Outcomes of Covid-19 Infection among Hospitalized Patients by Their Stage of Chronic Kidney Disease

INTRODUCTION: Chronic kidney disease (CKD) is an important risk factor for severe COVID-19 disease associated with increased intensive care unit (ICU) admission and mortality. Studies demonstrate an increased mortality rate among advancing CKD stages in patients without COVID-19 infection. However, it is unknown whether a graded association exists between the stages of CKD and COVID-19 mortality. We aim to compare the rates of ICU admission, mechanical ventilation (MV), and survival amongst COVID-19 patients with Stage IIIb -V CKD. METHOD(S): We conducted a retrospective cohort study on non-dialysis adults with Stages IIIb, IV, and V CKD without previous renal transplant hospitalized for COVID-19 infection in a community hospital. Patients were categorized into two groups, Stage IIIb CKD and Stages IV&V CKD, based on their pre-admission glomerular filtration rate (GFR 30-44ml/ min vs < 30ml/min). The primary endpoints were rates of ICU admission, MV, non-invasive mechanical ventilation (NIMV), and survival. The Mann-Whitney U test for continuous variables and the chi-square test for categorical variables were used for analysis. RESULT(S): We screened 228 patients and 153 met the inclusion criteria. Baseline demographics were distributed equally between the two groups. There were statistically significant differences in the ICU admission rate (45.2% vs 25.3%,p-0.01), MV rate (37.1% vs 16.5%,p-0.004) and NIMV rate (50% vs 28.6%,p-0.007) in patients with Stage IIIb versus Stages IV&V CKD respectively. However, there was no significant difference in the survival rates (79.1% vs 67.7%,p-0.1128) between the two groups. CONCLUSION(S): The association between reduced baseline eGFR and increased risk of severe COVID-19 infection has been established with multiple studies evaluating the prognostic impact of pre-existing CKD in patients with COVID-19. Our study illustrates the greater incidence of adverse outcomes, such as ICU admission rate, MV rate, and NIMV rate, in patients with Stages IV&V CKD versus Stage IIIb CKD. With recent guidelines recommending management of COVID-19 infection based on the presence of risk factors, these results will aid in risk stratification among CKD patients with COVID-19, and encourage future prospective studies to explore disease-modifying treatments for the vulnerable CKD population.

Hyperglycemia in Covid-19 Infection without Diabetes Mellitus: Association with Inflammatory Markers

INTRODUCTION: New onset hyperglycemia is common in patients with severe Covid-19 infection. Cytokine storm due to Covid-19 infection is an important etiology for new-onset hyperglycemia, but factors like direct SARS-CoV-2 induced pancreatic beta-cell failure have also been postulated to play a role. We assessed the validity of the cytokine-induced hyperglycemia hypothesis by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with Covid-19 infection. METHOD(S): We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for Covid-19 infection. The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected. Hyperglycemia was defined as glucose levels >=140mg/dL. CRP >=100mg/L, ferritin >=530ng/ mL, LDH>=590U/L, and D-dimer >=0.5mg/L were considered elevated. We used Chi-square test for categorical variables, Mann Whitney U test for continuous variables, and calculated the logistic regression for hyperglycemia. RESULT(S): Of the 520 patients screened, 248 met the inclusion criteria. Baseline demographics were equally distributed between the two groups. There were no statistically significant differences between serum inflammatory markers except LDH in patients with or without new-onset hyperglycemia [CRP(58.1%vs.65.6%,p-0.29), ferritin (48.4%vs.34.9%, p-0.14),D-dimer (37.1%vs.37.1%,p-0.76) & LDH (19.4%vs11.8%,p-0.02)]. However, Logistic regression analysis showed no difference in LDH levels between the two groups (OR-1.623,p-0.256). Additional analysis showed significantly higher mortality (24.2%vs.9.1%,p-0.001;OR-2.528,p-0.024) and length of stay(8.89 vs 6.69,p-0.026) in patients with hyperglycemia. CONCLUSION(S): Our pilot study showed no association between inflammatory marker levels and new-onset hyperglycemia in non-diabetic patients with Covid-19 infection, thus questioning the validity of the Covid-19 cytokine storm-induced stress hyperglycemia hypothesis. Our study also showed that new-onset hyperglycemia is an independent risk factor for higher mortality and length of stay. In light of the findings of our small single-center study, it becomes imperative to undertake a larger prospective study to understand the mechanism of SARS-CoV-2 infectioninduced hyperglycemia.

