Machine learning uncovers blood test patterns subphenotypes at hospital admission discerning increased 30-day ICU mortality rates in COVID-19 elderly patients

Introduction: Since March 2020, a number of SARS-CoV-2 patients have frequently required intensive care unit (ICU) admission, associated with moderate survival outcomes and an increasing economic burden. Elderly patients are among the most numerous, due to previous comorbidities and complications they develop during hospitalization [1]. For this reason, a reliable early risk stratification tool could help estimate an early prognosis and allow for an appropriate resources allocation in favour of the most vulnerable and critically ill patients. Method(s): This retrospective study includes data from two Spanish hospitals, HU12O (Madrid) and HCUV (Valencia), from 193 patients aged > 64 with COVID-19 between February and November 2020 who were admitted to the ICU. Variables include demographics, full-blood-count (FBC) tests and clinical outcomes. Machine learning applied a non-linear dimensionality reduction by t-distributed stochastic neighbor embedding (t-SNE) [2];then hierarchical clustering on the t-SNE output was performed. The number of clinically relevant subphenotypes was chosen by combining silhouette and elbow coefficients, and validated through exploratory analysis. Result(s): We identified five subphenotypes with heterogeneous interclustering age and FBC patterns (Fig. 1). Cluster 1 was the 'healthiest' phenotype, with 2% 30-day mortality and characterized by moderate leukocytes and eosinophils. Cluster 5, the severe phenotype, showed 44% 30-day mortality and was characterized by the highest leukocyte, neutrophil and platelet count and minimal monocytes and lymphocyte count. Clusters 2-4 displayed intermediate mortality rates (20-28%). Conclusion(s): The findings of this preliminary report of Eld-ICUCOV19 patients suggest the patient's FBC and age can display discriminative patterns associated with disparate 30-day ICU mortality rates.

A New Approach to Determine Cycling KPIs in the Context of Behavioral Data

The Corona pandemic has brought a great change in the mobility sector especially in European countries. As a consequence many cities invested much more budget in bike infrastructure than before while the percentage of people using bicycle as the mode of transport for every day routine has been rapidly increased at many places. Available data on cycling use, traffic safety etc. can support the decision making process. We dont't know much about distraction and stress factors when using the bike in a city because such kind of data was not available until now. In the beginning of this paper we present the current state-of-the-art in field of cycling KPIs. What is new in the cycling research domain are cycling KPIs that consider behavioral data. A set of new KPIs in this specific field are introduced in this contribution. As part of the SmartHelm project EEG, eyetracking and GPS data of cargo bike riders was collected and processed. The paper describes the preliminary results obtained from implementing the methodology to calculate behaviour based new cycling KPIs. The conclusion states how the KPIs can be applied in various fields and how it can be adjusted and expanded in the future to the specific stakeholder requirements. © 2022 Gesellschaft fur Informatik (GI). All rights reserved.

IDF21-0311 Pre-Admission, Diabetic Glycemic Control on 60-Day Mortality and Major Adverse Cardiovascular Events from COVID-19

