sound of air: point-of-care lung ultrasound in perioperative medicine

Purpose

Lung ultrasound (LUS) has emerged as an effective and accurate goal-directed diagnostic tool that can be applied in real time for the bedside assessment of patients with respiratory symptoms and signs. Lung ultrasound has definite and easily recognized findings and has been shown to outperform physical examination and chest radiography for the diagnosis and monitoring of many pulmonary and pleural conditions. In this article, we review the principles of LUS image acquisition and interpretation, summarizing key terms and sonographic findings.

Principal findings

Although LUS is easy to learn, adequate training and performance in an organized fashion are crucial to its clinical effectiveness and to prevent harm. Therefore, we review normal LUS findings and propose step-wise approaches to the most common LUS diagnoses, such as pneumothorax, pleural effusion, interstitial syndrome, and lung consolidation. We highlight potential pitfalls to avoid and review a recently published practical algorithm for LUS use in clinical practice.

Conclusions

Because of the unique physical properties of the lungs, only a careful and systematic analysis of both artifacts and anatomical images allows accurate interpretation of sonographic findings. Future studies exploring the use of software for automatic interpretation, quantitative methods for the assessment of interstitial syndrome, and continuous monitoring devices may further simplify and expand the use of this technique at the bedside in acute medicine and the perioperative setting.

     

Routine Biomarkers for the Severity of COVID-19 Pneumonia May Present Differently in Kidney Transplant Recipients

BackgroundThe treatment of coronavirus disease 2019 (COVID-19) is based on the patient's clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in kidney transplant (KT) patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non–SARS-CoV-2 etiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID-19 pneumonia and those with non–COVID-19 pneumonia over the same period.MethodsBiomarkers were measured and compared between KT patients with COVID-19 pneumonia (n = 57) and non-COVID-19 pneumonia (n = 20) from March 2020 to March 2021.ResultsBoth groups showed comparable demographics. The KT patients with COVID-19 had fewer neutrophils (6824 ± 5000 vs 8969 ± 4206; P = .09) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non–COVID-19 pneumonia was associated with higher d-dimer (median, 921 [interquartile range (IQR), 495-1680] vs median, 2215 [IQR, 879-3934]; P = 0.09) and interleukin-6 (median, 35 [IQR, 20-128] vs median, 222 [IQR, 38-500]; P = 0.006) levels. The ferritin level was higher in the COVID-19 group (median, 809 [IQR, 442-1,330] vs median, 377 [IQR, 276-885]; P = 0.008). In multivariable analysis, only d-dimer (hazard ratio [HR], 1; 95% confidence interval [CI],1-1.002; P = .02) and ferritin (HR, 1; 95% CI, 0.9-0.9; P = .02) increase the statistic signification.ConclusionCOVID-19 pneumonia in KT patients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be useful to identify KT patients with COVID-19. More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.     

Early outcomes of lung resections in non-small cell lung cancer after COVID-19 pneumonia

ObjectiveThere is limited literature on patients with a history of COVID-19 pneumonia who underwent anatomical lung resection for non-small cell lung cancer (NSCLC). This study was aimed to share the early postoperative outcomes in patients who underwent lung resection after COVID-19 pneumonia.Materials and methodsWe retrospectively evaluated 30 patients who underwent lobectomy with thoracotomy and systematic mediastinal lymph node dissection due to NSCLC in a single center between November 2018 and September 2021. The patients were divided into two groups regarding COVID-19 pneumonia history; the COVID-19 group consisted of 14 patients (46.7%) and the non-COVID-19 group 16 (53.3%) patients. The patients’ age, gender, comorbidity, Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) value, tumor type and size, resection type, postoperative air leak duration, total drainage volume, drain removal time, postoperative complications, and length of stay (LOS) were recorded.Results9 (30%) patients were female, and 21 (70%) were male. The mean age was 62.1 ± 8.91 years. Our comparison of postoperative air leak duration, total drainage volume, time to drain removal, postoperative complications, and LOS between the COVID-19 and non-COVID-19 groups revealed no statistically significant difference.ConclusionAnatomical lung resection can be performed safely in NSCLC patients with a history of COVID-19 pneumonia without significant difference in early postoperative morbidity and mortality.     

COVID-19 in hemodialysis patients: a single-center experience in Istanbul

Objective

Coronavirus disease 2019 (COVID-19) causes a wide spectrum of symptoms, from asymptomatic conditions to severe inflammatory response. Hemodialysis (HD) patients have a higher risk for developing severe COVID-19 because of older age, multiple co-morbid conditions, and impaired immune system compared to the general population. As little is known about these special groups, we evaluated the clinical characteristics and outcomes of HD patients with COVID-19.

Methods

All hospitalized HD patients with COVID 19 between March 11, 2020 and May 31, 2020 were included in the study. The composite end-points consisted of admission to the intensive care unit (ICU), discharging or death were analysed. Demographic, clinical, laboratory, and treatment data were retrieved and compared between survivors and nonsurvivors.

Results

A total of 45 patients (median age 65.33?±?12.22, 24 female, 53.96?±?40.68) were enrolled and of whom 14 were admitted to ICU and overall 14 (31.1%) have died. Hypertension was the most common comorbidity and fever (60%), dyspnea (55.6%) and cough (53.3%) were predominant symptoms at admission. 8.8% of patients developed severe complications (acute respiratory distress syndrome, macrophage activation syndrome) and secondary infection was observed in 51.1% of the patients. Elevation in the level of inflammatory markers, lactate dehydrogenase, liver enzymes, troponin, creatine kinase, and decrease in lymphocyte count and serum albumin level were observed in non-survivors compared with survivors throughout the clinical course. No significant difference was observed in the score of chest CT performed on the day of hospitalization for the survivors and non-survivors.

