Background: Considering the role of higher blood urea nitrogen and lower serum albumin (SA) levels in deceased coronavirus disease 2019 patients, an increased blood urea nitrogen to SA (B/A) ratio may help to determine those at higher risk of critical illness. This study aimed to evaluate the correlation of the B/A ratio with severity and 30-day mortality in COVID-19 patients.Methods: A total of 433 adult patients with COVID-19 were enrolled. The laboratory markers were measured on admission. Disease severity was categorized into mild disease, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock.The mortality was followed for 30 days after admission. χ 2 test, Fisher's exact test, and Mann-Whitney U test were performed, as appropriate. Also, logistic regression and the receiver operating characteristic (ROC) curve for the B/A ratio are included.Results: Thirty-day mortality rate was 27.25%. The frequency of mild, severe pneumonia, ARDS, sepsis, and septic shock was 30.72%, 36.95%, 24.02%, 6.00%, and 2.31%, respectively. B/A ratio and SA levels were statistically different between alive and deceased patients. The mean B/A ratio was different among classified disease severities, except for mild disease. Logistic regression revealed the B/A ratio as an independent risk factor for sepsis after adjusting for age and sex. ROC analysis showed B/A ratio had an area under the curve (AUC) of 0.733 for mortality at the cutpoint of 4.944. AUC for sepsis was 0.617 which was greater than other disease severities. Conclusion:The results showed that B/A ratio and SA levels are associated with mortality of COVID-19 patients. A higher B/A ratio is, additionally, associated with COVID-19 severity, except in mild cases and it can act as an independent risk factor in sepsis. However, a greater B/A ratio is not a significant predictor of COVID-19 severity, but it can predict mortality. Therefore, we suggest this marker for clinical assessment of patients with severe COVID-19.

Introduction: Coronavirus disease 2019 (COVID-19) can present with acute kidney injury (AKI). Although the rate of AKI among these patients is not high, their outcome could be much worse than the other patients. Serum creatinine rise along with other laboratory findings may help as a clinical predictor of COVID-19 disease prognosis. Objectives: We aimed to evaluate the incidence and possible predictors of AKI occurrence and its outcome during the COVID-19 pandemic. Patients and Methods: In a retrospective observational study of 946 hospital-admitted patients with confirmed COVID-19 between March 20, 2020 and May 9, 2020, we described AKI incidence and its stages along with their association with demographic data, comorbidities, habitual and past-medical history, and laboratory findings using STATA version 14. Results: The mean age of participants was 55.6 (±18.7) years of which 60.4% were male. The most and least frequent underlying diseases were hypertension and chronic liver disease, 20.1% and 1.5%, respectively. Among patients with AKI, 45.9% had a higher age mean and female sex was more prevalent. In addition, hypertension, ischemic heart disease, diabetes, and chronic renal disease were more common in patients with AKI compared to patients without AKI. Moreover, AKI patients had lower oxygen saturation and mean levels of lymphocytes and higher mean levels of LDH and CKMB in comparison with no AKI group on admission. Overall, 80% of the patients were discharged (i.e. alive), of which 63.7% were non-severe patients and 19.4% of the patients expired during hospitalization. Conclusion: Comorbidities were more prevalent among AKI groups. Female and older patients were more prone to AKI during COVID-19 progression. The level of CK-MB was also higher in AKI group, suggesting probable cardiac injury. Lymphopenia and leukocytosis may be poor-prognostic factors for both AKI and COVID-19.

Background: Organ donation from a brain-dead person is done through a three-step process that begins with the identification of a suspected brain-dead case, continues with the mission of coordinator, and ends with the allocation of an organ. Postponed identification processes and poor management led to organ and donor loss. In which, during the last 14 months in a single center procurement unit, out of 428 potential donors, 174 cases were missed. In case of developing a smart process, all cofounding factors, would be considered beyond the human faults. We introduce a platform to overcome all concerns of donation process. Methods: We created an application which nurses can use for input GCS of patients instead of writing on sheets. It alerts if their GCS is three and recommends further considerations. Coordinator will be notified if a clinical examination indicated brain death. Application guides coordinator step by step. Allocation system works as a block chain system which each receiver considered as a new block and more stakes get the organ. Also, it includes a social media to share experiences. We employed this method in Imam Hossein Hospital for 3 months in 2022 and compared donation rates with the same period in 2021. Results: There was an increase of 5.41 folds in potential donors, 1.5 folds in actual donors, and 1.5 folds in procured organs (four kidneys, three livers and one heart). Conclusions: Donors detection will improve by using this application and saves time and human sources. Also, reduces hospital staffs' mismanagement which lead to improvement in the process. Guidance of this application helps coordinators with better choices in the face of challenges and it can be used as a learning courses platform. Blockchain system ensures transparency and security in allocating resources, and social media improves colleagues' communication.

Background: Organ donation from brain death (BD) cases is the main mode of organ donation in Iran. An important index in organ donation is the organ per donor (OPD) number. OPD can be assessed versus several parameters, such as etiology of BD. This original research aimed to investigate the association of OPD and the most prevalent BD causes in Iran, including trauma, convulsion, cranial bleeding, cerebrovascular accidents, drug toxicity, falling, hanging, post-cardiopulmonary resuscitation (post-CPR), and brain tumor. Methods: This registry-based study retrospectively recruited the data of successful organ donation cases in our organ procurement unit (OPU) through years 2005-2022. OPD and age of donors were investigated among different BD etiologies and in two genders using descriptive and analytical data processes. Results: A total number of 2,299 BD cases with a mean age of 37.96 years (16.56) were included in this study. The average OPD was 2.60 (1.23) in our donors. The greatest OPD of 2.94 in trauma group was remarkably higher than the lowest OPD of 2.36 in post-CPR group (P=0.01). Moreover, the mean OPD in female donors was 2.67 (1.18), that was larger compared to OPD in male donors with a mean value of 2.561.26 (P=0.04). No significant difference in the age of female and male donors was found (38.52 years [16.71] vs. 37.65 years [16.48], respectively; P=0.23). The youngest BD causative group was convulsion with a mean age of 21.80 years (14.65). The age difference with the oldest BD causative group of cerebrovascular with a mean age of 50.16 years (10.49) was statistically significant (P=0.01). Conclusions: This study described the findings of OPD and BD etiologies during 18 years of medical record in our OPU. The OPD significantly depended on the BD etiology and the gender. Our findings can help coordinators to provide better organ-preservation care. Further research is recommended to refine the protocols of such care in specific BD causes.

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