The Effect of Telerehabilitation on Physical Fitness and Depression/Anxiety in Post-COVID-19 Patients: A Randomized Controlled Trial

Aim: The aim of this research was to evaluate the impact of a telerehabilitation program on physical fitness, muscle strength, and levels of depression and anxiety in post-COVID-19 patients. Methods: Thirty-two individuals recovered from COVID-19 (48.20±12.82 years) were allocated into either a telerehabilitation (TG n=16) or control (CG n=16) group. Physical fitness, handgrip strength, depression and anxiety levels were assessed before and after an 8-week intervention. Results: There was a significant improvement in muscle strength in both groups. Physical fitness significantly increased compared to the CG at the end of the intervention. Levels of anxiety and depression significantly decreased after the intervention when compared to the CG. Conclusion: Eight weeks of functional telerehabilitation training is a viable and efficient way to rehabilitate patients affected by COVID-19, as it improved physical conditioning and mental health. © 2023, University Library System, University of Pittsburgh. All rights reserved.

Physical activity and long COVID: findings from the Prospective Study About Mental and Physical Health in Adults cohort.

OBJECTIVES: The study investigated the longitudinal association between physical activity and the risk of long COVID in patients who recovered from COVID-19 infection. STUDY DESIGN: We analyzed longitudinal data of the Prospective Study About Mental and Physical Health cohort, a prospective cohort study with adults living in Southern Brazil. METHODS: Participants responded to an online, self-administered questionnaire in June 2020 (wave 1) and June 2022 (wave 4). Only participants who self-reported a positive test for COVID-19 were included. Physical activity was assessed before (wave 1, retrospectively) and during the pandemic (wave 1). Long COVID was assessed in wave 4 and defined as any post-COVID-19 symptoms that persisted for at least 3 months after infection. RESULTS: A total of 237 participants (75.1% women; mean age [standard deviation]: 37.1 [12.3]) were included in this study. The prevalence of physical inactivity in baseline was 71.7%, whereas 76.4% were classified with long COVID in wave 4. In the multivariate analysis, physical activity during the pandemic was associated with a reduced likelihood of long COVID (prevalence ratio [PR]: 0.83; 95% confidence interval [CI]: 0.69-0.99) and a reduced duration of long COVID symptoms (odds ratio: 0.44; 95% CI: 0.26-0.75). Participants who remained physically active from before to during the pandemic were less likely to report long COVID (PR: 0.74; 95% CI: 0.58-0.95), fatigue (PR: 0.49; 95% CI: 0.32-0.76), neurological complications (PR: 0.47; 95% CI: 0.27-0.80), cough (PR: 0.40; 95% CI: 0.22-0.71), and loss of sense of smell or taste (PR: 0.43; 95% CI: 0.21-0.87) as symptom-specific long COVID. CONCLUSION: Physical activity practice was associated with reduced risk of long COVID in adults.

The precariousness of teaching in the Covid-19 pandemic: impacts on the inclusion of visually impaired university students

This article aims to explain the challenges and barriers imbricated in teaching practice regarding the inclusion of visually impaired university students in times of the Covid-19 pandemic. It follows the foundations of Socio-Historical Psychology and Dialectical Historical Materialism. Six university students with visual impairments from different undergraduate courses at a public university in the Northeast of the country, participated in the research. The data were produced through a semi-structured interview, which was carried out individually by Google Meet. For data analysis we used the meaning nuclei. The results showed that the lack of knowledge about the inclusion of people with visual impairment, combined with the lack of appropriation of digital tools and the multiple demands contributed to an excluding pedagogical practice that is guided by an ideological bias of the normative body. However, we consider that remote teaching enhanced the precariousness of teaching practice, and that it exacerbated the exclusion of students with visual impairments.

