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
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