Becker's Clinical Quality & Infection Control

34 QUALITY IMPROVEMENT & MEASUREMENT COVID-19 viral load could help physicians predict illness severity By Erica Carbajal C OVID-19 viral loads could be a useful indicator of which patients may need higher levels of care, according to a Dec. 29 New York Times report. A sizable body of research articles show those with higher viral loads are more likely to deteriorate and more likely to die compared to those with lower viral loads. Viral load data is included in results from polymerase chain reaction tests, which are performed in cycles that double the viral ge- netic material from patients' samples. A low cycle threshold, or Ct, indicates a high viral load in the patient, meaning not many cycles had to be completed to yield a positive result, while a high Ct indicates a low viral load. e Times cited a study at New York City- based Weill Cornell Medicine in which researchers found 40 percent of patients with high viral loads, meaning their tests were positive at a Ct of 25 or below, died while in the hospital compared to 15 percent of patients with positive tests at higher Cts and lower viral loads. Since viral loads vary throughout the course of illness, some experts are wary of making assessments based on Ct values. e thresh- olds for a positive result also vary slightly de- pending on a machine's manufacturer. Others believe the benefits outweigh the concerns. "It doesn't change the fact that on average, when you look at the admission test results of these Ct values, they really identify patients at high risk of decompensating and dying," Michael Satlin, MD, lead of the Weill Cornell study, told the Times. In early December, Florida mandated clinical labs to start reporting viral load data, accord- ing to the Times. e FDA also recommend- ed that labs start reporting this information. n Childhood sepsis deadlier for Black patients, study finds By Mackenzie Bean B lack children with sepsis are more likely to die than white or Hispan- ic kids, a study published Dec. 14 in The Lancet Child & Adolescent Health found. Researchers analyzed data on 9,816 children with severe sepsis treated at 1,253 U.S. hospitals in 2016. Data came from an all-payer federal inpatient database for children. Sepsis mortality was 14.6 percent across all pediatric sepsis patients. How- ever, this rate was far higher for Black children (18.4 percent) compared to white (13.4 percent) or Hispanic children (13.7percent). After accounting for numerous factors that could influence mortality, re- searchers found Black children had an almost 20 percent greater chance of death than white children. Black and Hispanic patients with sepsis also stayed in the hospital for about two days longer than white children. "Our findings suggest that there might be differential sepsis recognition, approaches to treatment, access to healthcare services and provider bias that contribute to poorer sepsis outcomes for racial and ethnic minority pa- tients and those of lower socioeconomic position," study authors wrote. n Hospital alert system identifies at-risk patients, lowers mortality, study finds By Erica Carbajal P atients who were monitored with a real-time alert system had a 16 percent lower mortality rate compared to patients who were not monitored, according to research published Nov. 11 in The New England Journal of Medicine. The advanced alert monitor uses algorithms created from machine learn- ing and data from 1.5 million patients to scan hospital EHRs hourly and identify signs of patient decline, Gabriel Escobar, MD, lead study author, told Becker's. The system was used across 21 Oakland, Calif.-based Kaiser Permanente hospitals between August 2016 and February 2019 to compare outcomes between patients who reached the system's alert threshold to similar risk patients who were not monitored with the system. The study included 15,487 patients in the alert system group, and 28,462 patients in the control group. In addition to a lower mortality rate, researchers found patients monitored by the system had a lower chance of admission to an intensive care unit at nearly 18 percent compared to about 21 percent of patients who were not monitored, a shorter hospital stay (6.7 days versus 7.5 days) and overall lower mortality within 30 days of the initial alert (15.8 percent versus 20.4 percent). The system, homegrown at Kaiser hospitals, is automated and alerts are evaluated by off-site nurses, alleviating healthcare workers of additional responsibilities, according to a Nov. 11 news release. n

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