Chemical Safety Knowledge Assessment of Academic Researchers from Brazil During Covid-19 Pandemic

Introduction: Laboratories are inextricably dangerous work environ-ments, as fatal incidents are reported in both academic and non-aca-demic environments worldwide, where poor safety culture has been rec-ognized as the major accident contributor. Workers can be exposed to chemical, biological, physical, or radioactive hazards, in addition to mus-culoskeletal stresses. In Brazil, hundreds of thousands of workers are employed in laboratories, either in private or public institutions. Alt-hough laboratory safety can be governed by local, state, or federal regu-lations, learning how to identify common laboratory hazards is the first step to preventing accidents in the lab environment. Methods: The study aimed to assess the degree level of safety culture in an academic population of research laboratories, located in the largest city in Brazil, and their compliance with occupational safety regulations during the COVID-19 outbreak. This study was carried out between Oc-tober and November 2020. The results were obtained from the standard-ized questionnaire used to assess 98 researchers working in laboratories during the COVID-19 pandemic. Results: The majority of respondents (95%) reported being exposed to more than two risks, simultaneously. About two-thirds (66%) of them were not fully aware of the laboratory's risk map. About half of the re-searchers (50%) were lacking in safety culture, and 57%and 43% were preoccupied with chemical and non-chemical hazards, respectively. Per-sonal protective equipment (PPE) during laboratory work was used by most researchers, but 75% of researchers claim that security awareness learning should be a high priority for admission to laboratories. About 39% of researchers agreed that awareness of security must be improved in their laboratories Conclusion: The survey proves the lack of information and attitudes about chemical safety, especially among less experienced researchers, even if they use personal protective equipment when necessary. © 2023 by Animal Bioscience.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

Mild COVID-19 symptoms in a patient with multiple sclerosis in uninterrupted treatment with fingolimod

Introduction The use of fingolimod as a long-term therapy in people with Multiple Sclerosis (PwMS) is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. At the moment, the outbreak of the novel coronavirus SARS-CoV-2 brings new challenges to physicians when deciding to continue or stop the treatment with fingolimod. Objective We report one MS patient tested positive for SARS-CoV-2 that has not discontinued fingolimod treatment and developed only mild symptoms from COVID-19. Method(s): Descriptive observational study. Discussion and conclusion The effects of COVID-19 infection on MS patients treated with fingolimod are still uncertain. This case report outlines promising results by demonstrating a patient who didn't stop the fingolimod treatment during COVID-19 infection and developed only mild symptoms. Nevertheless, more studies are necessary to evaluate the risks and benefits of fingolimod in MS patients infected with COVID-19.Copyright © 2022 The Authors

Digital Tools and methods to Enhance Learning: The Digitools Project

The use of distance education using digital tools in higher education has increased over the last decade, particularly during the COVID-19 pandemic. COVID-19 has resulted in schools shutting down all across the world. This paper aims to present a brief summary of the Digitools Project and a multicultural analysis of the use of e-learning during Covid-19 in six countries. The methodology used was a survey by questionnaire involving teachers, librarians and students. The analysis of the questionnaire results allowed us to identify which dimensions to assess the sustainability of eLearning namely the organizational, socio-cultural and technological context. It also made it possible to assess the perceived usefulness, perceived ease of use, intention to use, actual use and perceived satisfaction. Furthermore, personal, technological and organizational dimensions are also valued for e-learning usage. After reviewing the state of the art, there was a need to define a strategic training plan for the acquisition of basic and advanced skills for eLearning's implementation and usage. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Molecular interaction between tissue repair via SDF-1/CXCR4 signaling and the inflammatory response in acute myocardial infarction with ST-segment elevation

The inflammatory response/ischemic damage relationship is a prerequisite for the initiation of the process of adaptation of the post-infarction cardiac tissue, in which the SDF-1/CXCR4 signaling plays a central role in tissue repair. This study aimed to investigate the modulation exerted by the SDF-1/CXCR4 axis on the inflammatory response after ST-segment elevation acute myocardial infarction (STEMI). Therefore, we developed Bayesian Networks from microarray (GEO) data and evaluated the expression of transcripts of interest in patients with STEMI by qPCR. In the chronic and anti-inflammatory scenario, we verified a relationship between proteins involved in tissue remodeling and the blockade of apoptotic pathways. The expression levels of the transcripts evaluated were increased in the initial moments after the infarction. In conclusion, the effects promoted by the SDF-1/CXCR4 interaction can be modulated according to the immunological profile, directly influencing its adaptive and cardioprotective effects. Therefore, we believe that students can contribute to the awareness of family and friends about COVID-19 and fake news. © 2023 Multidisciplinary Science Journal. All rights reserved.

