ObjectivesTo identify factors influencing the mortality risk in critically ill patients with COVID-19, and to develop a risk prediction score to be used at admission to intensive care unit (ICU).DesignA multicentre cohort study.Setting and participants1542 patients with COVID-19 admitted to ICUs in public hospitals of Abu Dhabi, United Arab Emirates between 1 March 2020 and 22 July 2020.Main outcomes and measuresThe primary outcome was time from ICU admission until death. We used competing risk regression models and Least Absolute Shrinkage and Selection Operator to identify the factors, and to construct a risk score. Predictive ability of the score was assessed by the area under the receiver operating characteristic curve (AUC), and the Brier score using 500 bootstraps replications.ResultsAmong patients admitted to ICU, 196 (12.7%) died, 1215 (78.8%) were discharged and 131 (8.5%) were right-censored. The cumulative mortality incidence was 14% (95% CI 12.17% to 15.82%). From 36 potential predictors, we identified seven factors associated with mortality, and included in the risk score: age (adjusted HR (AHR) 1.98; 95% CI 1.71 to 2.31), neutrophil percentage (AHR 1.71; 95% CI 1.27 to 2.31), lactate dehydrogenase (AHR 1.31; 95% CI 1.15 to 1.49), respiratory rate (AHR 1.31; 95% CI 1.15 to 1.49), creatinine (AHR 1.19; 95% CI 1.11 to 1.28), Glasgow Coma Scale (AHR 0.70; 95% CI 0.63 to 0.78) and oxygen saturation (SpO2) (AHR 0.82; 95% CI 0.74 to 0.91). The mean AUC was 88.1 (95% CI 85.6 to 91.6), and the Brier score was 8.11 (95% CI 6.74 to 9.60). We developed a freely available web-based risk calculator (https://icumortalityrisk.shinyapps.io/ICUrisk/).ConclusionIn critically ill patients with COVID-19, we identified factors associated with mortality, and developed a risk prediction tool that showed high predictive ability. This tool may have utility in clinical settings to guide decision-making, and may facilitate the identification of supportive therapies to improve outcomes.

BackgroundEnd-stage renal disease (ESRD) is a major health problem worldwide that is increasing in incidence, prevalence, and cost. Both the disease itself and negative illness perceptions negatively affect patients' health-related quality of life (HRQoL), morbidity, and mortality. This study assessed the relationship between illness perception and HRQoL. MethodsThis cross-sectional study was conducted among 342 patients at five dialysis centers in Jeddah, Saudi Arabia. We used a self-administered questionnaire that containing demographic questions, the Revised Illness Perception Questionnaire, and the Short Form 36 Health Survey Questionnaire. The data were analyzed using t-tests, analyses of variance, Pearson's correlation coefficients, and multiple linear regression analyses. ResultsThe mean (SD) age was 46.1 (16.5) years and the majority were men (53.8%). Except for treatment control, all domains of illness perception were significantly correlated with HRQoL; however, the correlations were positive only for personal control and illness coherence. Identity, disease timeline (acute/chronic), consequences, illness coherence, and emotional representations were independent predictors of HRQoL; together explaining 35% of the variance. Lower emotional response was the only domain of illness perception significantly associated with better HRQoL in both dialysis modalities across all dialysis centers. ConclusionThere were clear effects of illness perception on HRQoL, with emotional representations being the strongest predictor. As such, emotional representations should be targeted in interventions.

ContextFollowing total thyroidectomy and radioactive iodine (RAI) ablation, serum thyroglobulin levels should be undetectable to assure that patients are excellent responders and at very low risk of recurrence.ObjectiveTo assess the utility of stimulated (sTg) and non-stimulated (nsTg) thyroglobulin levels in prediction of patients outcomes with differentiated thyroid cancer (DTC) following total thyroidectomy and RAI ablation.MethodA prospective observational study conducted at a University Hospital in Saudi Arabia. Patients diagnosed with differentiated thyroid cancer and were post total thyroidectomy and RAI ablation. Thyroglobulin levels (nsTg and sTg) were estimated 3–6 months post-RAI. Patients with nsTg <2 ng/ml were stratified based on their levels and were followed-up for 5 years and clinical responses were measured.ResultsOf 196 patients, nsTg levels were <0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg <0.1 ng/ml, 120 (98%) had sTg levels <1 ng/ml, with no structural or functional disease. sTg levels >1 occurred in 26 (35%) of patients with nsTg 0.1–2.0 ng/ml, 11 (15%) had structural incomplete response. None of the patients with sTg levels <1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg < 0.1 ng/ml) indicates a very low risk of recurrence that does not require stimulation. Stimulated thyroglobulin is beneficial with nsTg 0.1–2 ng/ml for re-classifying patients and estimating their risk for incomplete responses over a 7 years follow-up period.

This study was aimed to determine the risk factors associated with COVID-19 infection among contacts of index cases in Saudi Arabia. This unmatched case-control study was conducted among contacts of confirmed COVID-19 cases in April and May 2020 in Al-Madinah, Saudi Arabia. A total of 118 cases and 115 controls were included in this study. All cases and controls were interviewed via telephone by using a structured questionnaire that included two sections. The first section included participants' personal and demographic information, and the second part included questions on the degree of distancing and the duration of contact prior to the appearance of the first symptom, seasonal influenza vaccination, and the nature of the relationship with the index case patient. The majority of cases (83.1%) and controls (67.2%) were males. The mean standard deviation age for the whole sample was 35.3 (10.6) years, and their ages ranged from 18 to 63 years. In the multivariate analysis, the risk for COVID-19 infection was increased by age [Adjusted Odds Ratio (aOR) = 2.2; 95% Confidence Interval (CI), 1.1-4.8, p = 0.046], and was higher among family members (aOR = 10; 95% CI, 3.3-20.0; p = 0.001), coworkers (aOR = 20.0; 95% CI, 4.4-50.0; p < 0.001), and those who communicated with an index case at a distance of <1.5 m (aOR = 4.3; 95% CI, 1.9-9.8; p = 0.001).