Search Results (1,235)

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Background: Osteogenesis imperfecta (OI) is a rare genetic connective tissue disorder characterized by bone fragility, most often caused by pathogenic variants in type I collagen genes. In this context, we aimed to describe the clinical and epidemiological characteristics of patients with OI who were hospitalized for coronavirus disease (COVID)-19 in Brazil between 2020 and 2024. Methods: We conducted a retrospective descriptive analysis using data from the Brazilian Unified Health System (SUS, which stands for the Portuguese Sistema Único de Saúde) through the Open-Data-SUS platform. Patients with a confirmed diagnosis of OI and hospitalization due to COVID-19 were included. Descriptive statistical analysis was performed to evaluate demographic, clinical, and outcome-related variables. We included all hospitalized COVID-19 cases with a confirmed diagnosis of OI between 2020 and 2024. Results: Thirteen hospitalized patients with OI and COVID-19 were identified. Most were adults (9; 69.2%), male (7; 53.8%), self-identified as White (9; 69.2%), and all were residents of urban areas (13; 100.0%). The most frequent symptoms were fever (10; 76.9%), cough (9; 69.2%), oxygen desaturation (9; 69.2%), dyspnea (8; 61.5%), and respiratory distress (7; 53.8%). Two patients had heart disease, one had chronic lung disease, and one was obese. As for vaccination status, five patients (38.5%) had been vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Four patients (30.8%) required admission to an intensive care unit (ICU), and six (46.2%) required noninvasive ventilatory support. Among those admitted to the ICU, only two required invasive mechanical ventilation. The clinical outcome was death in two cases (15.4%). Both patients were male, White, and had not been vaccinated against SARS-CoV-2. One was 47 years old, was not admitted to the ICU, but required noninvasive ventilation. Despite the underlying condition most patients had favorable outcomes, consistent with an international report. Conclusions: This is the first report to describe the clinical and epidemiological profile of patients with OI hospitalized for COVID-19 in Brazil, providing initial insights into how a rare bone disorder intersects with an acute respiratory infection. The generally favorable outcomes observed—despite the underlying skeletal fragility—suggest that individuals with OI are not necessarily at disproportionate risk of severe COVID-19, particularly when appropriately monitored. The occurrence of deaths only among unvaccinated patients underscores the critical role of SARS-CoV-2 vaccination in this population. Although pharmacological treatment data were unavailable, the potential protective effects of bisphosphonates and vitamin D merit further exploration. These findings support the need for early preventive strategies, systematic vaccination efforts, and dedicated clinical protocols for rare disease populations during infectious disease outbreaks. Full article

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of seropositivity. Predictions of final mortality burden under an alternate policy scenario for Japan were calculated and the COVID-19 outcomes for China were assessed. Results: By 2025, Western countries (US, UK, Brazil and Italy) had cumulative mortality rates in the range of 3339–3548 deaths per million, about 6-fold higher than East Asian and New Zealand ‘zero-COVID’ countries. Moderate virus suppression in Japan produced the lowest cumulative mortality of the countries analyzed; if earlier policies had been maintained, the predicted cumulative mortality rate by 2025 would be one-tenth that of the US, UK, Brazil and Italy and one-half to one-third that of other zero-COVID countries. For China, transitioning from a zero-COVID policy in 2022–2023, the estimated 2025 cumulative mortality was 1607/million, half that of Western countries. Conclusions: To minimize COVID-19 mortality would require: (1) Innovation on systematic sampling of ambient airborne virus exposure to sustain low but non-zero virus levels across entire populations, and (2) seropositivity assessment (instead of mass PCR testing for new cases) for calibrating exposure management, and tracking and protecting high-risk populations. Full article