Pathophysiological insights from lung diffusing capacity for nitric monoxide (DLNO) after COVID-19

Background: Gas exchange abnormalities in COVID-19 survivors might involve impairment of the transfer through alveolar-capillary membrane and/or loss of capillary bed. Membrane diffusing capacity (Dm) and capillary volume (Vc) can be calculated from combined DLCO-DLNO. Aim(s): To investigate the values of Dm and Vc after COVID-19. Method(s): We retrospectively included all the patients (Pts) having performed DLCO-DLNO after COVID-19 in 4 French centres between 2020/04/20 and 2021/12/16. We excluded Pts with known history of COPD, severe asthma, interstitial lung disease, pulmonary hypertension, and congestive heart failure. We collected data from clinical records, pulmonary function test (PFT), and CT-scan when performed +/-1.5 months from PFT. Result(s): Data from 132 Pts have been analysed yet (over a total of about 500): 72 men (55%), mean age 57.7+/-13 years, mean BMI 30+/-5.7. 25 Pts (19%) were grade 1-4 on COVID-19 WHO scale (no oxygen), 45 (34%) were grade 5 (oxygen), 44 (33%) were grade 6 (NIV or high-flow oxygen), and 18 (14%) were grade 7-9 (mechanical ventilation). Median time between COVID-19 and PFT was 4.4 months [3.1-6.1]. 58 Pts (44%) had DLCO < lower limit of normal (LLN), with a significant correlation between initial COVID-19 severity and later DLCO. Mean Dm and Vc were 48.7% +/-15.1 and 80.2% +/-21. The most frequent pattern was Dm < LLN and normal Vc, in 78 Pts (59%). Only 1 (1%) had isolated Vc < LLN with normal Dm. Among the 37 (28%) with both Dm and Vc < LLN, 36 performed a CT-scan that showed fibrosing sequellae in 26 (72%). Conclusion(s): Dm was the most decreased variable, suggesting delayed healing after COVID-19. Decreased Vc was frequently associated with pulmonary fibrosis.

A Case Series of Follow-ups in COVID-Related Diabetes: Could the Damage in Beta Cells be Recovered?

SARS-CoV-2 infection may be related to new-onset diabetes and diabetic ketoacidosis (DKA). We describe a long-term follow-up of 3 cases presented in the Emergency Department with DKA and COVID-19. In 2 of them, the clinical course permitted withdrawal of insulin therapy during follow-up. The third case, a more serious one with pulmonary thromboembolism, continued to require bedtime insulin during the follow-up period. Such cases demonstrate that insulin treatment can control glucotoxicity and help beta cells recover after an acute insult such as COVID-19.

Clinical outcome and associated factors in patients with COVID-19 admitted to an Intensive Care Unit

Methods: This is a case series, carried out from March to July 2020, with data recorded in the nutritional monitoring records of patients hospitalized with COVID-19. The variables analyzed were: demographic (age and sex);clinical (comor-bidities, underlying disease and outcome), anthropometric, biochemical and nutritional support. Results: The sample consisted of 102 patients, 65.7% had the severe acute respiratory syndrome, the main underlying disease observed was heart disease (23.5%) and 69.3% of patients were discharged from the ICU. Regarding nutritional variables, approximately 50% of patients received enteral feeding and 73.3% started early. Concerning biochemical markers, patients who died had higher C-reactive protein (CRP)/albumin ratios (p=0.024) and CRP concentrations (p=0.012) when compared to those who progressed to dis-charge from the ICU. In addition, it is observed that the eld-erly (adjusted HR = 3.62;95%CI 1.19 - 10.97) and early ini-tiation of enteral nutritional therapy (adjusted HR = 10.62;95%CI 2.41 - 46 .87) were factors related to ICU discharge. Conclusion: Monitoring the inflammatory process using different markers seems to be a good parameter for the clinical evolution of these patients. In addition, the benefits of early enteral nutrition therapy may be associated with better clinical outcomes and reduced complications during hospitalization.