Can Inflammatory Markers be used as an Early predictor for Mechanical ventilation in COVID-19 patients with Stages IIIb-V Chronic Kidney Disease?

Background. The clinical use of inflammatory markers soared during the COVID-19 pandemic. Though studies have shown C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with COVID-19, its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance of inflammatory cytokines. Our aim was to assess the association of inflammatory markers like CRP, ferritin, LDH, D dimer, and MV rate in patients with stages IIIb-V CKD and COVID-19. Methods. We conducted a cross-sectional study on inpatients in a community hospital from 12/1/19 to 1/1/22 with COVID-19 and stages IIIb-V CKD without a previous renal transplant. Primary endpoints were invasive MV(IMV) rates, noninvasive MV(NIMV) rates, and no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP 100 mg/L, ferritin 530ng/ml, D-dimer 0.5mg/L and LDH 590 U/L. Univariate analysis and Area under curve (AUC-ROC) between the covariates and outcomes were computed. Results. 290 patients were screened, and 118 patients met inclusion criteria. CRP, D dimer, and ferritin were significantly different among the three groups. On univariate analysis for IMV, CRP had an OR 5.44;ferritin, OR 2.8;LDH, OR 7.7;D-dimer, OR 3.9, WBC count, OR 4.2 (p< 0.05). Admission CRP level was 0.747 for the IMV group (AUC-ROC, sensitivity 80.8%, specificity 50%) and 0.663 for the NIMV group (AUC-ROC, sensitivity 69.2%, specificity 53%) Conclusion. Our results illustrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates. The ROC demonstrates a good sensitivity for CRP levels in detectingMVthereby emphasizing the utility of these biomarkers as good predictive markers in COVID-19 patients with CKD. With increasing use of inflammatory markers to prognosticate disease severity in COVID, the applicability of these markers in different populations should be investigated. A similar pattern of elevated inflammatory markers predicting the rate of MV was found in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation due to CKD alone.

AGILEST Approach: Using Machine Learning Agents to Facilitate Kinesthetic Learning in STEM Education through Real-time Touchless Hand Interaction

There is an increasing interest in creating interactive learning applications using innovative interaction technologies, especially in STEM (Science, technology, engineering, and mathematics) subjects. Recent developments in machine learning have allowed for nearly perfect hand-tracking recognition, introducing a touchless modality for interaction within Augmented Reality(AR) environments. However, the research community has not explored the pedagogical approach of Kinesthetic Learning or “Learning by Doing”, hand tracking, and machine learning agents combined with Augmented Reality technology. Fundamentally, this exploration of touchless interaction technologies has taken on new importance in the new post-COVID world. Meanwhile, machine learning has gained attention for its ability to enhance personalized learning and play a vital new role as a virtual instructor. This paper proposes a novel approach called the AGILEST approach, which uses machine learning Agents to facilitate interactive kinesthetic learning in STEM education through touchless interaction. The first case study for this approach will be an AR learning application for chemistry. This application uses real-time touchless hand interaction for kinesthetic learning and uses a machine learning agent to act as both trainer and assessor of the user. The evaluation of this research has been conducted remotely through a usability study with expert reviewers, which includes 15 young researchers with peer-reviewed work in Human-Computer Interaction & AR and 2 subject experts STEM teachers at the secondary school level. The usability evaluation through NASA Task Load Index (NASA-TLX), Perceived Ease of Use(PUEU), and Perceived Usefulness(PU) with expert reviewers provide positive feedback about this approach for productive learning gain, engagement and interactiveness in learning STEM subjects.