Background: Myocarditis and pericarditis are recognised risks following COVID-19 vaccination, including the mRNA-1273 vaccine. Most cases occur shortly following the second dose of this vaccine, and incidence is highest among young males. However, little is known about risk factors beyond age and sex and about the longer-term clinical course. This study aims to identify possible risk factors for myocarditis and pericarditis following mRNA-1273 vaccination, to characterise the clinical course of myocarditis and pericarditis, both associated with mRNA-1273 vaccination and not associated with vaccination, and to identify risk factors for severe outcomes (i.e., cardiac or thromboembolic complications, severe hospital outcomes, all-cause hospital readmission, and death). Methods: This study is being conducted within the Vaccine Monitoring Collaboration for Europe (VAC4EU) association using routinely collected healthcare data from five data sources from four European countries (Denmark, Norway, Spain, and the United Kingdom). The study is being performed using a common data model, and all analyses are performed separately in each data source in a federated manner following a common protocol. A case–cohort analysis set is identified within each data source for identifying potential risk factors for myocarditis and pericarditis following mRNA-1273 vaccination using logistic regression analysis. The clinical course of myocarditis and pericarditis is being assessed using a cohort study design and describes all cases (i.e., cases associated with mRNA-1273 and unexposed cases). Cox regression analysis is applied to assess the associations between risk factors and several follow-up outcomes. Conclusions: This protocol describes the study methodology of an international collaborative initiative with the aim of assessing the risk factors and clinical course of myocarditis and pericarditis following mRNA-1273 vaccination using a federated network of five European data sources. Full article

Invasive pneumococcal disease (IPD) is a serious infection caused by the bacterium Streptococcus pneumoniae (pneumococcus) that can produce a wide spectrum of clinical manifestations. The aim of this study was to analyze the comorbidity factors that influenced the mortality in patients with diabetes (D) according to IPD. A retrospective study to analyze patients with D and IPD was carried out. Based on the discharge reports from the Spanish Minimum Basic Data Set (MBDS) from 1997 to 2022, the Elixhauser Comorbidity Index (ECI) and the Charlson Comorbidity Index (CCI) were calculated to predict in-hospital mortality (IHM) in Spain. A total of 12,994,304 patients with D were included, and 84,601 cases of IPD were identified. The average age for men was 70.23 years and for women 73.94 years. In all years, ECI and CCI were larger for type 2 D than for type 1 D, with men having a higher mean than women. An association was found between risk factors ECI, age, type 1 D, COVID-19, IPD (OR = 1.31; 95% CI: 1.29–1.35; p < 0.001); CCI, age, type 1 D, COVID-19, IPD (OR = 1.45; 95% CI: 1.42–1.49; p < 0.001), and increased mortality. The IHM increased steadily with the number of comorbidities and index scores from 1997 to 2022. D remains a relevant cause of hospitalization in Spain. Comorbidities reflected a great impact on patients with D and IPD, which would mean a higher risk of mortality. Predicting mortality events and length of stay by comparing indices showed that CCI outperforms ECI in predicting inpatient death after IPD. Full article

Background and Objectives: Schizophrenia is a disabling psychiatric condition, affecting around 1% of people worldwide. It has been ranked among the ten most disabling conditions globally. Alongside the psychological and social burdens imposed on individuals suffering from this disease, there are also serious complications regarding the physical health of these patients. Pneumonia is a significant cause of death in patients with schizophrenia. This group of patients also has a higher risk of developing pneumonia and all-cause mortality compared to those without schizophrenia, along with an increased overall mortality rate. A retrospective study revealed that advanced age, underweight, smoking, and the use of high-dose atypical antipsychotics increase the risk of pneumonia-related mortality in hospitalized patients. Our study aims to examine differences in factors associated with pneumonia in hospitalized patients with schizophrenia, before and after the COVID-19 pandemic, as well as to identify potential changes in clinical characteristics and outcomes. Materials and Methods: This is an observational, retrospective analysis, based on the review of medical records of psychiatric inpatients diagnosed with schizophrenia according to the DSM-5 criteria. Patients were selected according to the following criteria: both schizophrenia and pneumonia diagnoses, hospitalized in Spitalul Clinic de Psihiatrie si Neurologie Brasov during 1 March 2018–1 March 2020, and 1 March 2022–1 March 2024, respectively. Results: A total of 27 patients met the inclusion criteria; 13 patients (48%) were in the pre-pandemic group and 14 patients (52%) in the post-pandemic group. Contrary to other reports, our results showed relatively low pneumonia rates in hospitalized schizophrenia patients (1.02% pre-pandemic and 1.63% post-pandemic), and rates were higher in female patients (61.54% pre-pandemic and 71.43% post-pandemic). Post-pandemic, most cases (42.86%) were registered during summer, in a schizophrenia population with mostly urban residence and with lower smoking rates than the pre-pandemic group. Physical restraints were, however, more frequently utilized in the post-pandemic group. Conclusions: Pneumonia risk factors might register a change in the post-pandemic years. Polypharmacy and physical restraints are probably underestimated risk factors for pneumonia in schizophrenia patients, while a multidisciplinary approach and preventive measures might exert a protective role. Full article