Prevalence et facteurs associes aux plaintes respiratoires fonctionnelles identifiees par le questionnaire de Nijmegen dans les suites d'une COVID-19

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022

Prospective cohort of elderly patients after hospitalization due to COVID-19: preliminary results

Background: Post Covid-19 syndrome is recognized as the maintenance of disease symptoms for weeks to months after the disease has healed. It is suspected that the involvement of the ACE enzyme and IL-6 may trigger an increased risk of dementia. Method(s): This is a cohort study that is evaluating over 12 months the functional status and cognition of elderly people after hospital discharge. One group is composed of elderly people admitted to the hospital for Covid-19 and the other group is composed of elderly people hospitalized for other clinical reasons. The groups are evaluated with The Mattis (DRS), AD8, IQCODE, ADCS-ADL, PCL-C, GDS-15, FIM, COPM, CFS, FSS, mMRC and SARC-calf. We will describe the preliminary results of the first 15 patients included in the COVID-19 group on functional status, cognition, mood and quality of life. Result(s): Fifteen patients with COVID-19 were evaluated three months after hospital discharge. One was excluded due to previous mental disorder and another due to a request to be excluded from the study. We found a mean age of 67.7 +/- 7.15 years, schooling 8.7 +/- 4.7 years, 61.5% female, Charlson Comorbidity Index 1.9 +/- 1.4, 69.2% with smoking history had incomplete vaccine protection for COVID-19. Considering cognition, 15.4% of the sample had no impairment, 53.9% had mild cognitive impairment (MCI) (30.8% amnestic MCI and 23.1% non-amnesic MCI) and 30.8% had dementia. 23.1% declared their health status and quality of life as fair or poor. Median CFS was 5 (3-5), mean GDS-15 was 4.7 +/- 2.9, FSS 32.9 +/- 18.9, PCL-c 32.6 +/- 12.5, SARC-calf 3.2 +/- 4.2. All had mMRC dyspnea classified between 2 and 4. Conclusion(s): There was a high prevalence of mild cognitive impairment and dementia among patients after three months of discharge, with a predominance of mild frailty due to CFS and the presence of fatigue. It is noteworthy that a quarter of the sample reported low quality of life. Copyright © 2022 the Alzheimer's Association.

Differences in Mortality Rates in Inpatients with Cirrhosis Depends on the Low, Middle or High Income Country Location: Multi-National Cleared Consortium Experience

Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).

Study of the sewage from a municipality in southern Minas Gerais, Brazil: correlation of physical and chemical variables, COVID-19 cases, and SARS-CoV-2 RNA concentration

Wastewater-based epidemiology is an important public health tool with great applicability when facing the COVID-19 pandemic, since infected individuals are able to excrete SARS-CoV-2 particles. In this context, this study aimed to correlate the number of cases of COVID-19 with physical and chemical variables and the presence of the virus in raw sewage samples from a sewage treatment plant (SIP) in the municipality of Lavras, Minas Gerais, Brazil, collected between the 19th and 25th epidemiological weeks. The samples were concentrated by electronegative membrane adsorption method and SARS-CoV-2 RNA was extracted, detected, and quantified by RT-qPCR using oligonucleotides and probes for the N gene. Moreover, the variables pH, total suspended solids, and chemical oxygen demand were evaluated. COVID-19 cases were obtained from epidemiological bulletins made available by the municipal government From the 24th epidemiological week on, a reduction in viral concentration (copies L-1) was observed concomitantly with the pandemic response countermeasures initiated by the municipality. A strong and significant positive correlation (p<0.05) between viral load and number of confirmed cases was obtained through Spearman's test. However, there was no correlation between the presence of the virus and the physical and chemical characteristics of the sewage. Therefore, it is suggested that further research be carried out in order to track SARS-CoV-2 concentrations in wastewater, thus corroborating with the fight against the pandemic and the achievement of epidemiological surveillance systems based on sewage monitoring.

Mortality, deep vein thrombosis, and D-dimer levels in patients with COVID-19

Aim: The aim of the present study was to analyze D-dimer levels and associate these levels with deep vein thrombosis and mortality in patients with COVID-19. Method: From a population of approximately 1200 patients evaluated for the investigation of deep vein thrombosis (DVT) of the lower limbs using bilateral venous Doppler ultrasound, 100 positive for DVT and 100 negative for DVT were selected to compose the present sample. Data were collected on sex, age and D-dimer levels. D-dimer levels were categorized as follows: > 20 mu g/mL, 10 to 20 mu g/mL, 5 to 10 mu g/mL, 3 to 5 mu g/mL and < 3 mu g/mL. The association between D-dimer category and mortality was evaluated. Results: The mean D-dimer level was 11.90 and 4.97 mu g/mL in the groups with and without DVT;this difference was significant (p = 0.0001, paired t-test). The mortality rate was higher than 35% in patients without DVT and with D-dimer > 3 mu g/mL. In the group with DVT, the mortality rate was higher than 55% independently of the D-dimer level. Conclusion: The assessment of the D-dimer level is fundamental in screening for deep vein thrombosis in patients with COVID-19, as higher levels are associated with greater mortality and the presence of deep vein thrombosis.

