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ABSTRACT Objective: We aimed to investigate the association between glucose coefficient of variation (CV) and mortality and disease severity in hospitalized patients with coronavirus disease-19 (COVID-19). Subjects and methods: Retrospective cohort study in a tertiary center of patients with COVID-19 admitted to designated departments between March 11th, 2020, and November 2nd, 2020. We divided patients based on quartiles of glucose CV after stratification to those with and without diabetes mellitus (DM). Main outcomes were length of stay and in-hospital mortality. Results: The cohort included 565 patients with a mean age of 67.71 ± 15.45 years, and 62.3% were male. Of the entire cohort, 44.4% had DM. The median glucose CV was 32.8% and 20.5% in patients with and without DM, respectively. In patients with DM, higher glucose CV was associated with a longer hospitalization in the unadjusted model (OR = 2.7, 95% CI [1.3,5.6] for Q4), and when adjusted for age, sex, comorbidities, and laboratory markers, this association was no longer statistically significant (OR = 1.3, 95% CI [0.4,4.5] for Q4). In patients with and without DM, higher glucose CV was associated with higher rates of in-hospital mortality in the unadjusted model, but adjustment for comorbidities and laboratory markers eliminated the association (OR = 0.5, 95% CI [0.1,3.4] for Q4 in patients with DM). Conclusion: Higher glucose CV was associated with increased in-hospital mortality and length of stay, but this association disappeared when the adjustment included laboratory result data. Glucose CV can serve as a simple and cheap marker for mortality and severity of disease in patients with COVID-19.
ABSTRACT
FUNDAMENTO: Os achados e investigações adicionais necessários com base na triagem pré-participação com eletrocardiograma (ECG) entre os recrutas militares estão mal definidos na literatura. OBJETIVOS: Este estudo foi elaborado para avaliar a taxa de achados anormais na triagem pré-participação com ECG em adultos jovens e as avaliações adicionais necessárias com base nestes resultados. MÉTODOS: Um estudo de coorte retrospectivo foi realizado no centro aero-médico da Força Aérea de Israel (IAF), para candidatos das unidades das academias de voo e de tropa s de elite. Os candidatos das unidades das Academias de voo e de elite passam por uma triagem pré-participação com ECG antes do alistamento nas Forças de Defesa de Israel (IDF). Desde 2010, todos os ECGs são realizados no centro aero-médico da IAF. Todos os ECGs realizados desde janeiro de 2010 foram analisados por um de três cardiologistas e todos aqueles nos quais resultados significativos foram identificados foram encaminhados para uma avaliação mais detalhada, a pedido do cardiologista. As causas de encaminhamento para avaliação posterior, as avaliações realizadas e os resultados dessas avaliações são notificados para a população de estudo. RESULTADOS: 1.455 ECGs foram realizados nos anos 2010-2011. Desses, 1.388 (95,39%) foram interpretadas como normais. 67 indivíduos foram encaminhados para uma avaliação mais detalhada com base nos achados do ECG. Os achados mais comuns levando a uma avaliação mais detalhada foram alterações da onda T (16 casos, 23,88%), padrão de pré-excitação (14, 20,89%) e critérios de voltagem para hipertrofia ventricular esquerda (11; 16,41%). Apenas 7 indivíduos (10,44%) tinham resultados anormais que foram considerados clinicamente significativos no final da avaliação médica. CONCLUSÕES: A taxa de achados significantes levando à desqualificação para a atividade militar é extremamente baixa e o encaminhamento para investigações adicionais baseado nos achados do ECG de 12 derivações deve ser criterioso.
BACKGROUND:The findings and additional investigations required based on pre-participation electrocardiography (ECG) among military recruits are poorly defined in the literature. OBJECTIVES: This study was designed to evaluate the rate of abnormal findings on pre-participation ECG in young adults and the additional evaluations required based on these findings. METHODS: A retrospective cohort study was performed in the Israeli Air Force (IAF) aero medical screening center for flight academy and elite units' candidates. Flight academy and elite units' candidates undergo pre-participation ECG prior to enlistment to the Israeli Defense Forces (IDF). Since 2010, all ECGS have been performed at the IAF aero medical center. All ECGs performed since January 2010 were analyzed by one of three cardiologists and all those in which significant findings were identified were referred to further evaluation upon the cardiologist's request. Causes of referral for further evaluation, the evaluations performed and the results of these evaluations are reported for the study population. RESULTS: 1455 ECGS were performed in the years 2010-2011. Of these, 1388 (95.39%) were interpreted as normal. 67 subjects were referred to further evaluation based on ECG findings. The most common findings leading to further evaluation were T wave changes (16 cases, 23.88%), pre-excitation pattern (14, 20.89%) and voltage criteria for left ventricular hypertrophy (11, 16.41%). Only 7 subjects (10.44%) had abnormal findings which were considered clinically significant at the end of the medical evaluation. CONCLUSIONS: The rate of significant findings leading to disqualification from military activity is extremely low and referral to continued investigations based on 12-lead ECG findings should be judicious.