COVID-19 continues to spread six years after its discovery. Cancer patients are at an increased risk of severe outcomes, likely due to immunosuppression and tumor-related dysregulation. Programmed cell death protein 1 (PD-1), encoded by the PDCD1 gene, is a critical immune checkpoint involved in T-cell regulation. Since genetic polymorphisms can influence immune responses and individual susceptibility to SARS-CoV-2 infection, this case–control study aimed to investigate the association between the PDCD1 rs41386349 polymorphism and COVID-19 severity in individuals with and without cancer. This study included 279 COVID-19-positive and 160 negative individuals, genotyped by qPCR. COVID-19- positive cancer patients were significantly more likely to develop moderate (OR = 13.6) and severe (OR > 200) disease compared to cancer-negative individuals. No association was observed between the PDCD1 polymorphism and SARS-CoV-2 infection or disease severity, even after adjusting for cancer status, age and sex. However, age and sex were independently associated with severe outcomes: each additional year of age increased the odds of severe disease by 5.3%, and male patients had a three times higher risk of severe COVID-19. These findings confirm that cancer, male sex and older age are major predictors of worse prognosis in COVID-19, while the rs41386349 polymorphism alone does not appear to influence susceptibility or disease progression. Full article

Background: The aim of the study is to determine whether environmental and climatic factors (air quality, precipitation rates, and air temperatures) alongside specific public health measures (social distancing and vaccination) have influenced total number of SARS CoV-2 positive cases (TOTAL CASES) and deaths (TOTAL DEATHS) from COVID-19 infection in the Republic of Serbia (RS). Method: An observational, retrospective study was conducted, covering the following three-year period in the RS: I (1 March 2020–1 March 2021); II (1 March 2021–1 March 2022); and III (1 March 2022–1 March 2023). Air quality was expressed as the values of the air quality index (AQI) and the concentrations of particulate matter 2.5 µm (PM_2.5). Precipitation rates (PREC) were expressed as the average monthly amount of rainfall (mm), while average air temperatures (AIR TEMP) were expressed in °C. Data were collected from relevant official and publicly available national and international resources. Data regarding the COVID-19 pandemic were collected from the World Health Organization. Results: No differences between the periods were observed for the average values of AIR TEMP (11.2–12.2 °C), PREC (56.1–66.8 mm), and AQI (57.2–58.8), while the average values of PM_2.5 significantly decreased in the III period (21.2 compared to 25.2, p = 0.03). Both TOTAL CASES and TOTAL DEATHS from COVID-19 infection showed positive correlation with the AQI and PM_2.5 and a negative correlation with the AIR TEMP. The correlation coefficient was strongest between TOTAL DEATHS and the AIR TEMP in the II period (r = −0.7; p = 0.007). The extent of rainfall and vaccination rates did not affect any of the observed variables. No differences in TOTAL CASES and TOTAL DEATHS were observed between the periods of increased social measures and other months, while both statistically significantly increased during the vaccination period compared to months without the vaccination campaign (p < 0.02, for both). Conclusions: Air quality, more precisely AQI and PM_2.5 and average air temperatures, but no precipitation rates, influenced the number of TOTAL CASES and TOTAL DEATHS from COVID-19 infection. These were the highest during the vaccination period, but vaccination could be considered as a confounding factor since the intensive vaccination campaign was conducted during the most severe phase of the COVID-19 pandemic. Social distancing measures did not reduce the number of TOTAL CASES or TOTAL DEATHS during the COVID-19 pandemic. Full article