A Tertiary Care Centre Experience of COVID-19-Associated AKI During the First and Second Waves of the Pandemic

Background: There is a scarcity of information on the incidence and outcomes of acute kidney injury in COVID-19 patients in India. Therefore, we analysed the correlation of AKI risk factors and compared the outcomes of the first and second COVID-19 waves in a tertiary care centre. Method(s): *Single centre retrospective analysis *Patients who tested positive for COVID-19 between July 2020 and May 2021, with serum creatinine levels measured on admission (n= 1260). *AKI was defined according to the KDIGO clinical practice guidelines. *Multivariate binomial logistic regression yielded odds ratios for risk variables of AKI. *Age-adjusted odds ratios(OR) were used to compare COVID-19 outcomes between the first and second waves. Result(s): Baseline characteristics: *Median Age= 56 (IQR 47-66) *Population with diabetes-55.2% *Population with hypertension-42.11% All AKI (n=86) *Stage 1 (n=57) *Stage 2 (n=20) *Stage 3 (n=9) Risk factors for AKI: *Diabetes OR 1.9 (1.2 - 3.1) *Hypertension OR 3.2 (2.0 - 5.2) *C-reactive protein >= 10 mg/dl, OR 3.6 (1.6 - 8.0). *D-dimer >= 250 pg/ml, OR 4.2 (2.5 - 6.8). *Need for ventilation OR 3.06 (1.8 - 4.9) Comparison of COVID -19 outcomes: Compared to the first wave, the second wave cohort had lower risk for: *Acute kidney injury (adj OR: 0.4;CI: 0.2-0.7) *Mortality (adj OR: 0.2;CI: 0.09-0.7) *Invasive mechanical ventilation (adj OR: 0.2;CI: 0.06 - 0.8) *Length of ICU stay > 5days (adj OR: 0.4;CI: 0.2 - 0.7) Conclusion(s): In our retrospective study, AKI prevalence was 6.8%, and the mortality rate of 2.9%. Our analysis shows that the second wave of COVID -19 exhibits improved clinical outcomes compared to the first wave. (Table Presented).

Current Challenges and Future Research Directions in Augmented Reality for Education

The progression and adoption of innovative learning methodologies signify that a respective part of society is open to new technologies and ideas and thus is advancing. The latest innovation in teaching is the use of Augmented Reality (AR). Applications using this technology have been deployed successfully in STEM (Science, Technology, Engineering, and Mathematics) education for delivering the practical and creative parts of teaching. Since AR technology already has a large volume of published studies about education that reports advantages, limitations, effectiveness, and challenges, classifying these projects will allow for a review of the success in the different educational settings and discover current challenges and future research areas. Due to COVID-19, the landscape of technology-enhanced learning has shifted more toward blended learning, personalized learning spaces and user-centered approach with safety measures. The main findings of this paper include a review of the current literature, investigating the challenges, identifying future research areas, and finally, reporting on the development of two case studies that can highlight the first steps needed to address these research areas. The result of this research ultimately details the research gap required to facilitate real-time touchless hand interaction, kinesthetic learning, and machine learning agents with a remote learning pedagogy.

EFFECT OF HYPERTENSION AND RAS INHIBITORS TO ADULT PATIENTS (OVER 18 YEARS OLD) WITH SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV2) INFECTION WHO WERE ADMITTED TO HOSPITAL

Objective: A meta-analysis published in March 2021 concluded that neither the ACE inhibitor nor ARB treatment came together with a higher COVID-19 mortality rate. Our aim was to assess the prevalence of treated HT, the number of antihypertensives and ACE-inhibitors or ARBs of them among Covid-positive patients older than 18 years admitted to the Center for Disease Control 1 of Department of Medicine of the University of Szeged. Design and method: Data of 165 randomly selected patients (mean age 59.9 ± 12.9 yrs., mean BMI 30.7 + 6.6 kg/m2.) were analysed retrospectively. They were admitted between middle of February and end of April 2021. Results: At the time of admission there were 103 (62.4% of all) HT patients (56 men, 47 women). The mean duration of HT was 12.9 ± 6.1 years. The mean number of antihypertensive drugs were 1.6 ± 1.6 pieces (max. 6) at the time of admission. At home 23 patients took more than 3 antihypertensives and 25 patients took exactly 3 drugs. At home 20 patients had monotherapy. The antihypertensive therapy did not change in 74 cases, decreased in 6 cases and increased in 31 cases. In one case we could reduce therapy with 100%, monotherapy was finished, in the other 5 cases it was reduced by 50%. HT patients spent more days in hospital than non-HT patients (10.9 ± 6.8 vs. 9.2 ± 6.3). Spontaneous oxygen saturation (SatO2) was lower in HT patients compared to non-HTs at admission (89.6 ± 9.7% vs. 92.6 ± 4.8) and patients who were on ARBs had the lowest SatO2 (87.5 ± 8.5%, p = 0.01 vs. non-HT). The total mortality rate was 8.7 % in HT patients and it was just 1.6% in non-HT patients. 16.3% of HT patients with RAS-inhibitors and 13.0% without it required admission to the intensive care unit. The mortality rate was 10 % of patients with RAS-inhibitors and 4.3 % of them without it. The mortality rate was 10% of patients with RAS-inhibitors and 4.3% without it. This rate was 13% in patients with ARB and 8.8% with ACE-inhibitor. Conclusions: According to our results, HT may have higher risk for Covid outcomes, including RAS-inhibitors also have a higher risk.

