A bstract Background Multiple parameters may be used to prognosticate coronavirus disease-2019 (COVID-19) patients, which are often expensive laboratory or radiological investigations. We evaluated the utility of age-adjusted Charlson comorbidity index (CCI) as a predictor of outcome in COVID-19 patients treated with remdesivir. Materials and methods This was a single-center, retrospective study on 126 COVID-19 patients treated with remdesivir. The age-adjusted CCI, length of hospital stay (LOS), need for invasive mechanical ventilation (IMV), and survival were recorded. Results The mean and standard deviation (SD) of age-adjusted CCI were 3.37 and 2.186, respectively. Eighty-six patients (70.5%) had age-adjusted CCI ≤4, and 36 (29.5%) had age-adjusted CCI >4. Among patients with age-adjusted CCI ≤4, 20 (23.3%) required IMV, whereas in those with age-adjusted CCI >4, 19 (52.8%) required IMV ( p <0.05, Pearson's chi-square test). In those with age-adjusted CCI ≤4, the mortality was 18.6%, whereas it was 41.7% in patients with age-adjusted CCI >4 ( p <0.05, Pearson's chi-square test). The receiver operating curve (ROC) of age-adjusted CCI for predicting the mortality had an area under the curve (AUC) of 0.709, p = 0.001, and sensitivity 68%, specificity 62%, and 95% confidence interval (CI) [0.608, 0.810], for a cutoff score >4. The ROC for age-adjusted CCI for predicting the need for IMV had an AUC of 0.696, p = 0.001, and sensitivity 67%, specificity 63%, and 95% CI [0.594, 0.797], for a cutoff score >4. ROC for age-adjusted CCI as a predictor of prolonged LOS (≥14 days) was insignificant. Conclusion In COVID-19 patients, the age-adjusted CCI is an independent predictor of the need for IMV (score >4) and mortality (score >4) but is not useful to predict LOS (CTRI/2020/11/029266). How to cite this article Shanbhag V, Arjun NR, Chaudhuri S, Pandey AK. Utility of Age-adjusted Charlson Comorbidity Index as a Predictor of Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Survival in COVID-19 Patients. Indian J Crit Care Med 2021;25(9):987–991.

Background. There is ambiguity in the literature regarding hypoalbuminemia as a cause of extravascular lung water and acute respiratory distress syndrome (ARDS) outcomes. The aim of the study was to determine if low serum albumin on admission leads to lung deaeration and higher lung ultrasound score (LUSS) in ARDS patients. Patients and Methods. It was a prospective observational study in which 110 ARDS patients aged between 18 and 70 years were recruited. Serum albumin level and lung ultrasound score were assessed on the day of ICU admission. Length of ICU stay and hospital mortality were recorded. Results. The mean and standard deviation of serum albumin level in mild, moderate, and severe ARDS was 2.92 ± 0.65 g/dL, 2.91 ± 0.77 g/dL, and 3.21 ± 0.85 g/dL, respectively. Albumin level was not correlated to the global LUSS (Pearson correlation r −0.006, p = 0.949 ) and basal LUSS (r −0.066, p = 0.513 ). The cut-off value of albumin for predicting a prolonged length of ICU stay (≥10 days) in ARDS patients was <3.25 g/dL with AUC 0.623, p < 0.05 , sensitivity of 86.67%, specificity of 45.45%, and 95% confidence interval (CI) [0.513–0.732], and on multivariate analysis it increased the odds of prolonged ICU stay by 8.9 times (Hosmer and Lemeshow p value 0.810, 95% CI [2.760–28.72]). Serum albumin at admission was not a predictor of mortality. LUSS on the day of admission was not useful to predict either a prolonged length of ICU stay or mortality. Basal LUSS contributed about 56% of the global LUSS in mild and moderate ARDS, and 53% in severe ARDS. Conclusion. Serum albumin level was unrelated to LUSS on admission in ARDS patients. Albumin level <3.25 g/dL increased the chances of a prolonged length of ICU stay (≥10 days) but was not associated with an increase in mortality. LUSS on the day of admission could not predict either a prolonged length of ICU stay or mortality. This trial is registered with CTRI/2019/11/021857.

ABSTRACT:Intussusception is the telescoping of the full thickness of the bowel wall into the distal segment. Here we present a rare case duodenoduodenal intussusception with symptoms of recurrent abdominal pain and vomiting since two years. Surgical excision remains the treatment of choice in such cases as done in ours with the histopathology confirming the lead point to be a benign tubulovillous adenoma. Intussusception in adults presents with vague abdominal symptoms, hence the diagnosis becomes a challenge. The diagnosis is usually confirmed with the help of a CT scan or at laparotomy in the event of an emergency.

Background: Postoperative sore throat is one of the most common complications after endotracheal intubation. The present study was conducted to assess the role of betamethasone gel applied over the endotracheal tube cuff for attenuation of POST in patients undergoing surgeries under GA with endotracheal intubation and compare it with ketamine nebulization. Subjects and Methods : This is a randomized controlled prospective study conducted in 90 patients of either sex between 18-70 years of age divided into three groups. Group I patients received ketamine 50 mg, group II received 3 ml of water soluble 0.05% betamethasone gel, group III received 3 ml of water soluble 2% lignocaine. POST was graded on a four-point scale (0–3); 0 = no sore throat; 1 = mild sore throat (complains of sore throat only on questioning); 2 = moderate sore throat (complains of sore throat on his/her own); 3 = severe sore throat (change of voice or hoarseness, associated with severe throat pain). Results: The mean duration of surgery in group I was 128.5 minutes, in group II was 131 minutes and in group III was 134.5 minutes. There were 6 (20%), 7 (23.3) and 14 (46.6%) cases in group I, II and III respectively. The difference was significant (P< 0.05). At 0 hour there were 3 cases in group I, II and 10 in group III, at 2 hours was 3, 5 and 12 in group I, II and III respectively, at 6 hours was 5,4 and 14 cases in group I, II and III respectively, at 12 hours was 3, 3 and 12 cases in group I, II and III respectively and at 24 hours was 2, 2 and 12 cases in group I, II and III respectively. Conclusion: Authors found that POST can be equally managed with nebulisation with ketamine preoperatively and application of betamethasone gel over endotracheal tube cuff.