COVID-19 mortality is a complex phenomenon influenced by multiple factors. This study aimed to identify factors associated with death in COVID-19 patients by considering clinical, demographic, environmental, and socioeconomic conditions, using machine learning models and a national dataset from Mexico covering all pandemic waves. We integrated data from the national COVID-19 dataset, municipal-level socioeconomic indicators, and water quality contaminants (physicochemical and microbiological). Patients were assigned to one of four datasets (groundwater, lentic, lotic, and coastal) based on their municipality of residence. We trained XGBoost models to predict patient death or survival on balanced subsets of each dataset. Hyperparameters were optimized using a grid search and cross-validation, and feature importance was analyzed using SHAP values, point-biserial correlation, and XGBoost metrics. The models achieved strong predictive performance (F1 score > 0.97). Key risk factors included older age (≥50 years), pneumonia, intubation, obesity, diabetes, hypertension, and chronic kidney disease, while outpatient status, younger age (<40 years), contact with a confirmed case, and care in private medical units were associated with survival. Female sex showed a protective trend. Higher socioeconomic levels appeared protective, whereas lower levels increased risk. Water quality contaminants (e.g., manganese, hardness, fluoride, dissolved oxygen, fecal coliforms) ranked among the top 30 features, suggesting an association between environmental factors and COVID-19 mortality. Full article

Severe Acute Respiratory Syndrome (SARS) represents a significant cause of morbidity and mortality in children under one year of age, a particularly vulnerable population due to immunological and respiratory immaturity. The diverse etiology includes multiple respiratory viruses such as Respiratory Syncytial Virus (RSV), influenza, rhinovirus, and SARS-CoV-2, each with distinct potential to cause severe illness and death. Understanding the specific incidence and lethality by etiological agents in the recent Brazilian context (2024), after the COVID-19 pandemic, is essential to guide surveillance and public health strategies. This study aimed to analyze the risk of incidence and lethality by specific etiology of SARS in children under one year of age hospitalized in Brazil during the year 2024. A descriptive cross-sectional study was performed using secondary data from the 2024 Influenza Epidemiological Surveillance Information System (SIVEP-Gripe), obtained via OpenDataSUS. Reported cases of SARS hospitalized in children <1 year of age in Brazil were included. Distribution by final classification and epidemiological week (EW) was analyzed; the incidence rate by Federative Unit (FU) (cases/100,000 < 1 year) with risk classification (Low/Moderate/High) was assessed; and, for cases with positive viral RT-PCR, the etiological frequency and virus-specific lethality rate (deaths/total cases of etiology ×100), also with risk classification, were extracted. A multivariate logistic regression model was performed for the risk factors of death. A total of 66,170 cases of SARS were reported in children under 1 year old (national incidence: 2663/100,000), with a seasonal peak between April and May. The majority of cases were classified as “SARS due to another respiratory virus” (49.06%) or “unspecified” (37.46%). Among 36,009 cases with positive RT-PCR, RSV (50.06%) and rhinovirus (26.97%) were the most frequent. The overall lethality in RT-PCR-positive cases was 1.28%. Viruses such as parainfluenza 4 (8.57%), influenza B (2.86%), parainfluenza 3 (2.49%), and SARS-CoV-2 (2.47%) had higher lethality. The multivariate model identified parainfluenza 4 (OR = 6.806), chronic kidney disease (OR = 3.820), immunodeficiency (OR = 3.680), Down Syndrome (OR = 3.590), heart disease (OR = 3.129), neurological disease (OR = 2.250), low O₂ saturation (OR = 1.758), SARS-CoV-2 (OR = 1.569) and respiratory distress (OR = 1.390) as risk factors for death. Cough (OR = 0.477) and RSV (OR = 0.736) were associated with a lower chance of death. The model had good calibration (Hosmer–Lemeshow p = 0.693) and overall significance (p < 0.001). SARS represented a substantial burden of hospitalizations, with marked seasonal and geographic patterns. RSV and rhinovirus were the main agents responsible for the volume of confirmed cases but had a relatively low to moderate risk of lethality. In contrast, less frequent viruses such as parainfluenza 4, influenza B, parainfluenza 3, and SARS-CoV-2 were associated with a significantly higher risk of death. These findings highlight the importance of dissociating frequency from lethality and reinforce the need to strengthen etiological surveillance, improve diagnosis, and direct preventive strategies (such as immunizations) considering the specific risk of each pathogen for this vulnerable population. Full article