Background: Patients with diabetes mellitus (DM) are at increased risk for intubation, death, and other complications from COVID-19. However, the importance of a patient’s glycemic control preceding the COVID-19 infection is less well understood. Method: From March to November 2020, data from adult patients with confirmed COVID-19 admitted to Rush University System for Health (RUSH) was studied. Patients with both a pre-existing history of diabetes mellitus (DM) and a hemoglobin A1c (HbA1c) measurement during their hospitalization were included. Based on their HbA1c, patients were then divided into 4 groups: adequate glycemic control (≤ 6.5), mild elevation (6.5 – 7.4), intermediate elevation (7.5 – 8.4), and severe elevation (≥ 8.5). Multivariable logistic regression, adjusted for age, body mass index, and pre-existing history of atrial fibrillation, coronary artery disease, hypertension, and chronic obstructive pulmonary disorder, was performed with glycemic control group as a predictor for 60-day mortality and severe COVID-19, which was a composite of 60-day mortality or requiring the intensive care unit, non-invasive positive pressure ventilation, or mechanical ventilation. Major adverse cardiac events (MACE) were defined as nonfatal myocardial injury, nonfatal stroke, or cardiovascular death. Results: Of the 1682 patients admitted, 774 had pre-existing DM, and 534 had HbA1c measurement during their hospitalization. The median HbA1c value was 8.0% (interquartile range 6.6% – 9.9%). In our entire cohort, 75 (14.0%) and 280 (52.4%) patients suffered 60-day mortality and severe COVID-19 infection, respectively. When adjusting for baseline characteristics and comorbidities, patients with mild (adjusted odds ratio [aOR] 2.39 [CI 1.04 – 5.83];p < 0.05) and intermediate (aOR 3.59 [CI 1.49 – 9.12];p < 0.01) HbA1c elevation were at increased risk of 60-day mortality compared to those with adequate glycemic control;no statistically significant difference was present in those with severe elevation (aOR 2.19 [CI 0.95 – 5.44];p = 0.08). Furthermore, only the mild HbA1c elevation group was at increased risk for severe COVID-19 infection (aOR 1.88 [CI 1.06 – 3.38];p < 0.05). Those with intermediate (aOR 1.77 [CI 0.94 – 3.33];p = 0.08) or severe (aOR 1.57 [CI 0.92 – 2.70];p = 0.10) HbA1c elevation were not at higher risk for severe COVID-19 infection. When comparing other 60-day outcomes, there was no difference between the glycemic groups in MACE, life-threatening arrhythmia, deep venous thrombosis, acute renal failure requiring renal replacement therapy, and pulmonary embolism (Table 1). Discussion: In our cohort, patients with DM with an HbA1c of 6.5 – 8.4 were at increased risk of 60-day mortality, while those with an HbA1c of 6.5 – 7.4 were at an increased risk of severe COVID-19 infection.

AN INTEGRATIVE AGILE ITSM FRAMEWORK OF TENETS AND PRACTICES - ITS DESIGN AND EXPLORATORY UTILIZATION

The modern business environment and global covid-19 pandemic effects have led to any relevant business organizational activity, like e-commerce, to rely on on-premise and cloud information technology (IT) services. To deliver high-quality IT services, plan-driven IT Service Management (ITSM) frameworks and standards have been used in business organizations in the last two decades. Nowadays, new and claimed agile ITSM frameworks and standards have emerged but there is a scarcity of studies on their extent of agility coverage. This research addresses this knowledge gap. First, we elaborated a plausible Integrative Agile ITSM Framework of Tenets and Practices from a selective review of the main related SwE and ITSM literature. Second, we populated the integrative framework with all available evidence about the agile tenets and practices reported in the official publications of the new five ITSM frameworks and standards. Third, we explored its utilization with a Panel of ITSM Experts for ranking how much the new five ITSM frameworks and standards fit the integrative framework. Exploratory results revealed high concordance among experts to qualify ITIL v4 and VeriSM as agile, and FitSM, and the two ISO/IEC standards as lightweight but not agile. This research contributes to the ITSM literature with an Integrative Agile ITSM Framework of Tenets and Practices, and the ITSM practice with an exploratory evaluation from ITSM experts on the adherence to it from the new five ITSM frameworks and standards. Given the critical dependence of any business activity on IT services, further theoretical and empirical research is worthy to be pursued.

ASSOCIATION BETWEEN IN-HOSPITAL MORTALITY AND ACE/ARB INHIBITOR USAGE

Background: The use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) in COVID-19 patients has been controversial given the role of the angiotensin-converting enzyme 2 receptor as a cellular infiltration point for the virus. Methods: Since March of 2020, data was obtained from adult patients with COVID-19 admitted to Rush University Systems for Health through automatic extraction from the electronic medical record. We looked for other factors that were associated with mortality. All variables in Figure 1 were included in a single multivariable logistic regression model with in-hospital mortality as the primary outcome. Results: Of the 3863 patients in the cohort, 1290 (33.4%) were on an ACEi/ARB during their admission. When adjusted for the other variables in Figure 1, in-hospital ACEi/ARB usage was associated with decreased risk of mortality (adjusted odds ratio [aOR] 0.52 [CI 0.38 - 0.73];p < 0.001) compared to those not taking them. In the same model, oral anticoagulation (aOR 0.25 [CI 0.17 - 0.37];p < 0.001) was also found to be protective against in-hospital mortality. Increased BMI, male sex, initial high respiratory rate, history of atrial fibrillation and valve disease increased the risk of in-hospital mortality. Conclusion: Consistent with previous findings certain factors increase mortality, but in-hospital use of ACEi/ARBs and anticoagulation were independently associated with decreased mortality during COVID-19 hospitalization. [Formula presented]