Longitudinal study about the impact of COVID-19 pandemic in a southern Brazilian state: the PAMPA cohort

This study aimed to describe the effects of social distancing due to the COVID-19 pandemic on physical and mental health, chronic disease management, and economic situation in adults from a southern Brazilian state. Data from the baseline of the PAMPA (Prospective Study About Mental and Physical Health) cohort, a population-based, longitudinal study is presented. An online-based questionnaire was used to assess the variables pre- and during social distancing. Most of the respondents (N=2,321) were women (76.7%), white (90.6%), had at least university degree (66.7%), and were overweight or obese (53.3%). Nearly 40% were not able to work from home and 45.3% had monthly income reduced during social distancing. Moderate-to-severe symptoms of depression and anxiety increased 7.3x and 8.4x from before to during social distancing. Three quarters reported low back pain (74.2%;95%CI: 71.9%, 76.3%) during the same period while the prevalence of physical inactivity increased 31.2%. Managing chronic conditions was harder during social distancing for 28.5% of the participants. Roughly 40% reported that did not seek medical assistance even when necessary during this period. COVID-19 pandemic has disrupted the health of adults from a southern Brazilian state in several aspects.

CLEARED Global consortium results highlight regional variation and need for equity in inpatient outcomes in hospitalized patients with Chronic Liver Disease

Background and aims: A global study with equitable participation for cirrhosis and chronic liver disease (CLD) outcomes is needed. We initiated the Chronic Liver disease Evolution And Registry for Events and Decompensation (CLEARED) study to provide this global perspective. Aim to evaluate determinants of inpatient mortality and organ dysfunction in a multi-center worldwide study. Method: We prospectively enrolled pts with CLD/Cirrhosis >18 years without organ transplant or COVID-19 who were admitted non-electively. To maintain equity in outcome analysis, a maximum of 50 pts/site were allowed. Data for admission variables, hospital course, and inpatient outcomes (ICU, death, organ dysfunction [ODF]) were recorded. This was analyzed for death and ODs using significant variables on admission and including World Bank classification of low/middle-income countries (LMIC). A model for in-hospital mortality for all variables during the hospital course, including ODs) was analyzed. Results: 1383 pts (55 ± 13 yrs, 64% men, 39% White, 30% Asian, 10% Hispanic, 9% Black, 12% other) were enrolled from 49 centers (Fig A). 39% were from high-income while the rest were from LMICs. Admission MELDNa 23 (6–40) with history in past 6 months of hospitalizations 51%, infections 25%, HE 32%, AKI 23%, prior LVP 15%, hydrothorax 8% and HCC 4%. Leading etiologies were Alcohol 46% then NASH 23%, HCV 11% and HBV 13%. Most were on lactulose 52%, diuretics 53%, PPI 49% and statins 11%, SBP prophylaxis 16%, beta-blockers 35% and rifaximin 31%. 90% were admitted for liver-related reasons;GI bleed 30%, HE 34%, AKI 33%, electrolyte issues 30%, anasarca 24% and 25% admission infections. In-hospital course: Median LOS was 7 (1–140) days with 25% needing ICU. 15% died in hospital, 3% were transplanted, 46% developed AKI,15% grade 3–4 HE, 14% shock, 13% nosocomial infections and 13% needed ventilation. Logistic Regression: Fig B shows that liver-related/unrelated factors on admission which predicted in-hospital mortality and development of organ dysfunction with MELDNa and Infections being common among all models. Nosocomial infections and organ dysfunctions predicted mortality when all variables were considered. High-income countries had better mortality outcomes likely due to transplant and ICU availability. AUCs were >0.75 (Figure Presented) Conclusion: In this worldwide equitable experience, admission cirrhosis severity and infections are associated with inpatient outcomes, which are greater in low-income settings. Liver-related and unrelated factors and regional variations are important in defining critical care goals and outcome models in inpatients with cirrhosis.