Background: Professional knowledge and experience of healthcare organization went through continuous change and development with the progression of COVID-19 pandemic waves. However, carefully developed guidelines for cardiopulmonary resuscitation (CPR) remained largely unchanged regardless of the epidemic situation, with the largest change being a more prominent bioethical approach. It would be possible to further improve the quality of CPR by systematic data collection, the facilitation of prospective studies, and further development of the methodology based on this evidence, as well as by providing information and developing provisions on interventions with expected poor outcomes, and ultimately by refusing resuscitation. Methods: This study involved the critical collection and analysis of literary data originating from the Web of Science and PubMed databases concerning bioethical aspects and the efficacy of CPR during the COVID-19 pandemic. Results: According to the current professional recommendation of the European Resuscitation Council (ERC), CPR should be initiated immediately in case of cardiac arrest in the absence of an exclusionary circumstance. One such circumstance is explicit refusal of CPR by a well-informed patient, which in practice takes the form of a prior declaration. ERC prescribes the following conjunctive conditions for do-not-attempt CPR (DNACPR) declarations: present, real, and applicable. It is recommended to take the declaration as a part of complex end-of-life planning, with the corresponding documentation available in an electronic database. The pandemic has brought significant changes in resuscitation practice at both lay and professional levels as well. Incidence of out-of-hospital resuscitation (OHCA) did not differ compared to the previous period, while cardiac deaths in public places almost halved during the epidemic (p < 0.001) as did the use of AEDs (p = 0.037). The number of resuscitations performed by bystanders and by the emergency medical service (EMS) also showed a significant decrease (p = 0.001), and the most important interventions (defibrillation, first adrenaline time) suffered a significant delay. Secondary survival until hospital discharge thus decreased by 50% during the pandemic period. Conclusions: The COVID-19 pandemic provided a significant impetus to the revision of guidelines. While detailed methodology has changed only slightly compared to the previous procedures, the DNACPR declaration regarding self-determination is mentioned in the context of complex end-of-life planning. The issue of safe environment has come to the fore for both lay and trained resuscitators. Future Directions: Prospective evaluation of standardized methods can further improve the patient’s autonomy and quality of life. Since clinical data are controversial, further prospective controlled studies are needed to evaluate the real hazards of aerosol-generating procedures. Full article

Background: Immunomodulatory treatments targeting excessive host immune responses favorably shifting the course of COVID-19. High doses of calcifediol may reduce the mortality of this infection. Objective: To evaluate how a high dose of calcifediol modifies the risk of death in patients hospitalized with COVID-19 during the first outbreaks. Design: A retrospective, observational study to evaluate the relationship between treatment with calcifediol and the risk of death in patients hospitalized with COVID-19 at the “Complejo Hospitalario Universitario de Albacete” (CHUA), Spain, during the months of January to March 2021. Patients were treated with corticosteroids, and some patients also received baricitinib and/or high doses of calcifediol, according to CHUA’s therapeutic protocol 2021 for COVID-19. The primary outcome measure was mortality according to calcifediol treatment. Results: A total of 230 patients were included. 25(OH)D levels were measured on admission in 148 patients, showing a high prevalence of vitamin D deficiency [median 25(OH)D: 17.5 ng/mL]. Thirty-four (23%) had severe deficiency (25(OH)D ≤ 10 ng/mL). In the 119 patients (51.7%) who received in-hospital treatment with a high dose of calcifediol, the mortality rate was 12.6% (15 cases, 95% confidence interval [CI], 7.8–19.8%), while in 111 patients who did not receive treatment with calcifediol, the death rate was 23.4% (26 cases, 95% CI: 16.5–32.1%; p = 0.039). The odds ratio (OR) in treated vs. untreated patients was 0.47 (95% CI: 0.23–0.95). Among the patients admitted with severe deficiency, 16 received treatment with calcifediol, with a mortality rate of 0.0% (0 cases, 95% CI: 0.0–19.4%), while in the 18 not treated with calcifediol, a death rate of 38.9% was observed (7 cases, 95% CI: 20.3–61.4%; p = 0.008). The mortality rate was lower in patients treated with the combination of calcifediol and corticosteroids vs. those treated with corticosteroids alone (p = 0.038) and vs. those treated with corticosteroids and baricitinib (p = 0.033). Conclusions: In the ALBACOVIDIOL study, calcifediol treatment was associated with a lower observed mortality rate in hospitalized patients with COVID-19 treated with corticosteroids (with or without baricitinib), especially in those with severe vitamin D deficiency. Causality cannot be inferred due to the retrospective study design. (Public database: ClinicalTrials.gov, NCT05819918). Full article