COVID-19 ASSOCIATED REDUCTION IN HYPERTENSION-RELATED DIAGNOSTIC AND THERAPEUTIC PROCEDURES IN EXCELLENCE CENTERS OF THE EUROPEAN SOCIETY OF HYPERTENSION

Objective: The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension. Design and method: We conducted an electronic survey regarding 6 key procedures in hypertension care among our ECs. Results: Overall, 54 ECs from 18 European and 3 non-European countries participated. From 2019 to 2020, there was a significant decrease in the median number per center of ambulatory blood pressure monitorings (ABPMs;544 vs 289), duplex ultrasound investigations of renal arteries (DUS RA;88.5 vs 55), computed tomographic investigations of renal arteries (CT RA;66 vs 19.5), percutaneous renal artery angioplasties (PTA RA;5 vs 1), laboratory tests for catecholamines (2019: 116 vs 67.5) and for ennin/aldosterone (146 vs 83.5). All comparisons were statistically significant with p < 0.001, respectively (Figure). While the reduction in all diagnostic and therapeutic procedures was observed in all 3-months period comparisons between 2019 and 2020, the most profound decrease occurred from April to June 2020, which was the period of the first wave and the first lockdown in most countries. In this period, as compared to 2019, the median reduction in 2020 was 50.7% (ABPM), 47.1% (DUS RA), 50% (CT RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41% ( ennin/aldosterone), respectively. Based on Friedman test, overall differences in reduction between 3 months time intervals were statistically highly significant. Conclusions: Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.

Potential security and privacy issues in zero UI touchless technology

Touchless technology often called Zero User Interface (UI) has begun to permeate every aspect of our lives as its use became necessary for hygiene measures in public places. The evolution of touchless technology replacing touchscreen interaction started as a luxury concept to give a fancier look to digital interactions, but now it has gained real value as a health-oriented interaction method. Switching to a touchless interface reduces common touchpoints, which help to safeguard against the spread of pathogens. Although the evolution of touchless technology is not new, its use massively increased due to its inherent hygienic nature during the COVID-19 pandemic. However, this investment in a new form of digital interaction has several privacy and security issues that need attention, in order to allow for safe human–machine interaction to cope with security breaches and cyber-attacks to protect our credentials. This paper outlines the potential security and privacy issues concerning Zero UI adoption in various technologies that need to be considered if one wishes to adopt responsible technology practices with this technology.

The Gut Microbiome Of Covid-19 Recovered Patients Returns To Uninfected Status In A Minority-Dominated United States Cohort

