How Doctors Can Predict Who Dies From COVID

how doctors can predict which patients are more  likely to die of COVID 19. there are a number of   studies that have come out about covid19 prognosis  based on a recent one in the journals of annals of   annals of rheumatic studies we now have a  powerful way to predict which patients with   covid 19 pneumonia are more likely to die and more  likely to require longer stays in the hospital   this is thanks to researchers at temple  university in philadelphia who were able to come   up with a statistical model that can accurately  predict this not 100 accuracy but pretty close   we already know that less than 15 percent of  people who get covid 19 have severe disease to   the point of requiring hospitalization and less  than five percent of people who get coronavirus   require icu for those with covid 19 pneumonia who  do require icu and for some other patients in the   hospital who might not necessarily need icu these  are the patients who have the cytokine storm that   we keep hearing about meaning the immune system  is going haywire and there's a ton of inflammation   taking place in the body especially in the lungs  for example here's a ct scan of one of my patients   who as of the making of this video is barely  clinging to life 70 year old male who's otherwise   healthy he has type a blood so not only does he  have covid 19 pneumonia but he has ards as well   acute respiratory distress syndrome he's on  maximum ventilator support and we're giving him   the maximum amount of oxygen and we've tried every  tool in our arsenal to try and get him better   including proning aprv mode ventilation nitric  oxide the whole nine yards and despite all that   we still can't get his oxygenation to adequate  levels the cytokine storm has caused his lungs   to be flooded with inflammation which dramatically  impairs his lungs ability to move oxygen from the   air and into his bloodstream unfortunately he is  highly unlikely to survive and yes the overall   case fatality rate of covid 19 is estimated to  be around 0.5 to 1 the case fatality rate only   indicates the mortality rate among documented  cases because about 30 to 40 percent of cases   are either asymptomatic or mildly symptomatic  that means there are a lot of undiagnosed   cases and most of us by now already know the  covid 19 risk factors that make certain people   more prone to having more severe illness older age  medical comorbidities like heart disease diabetes   hypertension obesity smoking being a male having  type a blood but now we have a more specific   way of predicting who is more likely to develop  cytokine storm and therefore more likely to die   and who's more likely to require a longer stay  in the hospital and it's based on the blood work   we get when patients are hospitalized when we  get blood work we're doing various lab tests   most commonly a complete blood count or a cbc  but also a complete metabolic panel or a cmp   we often check other things like troponin d  dimer ldh ferritin and crp or c-reactive protein   a complete blood count is specifically looking at  three things levels of hemoglobin platelets and   white blood cells we can see not only total number  of white blood cells but also the breakdown of   the percentages of the types of white blood cells  meaning what percentage are neutrophils monocytes   lymphocytes eosinophils and basophils lymphocytes  generally make up about 15 to 45 percent of white   blood cells this is very important as it pertains  to covid 19 and you'll see why in a little bit the   cmp or complete metabolic panel that's looking at  levels of sodium potassium chloride bicarbonate   blood urea nitrogen creatinine glucose calcium  bilirubin albumin and liver enzymes like ast   alt and alkaline phosphatase some of these also  have important implications when it comes to covid 19   disease severity and prognostic implications  because in the recent study done at temple   university they analyzed over 500 hospitalized  covid 19 patients all of which had inflammation in   their lungs that was seen on cat scan of the chest  they determined the criteria for covid 19 cytokine   storm as follows okay one is they had to have  inflammation that was seen on the chest that was   part of the initial diagnostic criteria so it's  either c to the chest or chest x-ray that shows   these infiltrates or sometimes we call them ground  glass opacities that's what we're talking about   here when you do imaging of the chest okay number  two is having a fairly level of more than 250.   number three is a crp level more than 4.6 4 is an  albumin level that's less than 2.87 or lymphocytes   that's less than 10.2 percent or an anc absolute  neutrophil count that's greater than 11. the   fifth criteria they needed to meet was having  an alt more than 60 or an ast more than 87 or a   d diamond more than 4930 or in ldh more than 416  or at your opponent level that's more than 1.09   and finally the sixth criterion that they needed  to me is having an anion gap of less than seven   or a chloride more than 106 or potassium  more than 4.9 or a bun to creatinine ratio   of more than 29. so they had to meet all six  of these criteria for patients who met these   criteria their length of stay in the hospital  was on average 15 days and that's compared to six   days if they did not meet the criteria mortality  was 28.8 percent in the group that met criteria   and 6.6 in those who did not meet criteria so if  they met cytokines storm criteria for cover 19   their likelihood of dying was four times higher  and maybe you're wondering how accurate was this   prediction model it was pretty accurate as this  study had a specificity of 79 in a sensitivity of   85 which is a lot of predictive power most of the  patients who met criteria for the cytokine storm   did so at the time of admission or shortly  after they were admitted to the hospital   and this suggests that there's an early and rapid  progression in these patients and also suggests   that there is a low likelihood of developing  cytokine storm after 10 days of hospitalization   so based on these specific lab parameters this is  how doctors can predict which patients are more   likely to die of covid 19. and i do find that  this study correlates with what i've seen in   my personal experience with hospitalized  covid patients and yes the man whose   ct scan i showed you earlier in this video he  met all of these criteria for the cytokine storm   and he did so as soon as at least within 24 hours  of being admitted to the hospital so that's all   i got for this one in my next one i'm not sure  what i'm going to do yet maybe it's going to be   on the new vaccines that are coming out  there's the moderna vaccine but there's also   the new monoclonal antibody  treatments that have potential   or maybe you want me to make a video on something  else either way let me know in the comments below   thanks for watching and if you haven't  done so already hit that subscribe button   and that bell notification and you'll be  notified of when my next one comes out

Channel: Doctor Mike Hansen

Views: 2,351,813

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Id: nqNxSRcIQPY

Length: 7min 50sec (470 seconds)

Published: Wed Nov 18 2020