ABSTRACT
Background Although a higher body mass index (BMI) has been reported to be associated with severe COVID-19 pneumonia (severe disease), it is unclear if metabolic status plays a role. Being metabolically unhealthy (MU) is defined as having either hypertension, hyperlipidemia, type 2 diabetes mellitus/pre-diabetes, or non-alcoholic fatty liver disease. We aimed to derive a risk score to predict severe disease in patients with obesity or overweight according to metabolic status. Methods A retrospective study was performed for patients hospitalized with COVID-19 pneumonia between March 2020 and August 2021 at a single tertiary center. Patients were excluded if they were immunocompromised or had a BMI < 25.0. Wilcoxon rank sum test or Fisher's Exact test were performed. Univariate logistic regression was performed followed by multivariate logistic regression to derive a risk score to predict severe disease. Variables with the highest p-values were sequentially removed until removal led to less than a 1-point reduction (improvement) in the Akaike information criterion. Accuracy of the model was calculated using bootstrap resampling estimates of the area under the receiver operating characteristic curve (AUROCC). Results 334 of 450 patients hospitalized with COVID-19 pneumonia (74.2%) were MU. Older age, higher BMI, being a former smoker, and having been vaccinated for SARS-CoV-2 were associated with being MU. There was no difference in treatments for COVID-19 pneumonia according to metabolic status. Patients who were MU had a higher death rate (10.5% vs. 2.6%) and longer total length of stay (median 6 vs. 5 days). Figure 1. On univariate analysis, age at admission, male gender, Asian race, hypertension, and type 2 diabetes mellitus were significant predictors of severe disease, whereas being MU was not, p=0.27. On multivariate logistic regression, older age, male gender, and Asian race were associated with having severe disease. Not being vaccinated was associated with a doubled odds of severe disease (OR 2.24, 95% CI: 1.07, 4.59). Figure 2. The AUROCC of the final model was 0.66 (95% CI: 0.60 to 0.71). The risk score at the lowest quintile had a 33.1% to 65.5% predicted risk and a 58.7% observed risk of severe disease, whereas at the highest quintile there was an 85.7% to 97.7% predicted risk and an 89.7% observed risk of severe disease in our cohort. Conclusion In this retrospective study of hospitalized patients with COVID-19 pneumonia, being MU was not a predictor of severe disease, even though mortality rate and total length of stay were higher in this group despite having higher rates of vaccination. Older age at admission, male gender, Asian race, and being unvaccinated were associated with severe disease. Using this risk score may help to predict severe disease in hospitalized patients with obesity or overweight. External validation is recommended (Table Presented)(Table Presented)
ABSTRACT
The waiting list in Clinical Genetics is prolonged. Anecdotally, we noted our service receiving duplicate referrals (referrals for patients already on the waiting list who hadn't yet been seen). Each of these waste both consultant and administrative time, it diverts attention away from ongoing cases and therefore is a clinical risk. We audited duplicate referrals over a 3 month period (01/11/2020-31/01/2021) to estimate costs to the Irish health service;82/986 (9%) referrals that were received were duplicate referral, 26/82 were a triplicate or more referral for same patient. The average length of time between first and second referral was 378 days indicating they arise at annual review with original referrer;52 (63%) were from the same initial referring consultant. Duplicate referrals changed the triage outcome in 7/82 (8.54%) cases. We performed time analyses managing duplicate referrals from both the referring and receiving consultant and administrative teams. Each individual re-referral costs €47.6. For the study period, the total cost of re-referrals to the health care system was €3,908.6. The National treatment purchase fund (www. ntpf. ie) cited > 200,000 patient waiting > 12 months for an appointment in the Irish Republic on 01/01/2021. Assuming duplicate referrals are occurring at a similar rate in other specialties (9%), then ∼ 18,000 duplicate referrals are sent annually within the HSE. Extrapolating from this, we estimate the overall cost to the HSE being €856,800 per annum. Our study was carried out during covid 19, referrals were down 10% indicating that the true cost is likely higher.