In-hospital predictors of 60-day readmission in COVID-19 patients

Introduction: Preventing hospital readmissions can improve a patient's quality of life and decrease healthcare costs. While prior work has focused on pre-existing comorbidities to predict COVID-19 readmissions, the prognostic role of in-hospital data and complications has been less studied. Methods: Data was collected on adult patients diagnosed with COVID-19 and admitted to a multicenter hospital system in Illinois between March and November 2020. Our cohort consisted of COVID-19 hospitalization survivors excluding those discharged to hospice care. Major adverse events (MAEs) were defined as venous thromboembolism (VTE), myocardial injury (troponin greater than upper limit of normal), stroke, new requirement for renal replacement therapy (RRT), life-threatening arrhythmia, or acute heart failure exacerbation. The primary outcome was readmission within 60 days of initial hospitalization. Results: From the 1406 survivors of the index hospitalization, 223 (15.9%) patients were readmitted within 60 days. Those readmitted were older and more likely to have underlying comorbidities including atrial fibrillation, coronary artery disease, and hypertension (Table 1). Length of stay between the readmission and non-readmission groups was trending towards statistical significance (10.52 days vs 8.95 days, p=0.053). Those with one or more MAE during their index hospitalization, when adjusted for age and body mass index, were at an increased risk of readmission (adjusted odds ratio [aOR] 1.90, p<0.01). Readmitted patients were more likely to have VTE during their index hospitalization than those not readmitted (7.2% vs 3.7%, p<0.05). The incidence of new RRT (4.9% vs 2.5%, p=0.083) and myocardial injury (3.6% vs 1.5%, p=0.067) between the groups was also trending towards statistical significance (Table 1). No statistical difference was present between the other individual MAEs;however, this is limited by small sample sizes of certain MAEs. Of the 322 patients with echocardiography during the index admission, 82 (25.5%) were readmitted. In this cohort, left ventricular ejection fraction (LVEF) that was reduced (LVEF <50%) or hyperdynamic (LVEF >65%) was not a statistically significant predictor of readmission (Figure 1). Lastly, discharge disposition was predictive of readmission as those being sent to acute rehab (OR 2.04, p<0.01), long-term acute care (OR 2.58, p<0.01), or skilled nursing facility (OR 2.67, p<0.001) were at higher risk compared to those who were discharged to home (Figure 1). Conclusion: In this cohort, the occurrence of any MAE during index COVID-19 hospitalization, particularly VTE, RRT, and myocardial injury, can be used to predict 60-day readmission. Furthermore, discharge disposition, but not LVEF, demonstrated prognostic value in our cohort. Identifying high risk patients prior to discharge helps health care providers focus resources on patients most likely to be readmitted.

Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with risk for thromboembolic complications and mortality in patients with COVID-19

Background/Introduction: The high prevalence of thromboembolism in patients with COVID-19 causes significant morbidity and mortality. The soluble urokinase-type plasminogen activator receptor (suPAR), a known inflammatory and immune mediator in several renal and cardiovascular conditions, has recently been shown to correlate with acute kidney injury and severe respiratory failure in COVID-19. To date, no study has investigated the association between suPAR and thromboembolism in COVID-19. Purpose: To evaluate associations between suPAR, thromboembolic complications, and mortality in COVID-19. Methods: We conducted a retrospective cohort study of a random sample of 109 patients among those hospitalised at a tertiary medical centre comprising three hospitals between March and June 2020 for COVID-19 who had blood samples collected and stored on admission. Serum suPAR was measured using a commercially available enzyme immunoassay. Baseline (hospital admission) variables extracted from electronic medical records included age, sex, race/ethnicity, body mass index (BMI), history of cardiovascular disease (including deep venous thrombosis [DVT] and pulmonary embolism [PE]), serum creatinine, serum D-dimer, incident DVT/PE, and death during hospitalization. Patients were subsequently grouped by su- PAR quartiles. Associations between suPAR, thromboembolic complications (PE and/or DVT), and overall mortality were evaluated using multivariable logistic regression. Results: Among the 109 patients, mean age was 56 (standard deviation [SD], 16) years, 34 (39%) were women, mean BMI was 35 (SD, 8) kg/m2, 78 (71%) had coexisting cardiovascular disease, median creatinine level was 1.2 (interquartile range [IQR]: 0.8-2.3) mg/dl, median D-dimer level was 1.5 (IQR, 0.8-6.4) μg/ml, and median suPAR level was 10.1 (IQR: 4.1-14.4) pg/mL. Seven (6%) patients were found to have PE, 18 (17%) developed PE/DVT, and 22 (20%) died during the admission (Table). Per quartile higher suPAR level, there was higher risk for PE or DVT (OR=2.02, 95% CI 1.07-3.83, p=0.03). Compared to those in the lowest suPAR quartile, patients in the highest quartile had 11.1 times higher risk for PE/DVT (OR=11.1, 95% CI 1.51-81.8, p=0.02, Figure). SuPAR is also associated with overall mortality, with 2.25 times higher risk of death seen per quartile increase in suPAR level (OR= 2.25, 95% CI 1.24-4.06, p=0.007). Conclusion: Higher suPAR levels at the time of hospital admission is associated with higher risk for thromboembolic complications i.e., PE and DVT, as well as mortality in patients with COVID-19.

