ABSTRACT
Background: Acute kidney injury (AKI) is frequently associated with COVID-19 and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalized COVID-19 patients. Methods: This study is part of the multicentre cohort, the Brazilian COVID-19 Registry. A total of 5,212 adult COVID-19 patients were included between March/2020 and September/2020. We evaluated four categories of predictor variables: (1) demographic data; (2) comorbidities and conditions at admission; (3) laboratory exams within 24 h; and (4) the need for mechanical ventilation at any time during hospitalization. Variable selection was performed using generalized additive models (GAM) and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. The accuracy was assessed using the area under the receiver operating characteristic curve (AUCROC). Risk groups were proposed based on predicted probabilities: non-high (up to 14.9%), high (15.0 to 49.9%), and very high risk ([≥] 50.0%). Results: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalization. The validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. Thirty-two variables were tested and four important predictors of the need for KRT during hospitalization were identified using GAM: need for mechanical ventilation, male gender, higher creatinine at admission, and diabetes. The MMCD score had excellent discrimination in derivation (AUROC = 0.929; 95% CI 0.918-0.939) and validation (AUROC = 0.927; 95% CI 0.911-0.941) cohorts an good overall performance in both cohorts (Brier score: 0.057 and 0.056, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/). Conclusion: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalized COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
Subject(s)
Diabetes Mellitus , Kidney Diseases , Acute Kidney Injury , COVID-19ABSTRACT
Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1, N = 49,968 across 67 countries), we investigated self-reported factors that associated with people reported adopting public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N = 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r = -.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.
Subject(s)
COVID-19ABSTRACT
We investigated laypersons’ agreement with technical claims about the spread of the Sars-CoV-2 virus and with claims about the risk from COVID-19 in the general public in Germany (N = 1,575) and compared these with the evaluations of scientific experts (N = 128). Using Latent Class Analysis, we distinguished four segments in the general public. Two groups (mainstream and cautious, 73%) are generally consistent with scientific experts in their evaluations. Two groups (doubters and deniers, 27%) differ distinctively from expert evaluations and tend to believe in conspiracies about COVID-19. Deniers (8%) are characterized by low risk assessments, anti-elitist sentiments and low compliance with containment measures. Doubters (19%) are characterized by general uncertainty in the distinction between true and false claims and by low scientific literacy in terms of cognitive ability and style. Our research indicates that conspiracy beliefs about COVID-19 cannot be linked to a single and distinct motivational structure.
Subject(s)
COVID-19ABSTRACT
We investigated pandemic denial in the general public in Germany after the first wave of COVID-19 in May 2020. Using latent class analysis, we compared patterns of disagreement with claims about (a) the origin, spread, or infectiousness of the SARS-CoV-2 virus and (b) the personal risk from COVID-19 between scientific laypersons (N = 1,575) and scientific experts (N = 128). Two groups in the general public differed distinctively from expert evaluations. The Dismissive (8%) are characterized by low-risk assessment, low compliance with containment measures, and mistrust in politicians. The Doubtful (19%) are characterized by low cognitive reflection, high uncertainty in the distinction between true and false claims, and high social media intake. Our research indicates that pandemic denial cannot be linked to a single and distinct pattern of psychological dispositions but involves different subgroups within the general population that share high COVID-19 conspiracy beliefs and low beliefs in epistemic complexity.