The introduction of COVID-19 vaccinations has significantly altered the course of the pandemic by markedly reducing the number of severe infection cases, hospitalizations, and deaths due to COVID-19. Elderly individuals constitute a particularly vulnerable group at risk of severe disease progression, which is often related to decreased immune system effectiveness and comorbidities. Severe infection outcomes in vaccinated individuals, though substantially rarer than in the unimmunized population, can still lead to death due to underlying health conditions. This analysis aims to describe the population of elderly individuals who, despite being vaccinated, died from interstitial pneumonia complicating SARS-CoV-2 infection. Data on the infection course and co-existing diseases were obtained from the database of the Józef Struś Multispecialty City Hospital in Poznań, which was converted into a dedicated facility during the pandemic. The inclusion criteria for the analysis were being over 60 years of age on the day of hospital admission, confirmed pneumonia in radiological examination, COVID-19 infection confirmed by PCR test, and an adverse disease course resulting in death. Patients admitted to the hospital from 1 June 2021 to 31 December 2021 were analyzed. Out of all hospitalizations, only 18 individuals met the inclusion criteria. Given the small number of patients, the authors employed descriptive methods to illustrate the clinical states of the individual patients, presenting SARS-CoV-2 infection in the context of co-existing diseases that significantly affect prognosis. The qualitative analysis employed highlights the complex and multidimensional courses of severely ill COVID-19 patients more emphatically. Full article

Background/Objectives: The clinical forms of coronavirus disease 2019 (COVID-19) vary widely in severity, ranging from asymptomatic or moderate cases to severe pneumonia that can lead to acute respiratory failure, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and death. Our main objective was to determine the prevalence of bacterial and fungal secondary infections in an intensive care unit (ICU). Secondary objectives included analyzing the impact of these infections on mortality and medical resource utilization, as well as assessing antimicrobial resistance in this context. Methods: We conducted a retrospective cohort study that included critically ill severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients treated in an ICU and analyzed the prevalence of co-infections and superinfections. Results: A multivariate analysis of mortality found that the presence of superinfections increased the odds of death by more than 15-fold, while the Sequential Organ Failure Assessment (SOFA) score and C-reactive protein (adjusted for confounders) increased the odds of mortality by 51% and 13%, respectively. The antibiotic resistance profile of microorganisms indicated a high prevalence of resistant strains. Carbapenems, glycopeptides, and oxazolidinones were the most frequently used classes of antibiotics. Among patients, 27.9% received a single antibiotic, 47.5% received two from different classes, and 24.4% were treated with three or more. Conclusions: The incidence and spectrum of bacterial and fungal superinfections are higher in critically ill ICU patients, leading to worse outcomes in COVID-19 cases. Multidrug-resistant pathogens present significant challenges for ICU and public health settings. Early screening, accurate diagnosis, and minimal use of invasive devices are essential to reduce risks and improve patient outcomes. Full article

Background: This study investigated hematological and biochemical parameters, including cell population data (CPD), to evaluate their association with severity in COVID-19 and non-COVID-19 patients. Identifying these parameters could aid in disease monitoring and clinical decision-making. Methods: A retrospective analysis of 8401 patients, including 603 COVID-19 cases and 7546 non-COVID-19 cases, were conducted. Complete blood count (CBC) and routine chemistry results obtained near the time of real-time polymerase chain reaction testing were analyzed to assess their associations with disease severity. A matched cohort analysis was performed to adjust for potential confounding factors, such as age and sex. Results: COVID-19 patients with elevated neutrophil side fluorescence light (NE-SFL), platelet-to-lymphocyte ratio (PLR), glucose, and aspartate aminotransferase (AST), along with decreased plateletcrit, were more likely to experience severe outcomes, such as hospitalization or death. In addition, decreased hemoglobin, lymphocyte side scatter (LY-SSC), and albumin, as well as increased leukocyte and monocyte side scatter (MO-SSC), were associated with a greater severity, regardless of COVID-19 status. Conclusions: We identified hematologic and chemical assay biomarkers that correlate with severe COVID-19. These findings may provide important information regarding the disease progression and clinical management. Incorporating these biomarkers into clinical decision support systems could facilitate personalized treatment strategies, optimize resource allocation, and enable real-time severity stratification. Full article