Cardiac arrest in patients hospitalized for COVID-19: A tertiary medical center retrospective cohort study

Background/Introduction: Patients with COVID-19 are at increased risk for mortality during hospitalization. Better definition of the incidence, predictors, and outcomes of cardiac arrest during hospitalization for COVID-19 may support early identification and intervention. Purpose: To estimate the incidence of in-hospital cardiac arrest in patients with COVID-19, describe the temporal trends in incidence of and survival after cardiac arrest, summarise characteristics of those who experienced a cardiac arrest, and compare the characteristics of survivors versus nonsurvivors of cardiac arrest. Methods: We conducted a retrospective cohort study of patients admitted for COVID-19 to a tertiary medical center comprising three hospitals between March and November 2020. Data entry is ongoing for more than 2000 patients admitted through 2021. Clinical variables extracted via review of electronic medical records included age, sex, race/ethnicity, body mass index, history of cardiovascular disease (ie., coronary artery disease, congestive heart failure, atrial fibrillation, or cerebrovascular event), other comorbidities included in the Charlson comorbidity index, date of admission, duration of hospitalization, all cardiac arrest events during hospitalization, presenting rhythm during first cardiac arrest, and death. Data were described using summary statistics. Multivariable logistic regression was used to evaluate associations. Results: Among 1666 patients, 107 (6.4%) experienced at least one inhospital cardiac arrest event during hospitalization for COVID-19, of which 25 (23%) survived to hospital discharge. From March to October 2020, there was a decrease in estimated cardiac arrest incidence in-hospital from 8.2% to 3%, whereas estimated survival to hospital discharge after an arrest remained similar at approximately 20% (Figure). Compared to those who did not, patients who experienced in-hospital cardiac arrest were older and more likely to have existing cardiovascular disease, as well as other comorbidities. Similar factors were associated with lower chance of survival after cardiac arrest (Table). Patients with pulseless ventricular tachycardia/ fibrillation (VT/VF) as presenting rhythm in cardiac arrest had better survival to hospital discharge compared to those with other rhythms (OR 3.3, p=0.02). Younger age (per 10 years, OR=0.7, p=0.03) and fewer comorbidities (per one fewer comorbidity, OR=1.5, p=0.05) were associated with better survival after cardiac arrest in multivariable logistic regression. Conclusion: There was a decline in estimated incidence of cardiac arrest during hospitalization for COVID-19 since beginning of pandemic, with survival to hospital discharge after cardiac arrest estimated to be stable at around 20%. Younger age and fewer comorbidities especially cardiovascular disease were associated with better survival after an in-hospital cardiac arrest. (Figure Presented).

Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer. The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 h and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

Editorial preface for the special issue on 'decision-making frameworks and methods for crisis management in a global pandemic'

This special JDS issue is focused on highlighting the new and updated decisional concepts, frameworks, methods, and technologies needed to assist decision makers and policymakers in the context of a global pandemic. This introductory editorial contains a brief overview of the eleven research articles provided by the international community.

[Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care]. / Cambios en el manejo ambulatorio de pacientes con cáncer de próstata durante la pandemia por SARS-CoV-2. Revisión bibliográfica y aporte de nuestro grupo en atención telemática.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 hours and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.