Introduction: Intestinal Microbiota Influences Both Susceptibility And Severity Of Bacterial And Viral-Induced Pathogenicity, Including Respiratory Diseases. In This Study, We Investigated The Relationship Between Intestinal Microbiota And Sars-Cov-2-Mediated Pathogenicity In The United States, Majority African American Cohort. Hypothesis: Intestinal Microbiota Is Modulated By Sars-Cov-2 Infection And Is Related To Symptom Severity And Recovery From The Disease. Methods: We Conducted A Single-Institution Study, Prospectively Collecting Fecal Samples From 50 Sars-Cov-2 Infected Patients Within 3 Days Of Icu Admission And 9 Sars-Cov-2 Recovered Patients Upon Testing Negative For The Virus. Feces Of 34 Uninfected Subjects At The Hospital With Unrelated Respiratory Medical Conditions Were Used As Controls. Total Fecal Rna/Dna Was Extracted And Microbiota Composition Was Determined Using 16s Rrna Gene Sequencing Of The V1-V3 Region. The 16s Rdna Sequencing Reads Were Processed Using Dada2 To Generate Amplicon Sequence Variants (Asv). Rt-Pcr On Fecal Rna Using Two Sets Of Validated Primer/Probes Was Performed To Establish The Presence Or Absence Of Sars-Cov-2 Viral Rna. Results: The Fecal Microbial Composition Was Found To Be Significantly Different Between Sars-Cov-2 Patients And Controls (Permanova Fdr-P=0.004), Independent Of Treatments Such As Antibiotic Exposure. Peptoniphilus, Corynebacterium And Campylobacter Were Identified As The Three Most Significantly Enriched Genera In Covid Patients Compared To Controls. Actively Infected Patients Were Also Found To Have A Different Gut Microbiota Than Recovered Patients (Permanova Fdr-P=0.003), And The Most Enriched Genera In The Covid-19 Patients Was Campylobacter, With Agathobacter Being Enriched In The Recovered Patients. No Difference In Microbial Community Structure Between Recovered Patients And Uninfected Controls Was Observed (Permanova Fdr-P=0.93), With Phocea Being The Top Genus Associated With Patients Who Recovered From Covid-19. Furthermore, No Difference In Alpha Diversity Between The Three Groups Was Noticed. More Importantly, 24 Of The 50 Covid-19 Patients (48%) Tested Positive Via Rt-Qpcr For Fecal Sars-Cov-2 Rna. A Significant Difference In Gut Microbial Composition Between Sars-Cov-2 Positive And Negative Samples Was Observed, With Klebsiella And Agathobacter Being Enriched In The Positive Cohort And Phocea In The Negative Cohort. No Significant Associations Between Microbiome Composition And Disease Severity Or Proton Pump Inhibitor Treatment Were Found. Conclusion: The Intestinal Microbiota Is Sensitive To The Presence Of Sars-Cov-2, With Increased Relative Abundance Of Genera (Campylobacter, Klebsiella) Associated With Gi Disease. Further Studies Are Needed To Investigate The Functional Impact Of Deleterious Bacterial Genera In Sars-Cov-2 On Gi Health.

From luxury to necessity: Progress of touchless interaction technology.

Touchless Technology is facilitating the move to Zero User Interface(UI) propelled by the COVID-19 pandemic which has accelerated the use of this technology due to hygiene requirements. Zero UI can be defined as a controlled interface that enables user interaction with technology through voice, gestures, hand interaction, eye tracking, and biometrics such as facial recognition and contactless fingerprints. Smart devices, IoT sensors, smart appliances, smart TVs, smart assistants and consumer robotics are predominant examples of devices in which Zero UI is becoming increasingly adopted. These control interfaces include natural interaction modes such as voice or gestures. Touchscreens and shared devices such as kiosks, self-service counters and interactive displays are present in our everyday lives. Each of these interactions however is a concern for consumers in a post-COVID-19 world where hygiene is of utmost importance. The one-stop solution to hygienic interactions includes touchless technology such as voice control, remote mobile screen take over, biometric, and gesture control as Zero User interfaces. With the breakthroughs in image recognition and natural language processing, powered by advanced computer vision and machine learning, "Zero UI" is becoming a new normal. This paper is focusing on the progress of the touchless interaction technology during the COVID-19 pandemic, which actually accelerated development in this concept and moved it from being a luxury to a life necessity.

Transient knockdown of Anopheles stephensi LRIM1 using RNAi increases Plasmodium falciparum sporozoite salivary gland infections.