Conclusion

Mortality of COVID-19 in HD patients is high and follow up of certain laboratory parameters can help to predict the prognosis of the patients.

     

Role of Lung Ultrasound in the Detection of Postoperative Pulmonary Complications in Pediatric Patients: A Prospective Observational Study

ObjectiveTo evaluate the incremental benefit of lung ultrasound (LUS) over clinical examination and chest x-rays (CXR) together (clinico-radiologic examination) for the diagnosis of postoperative pulmonary complications (PPC).DesignProspective observational study.SettingTertiary care center.ParticipantsOne hundred children after corrective congenital cardiac surgery with left-to-right shunts.InterventionParticipants were independently evaluated with clinico-radiologic examination by the treating team, as well as LUS by an investigator at 12, 24, 48, and 72 hours after surgery. After recording the diagnoses, the LUS findings were disclosed to the treating team and a final diagnosis was made. CXR scores and LUS scores were evaluated for their ability to predict PPC.Measurements and Main ResultsA total of 34 cases of PPCs were observed. Of these, 32 each were detected by clinico-radiologic examination and LUS alone. Addition of LUS improved total number of PPCs detected in the early postoperative period but not in the late postoperative period. Preoperative and early postoperative LUS scores were superior to CXR scores in predicting occurrence of PPC (area under receiver operating characteristics curve [AUROC] 0.920 v 0.732; p < 0.001 preoperatively; AUROC 0.987 v 0.858, p = 0.001 at 12 hours postoperatively). Multivariate analysis suggested LUS score as an independent predictor of PPC, and LUS score along with aortic cross-clamp time as independent predictors of duration of mechanical ventilation and intensive care unit stay.ConclusionsLUS improves identification of PPC over clinico-radiologic examination in the early postoperative period. Preoperative LUS scores have better predictive ability than CXR scores for the occurrence of PPC.     

COVID-19 Infection in Kidney Transplant Recipients: A Single Center Experience

BackgroundKidney transplant recipients appear to be particularly high risk for critical COVID-19 illness owing to chronic immunosuppression and coexisting conditions. The aim of this study is to present the clinical characteristics and outcomes of our hospital's kidney transplant recipients who were hospitalized due to COVID-19 infection.MethodsIn our retrospective observational study of COVID-19 PCR-positive patients, 31 of them were hospitalized with COVID-19 pneumonia and they were evaluated using demographics, laboratory data, treatment, and outcome. The prognostic nutritional index (PNI), which is calculated using the serum albumin concentration and total lymphocytic count, was also evaluated. The baseline immunosuppressive therapy of patients at the time of admission and the treatments they received during their hospitalization were recorded. All patients were treated with favipiravir.ResultsOf the 31 renal transplant patients with COVID-19 pneumonia, 20 were male and the mean age was 52.7 ± 13.4. Nine (29%) of the patients died. All patients were treated with favipiravir for 5 days; laboratory tests were recorded before and after treatment. The mean PNI of the patients who survived was higher than the patients who died.ConclusionsThe 9 patients who died had lower PNI and higher neutrophil-to-lymphocyte ratio (NLR), creatinine, l-lactate dehydrogenase (LDH), ferritin, and C-reactive protein (CRP) levels. Hospitalized kidney transplant recipients with COVID-19 have higher rates of mortality. The PNI exhibited good predictive performance and may be a useful clinical marker that can be used for estimating survival in COVID-19 patients.     

Impact of COVID-19 on volume of elective and nonelective ventral hernia repair

BackgroundThe significant decrease in elective surgery during the COVID-19 pandemic prompted fears that there would be an increase in emergency or urgent operations for certain disease states. The impact of COVID-19 on ventral hernia repair is unknown. This study aimed to compare volumes of elective and nonelective ventral hernia repairs performed pre–COVID-19 with those performed during the COVID-19 pandemic.MethodsAn analysis of a prospective database from 8 hospitals capturing patient admissions with the International Classification of Diseases, Tenth Revision Procedure Coding System for ventral hernia repair from January 2017 through June 2021 were included. During, COVID-19 was defined as on or after March 2020.ResultsComparing 3,558 ventral hernia repairs pre–COVID-19 with 1,228 during COVID-19, there was a significant decrease in the mean number of elective ventral hernia repairs per month during COVID-19 (pre–COVID-19: 61 ± 5 vs during COVID-19 19: 39 ± 11; P < .001), and this persisted after excluding the initial 3-month COVID-19 surge (61 ± 5 vs 42 ± 9; P < .001). There were fewer nonelective cases during the initial 3-month COVID-19 surge (32 ± 9 vs 24 ± 4; P = .031), but, excluding the initial surge, there was no difference in nonelective volume (32 ± 9 vs 33 ± 8; P = .560).During COVID-19, patients had lower rates of congestive heart failure (elective: 9.0% vs 6.6%; P = .0047; nonelective: 17.7% vs 11.6%; P < .001) and chronic obstructive pulmonary disease (elective: 13.7% vs 10.2%; P = .017; nonelective: 17.9% vs 12.0%; P < .001) and underwent fewer component separations (10.2% vs 6.4%; P ≤ .001). Intensive care unit admissions decreased for elective ventral hernia repairs (7.7% vs 5.0%; P = .016). Length of stay, cost, and readmission were similar between groups.ConclusionElective ventral hernia repair volume decreased during COVID-19 whereas nonelective ventral hernia repairs transiently decreased before returning to baseline. During COVID-19, patients appeared to be lower risk and less complex. The possible impact of the more complex patients delaying surgery is yet to be seen.