Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes / 中华医学杂志(英文版)

BACKGROUND@#In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission.@*METHODS@#Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan-Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC).@*RESULTS@#From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients' age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0-1); 769 (47.2%) light (2-4); 585 (35.9%) moderate (5-8); and 79 (4.9%) severe (9-12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676-0746).@*CONCLUSION@#The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patients.

asthma cost in Oman

This study evaluates the direct costs of treating asthma in Oman. Asthma prevalence and unit cost estimates were based on results from a panel using the Delphi technique, and were applied to the total Omani population aged 5 and older to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise were multiplied by the percentage of patients using government facilities to estimate the number of asthma patients managed in Oman. Treatment costs were also calculated using data from the Delphi exercise and the Asthma Insights and Reality for the Gulf and Near East study [reported in Omani riyals [OMR] and US dollars [USD]]. The prevalence of asthma was estimated to be 7.3% of adults [n = 96,470] and 12.7% of children [n = 58,344]. Of these, 95% of both adults and children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest proportion of total direct costs [55%], followed by emergency room and outpatient visits [25% and 20%, respectively] and medications [<0.2%]. The annual cost of treatment excluding medications, was OMR 34,273,696 [USD 89,111,609] for adults and OMR 27,014,735 [USD 70,238,311] for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over OMR 61,500,294 [USD 159,900,761]. Given the high medical expenditures associated with facility visits relative to the lower medication costs, the focus of Oman's asthma cost savings should be on improving asthma control rather than reducing medication costs

Asthma control in Oman. National results within the asthma insights and reality in the gulf and the near east [AIRGNE] study

The Asthma Insights and Reality [AIR] study in the Gulf and Near East [one of a worldwide series of surveys conducted in adults and children to assess asthma control] was conducted in Oman to assess how closely asthma control meets international guidelines recommendations. From January 2007 to March 2008, asthmatics receiving treatment or currently suffering from asthma symptoms were interviewed among nationals randomly surveyed from the most populated urban areas in Oman [Muscat, Sohar and Nizwa]. The standard AIR questionnaire was used to assess symptom severity, health care utilization, limitation of activity and medication use. From 201 asthmatic participants, 21% were under 16 years and 43% were female. Tobacco use was low in our asthmatics. Disparity in asthma perception was wide in Oman; while 57% of asthmatics perceived their asthma as well or completely controlled, actually 54% had poorly or not well controlled asthma. All recommendations for asthma control by the Global Initiative for Asthma were largely unmet, especially in child asthmatics, with 44% reporting night awakenings due to asthma during the previous 4 weeks and 47% exerciseinduced asthma in the previous 12 months. Overall, 32.6% of children and 34.8% of adults reported absence due to asthma from school/work during the previous year. Use of preventive inhaled corticosteroids was only 5.0%, one of the lowest even within the AIR Gulf and Near East study, producing an unacceptable ratio ICS/SABA [inhaled corticosteroid/short acting beta-agonist] of 0.054 in Omani asthmatics. Asthma control in Oman falls far below the goals of current international guidelines therefore corrective strategies are needed

Asthma control in Lebanon the asthma insights and reality in Lebanon

Current practice guidelines provide recommendations for the optimal management and control of asthma. However, the implementation of the recommendations in specific areas needs to be adapted to local conditions. No data on the burden of asthma and on the quality of asthma treatment and control are currently available in Lebanon. This study was therefore conducted to determine how closely asthma management guidelines are being followed in Lebanon. The Asthma Insights and Reality in Lebanon [AIREL] survey is based on information from 200 adults and children with asthma in 2007-2008. Participants were interviewed on symptoms and severity, health care utilization, activity limitations and medication use. Daytime asthma symptoms were reported by 80% of respondents and 72% reported being awakened by their asthma in the preceding 4 weeks. Use of health services in the last 12 months due to asthma was high with 22% been hospitalized and 21% attended a hospital emergency department. Absence from school and work in the past year were reported by 69% of children and 31% of adults, respectively. Use of peak expiratory flow was only 14%, and 50% of participants had never undergone a lung function test. Current levels of asthma control in Lebanon fall far short of goals specified in international guidelines for asthma management. In many aspects, asthma care and control in Lebanon is at least as poor as in other areas of the world

Asthma insights and reality in the United Arab Emirates

The burden of asthma in the United Arab Emirates [UAE] and the extent to which guidelines are being followed for optimum asthma control are largely unknown. This survey assessed the current level of asthma control, the burden of the disease, and adherence to asthma guidelines by patients. A face-to-face interview of 200 asthmatics in the UAE was conducted. In addition to the questionnaire administered by expert interviewers, each respondent self-completed an Asthma Control Test. The sample was stratified by region within the country and sampled proportionately. Sudden severe attacks of asthma were reported by 64% in the past year. Day time symptoms and night time symptoms were reported by 57.5% and 35.5%, respectively, in the past 4 weeks. Overall, 52.8% of the children and 17.1% of the adults missed school and work in the past year, respectively. The percentage of asthmatics that had emergency room visits within the past year was 27.5%, and 4% were hospitalized. Only 5.5% used inhaled corticosteroids in the past year and 47.5% were on short-acting beta-2 agonists. Only 17.8% ever owned a peak flow meter and only 30% ever had a lung function test. Only 17% had scheduled follow-up and 66% were followed-up by general practitioners. This survey shows that the current level of asthma control in the UAE is far from optimal. Therefore, it is necessary to increase the awareness among patients and update doctors about asthma control guidelines for attaining optimal asthma control, and thus reducing the burden of the disease