BACKGROUND: Plasmodium falciparum (Pf) sporozoites (PfSPZ) can be administered as a highly protective vaccine conferring the highest protection seen to date. Sanaria® PfSPZ vaccines are produced using aseptically reared Anopheles stephensi mosquitoes. The bionomics of sporogonic development of P. falciparum in A. stephensi to fully mature salivary gland PfSPZ is thought to be modulated by several components of the mosquito innate immune system. In order to increase salivary gland PfSPZ infections in A. stephensi and thereby increase vaccine production efficiency, a gene knock down approach was used to investigate the activity of the immune deficiency (IMD) signaling pathway downstream effector leucine-rich repeat immune molecule 1 (LRIM1), an antagonist to Plasmodium development. METHODS: Expression of LRIM1 in A. stephensi was reduced following injection of double stranded (ds) RNA into mosquitoes. By combining the Gal4/UAS bipartite system with in vivo expression of short hairpin (sh) RNA coding for LRIM1 reduced expression of LRIM1 was targeted in the midgut, fat body, and salivary glands. RT-qPCR was used to demonstrate fold-changes in gene expression in three transgenic crosses and the effects on P. falciparum infections determined in mosquitoes showing the greatest reduction in LRIM1 expression. RESULTS: LRIM1 expression could be reduced, but not completely silenced, by expression of LRIM1 dsRNA. Infections of P. falciparum oocysts and PfSPZ were consistently and significantly higher in transgenic mosquitoes than wild type controls, with increases in PfSPZ ranging from 2.5- to tenfold. CONCLUSIONS: Plasmodium falciparum infections in A. stephensi can be increased following reduced expression of LRIM1. These data provide the springboard for more precise knockout of LRIM1 for the eventual incorporation of immune-compromised A. stephensi into manufacturing of Sanaria's PfSPZ products.

Statins and mortality risk in hospitalized community acquired pneumonia patients

Rationale: Statins, anti-hypertensives, Proton pump inhibitors (PPIs) and H2 receptor antagonist (H2RAs) are amongst the most commonly prescribed medications for adults over the age of 50 (Kantor et al, 2015). PPI use was recently reported to have worse clinical outcomes during the COVID-19 pandemic (Lee et al, 2020). Before COVID-19, PPI use was associated with an increased risk of community acquired pneumonia (CAP) (Hertzig et al, 2009;Othman et al, 2016;Zirk-Sadowski et al, 2018). In this study, we examined the mortality risk associated with these four medications in hospitalized CAP patients not due to novel SARS-CoV-2 infection. Methods: We analyzed de-identified patient data from a research database of 6 hospitals in an integrated tertiary university healthcare system from January 1 to December 31, 2019. ICD-10 codes for CAP at the time of hospital admission were used to identify patients. A list of 17 variables relevant to outcome of CAP including demographic, comorbid conditions and medications of interests were extracted. Statistical analysis included Wilcoxon rank-sum tests, chi-squared tests, and multivariable logistic regression models were used to assess the mortality risk of all the factors. Results: Of 1223 patients admitted with CAP, the overall mortality rate was 19.9% (243/1223), baseline characteristics are shown in Table 1. There were 613 (50%) patients on PPIs, 551 (45%) on anti-hypertensives, 276 (23%) on H2RAs, and 271 (22%) on statins. PPI users had a mortality rate of 26.3% (161/613) vs 13.4% (82/610) in non-PPI users (p < 0.001). In multivariate analysis, PPI use without statins was not associated with increased mortality OR = 1.10 (0.76 to 1.60), while statin use without PPI was associated significant lower mortality: OR = 0.28 (0.13 to 0.59). This benefit was eliminated when statins and PPI were used together (OR = 0.86;95% CI of 0.53 to 1.39). Variables associated with increased mortality risk in the logistic regression model are: each decade of age (OR = 1.16;95% CI of 1.08 to 1.25), congestive heart failure OR = 2.09 (1.48 to 2.95), cancer (OR = 1.69;95% CI of 1.23 to 2.34), cardiovascular disease (OR = 2.18;95% CI of 1.27 to 3.75), and stroke (OR = 1.48;95% CI of 1.01 to 2.16). Conclusions: Statin use was associated with reduced mortality in patients with CAP, but the benefit was no longer present when combined with PPIs. The etiology for the increased mortality warrants further investigation.