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1.
Analele Universitatii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara ; 21(B):95-98, 2022.
Article in English | CAB Abstracts | ID: covidwho-20241425

ABSTRACT

The present time brings a lot of controversy and issues on economic, social and political ground. Time did not pass leaving opportunity for taking a breath from the Covid-19 pandemic, because the Ukrainian-Russian war started. This conflict unbalanced the commercial frame of Europe and prices started to go up, inducing reasons for insecurity fear for the wellbeing of tomorrow. Many people started to be anxious, and their symptoms included tachycardia, dyspnea, insomnia, headaches etc. All these symptoms are exacerbated by interfering with news from the media regarding the abovementioned socio-economic problems. Usually women are tented to be more influenceable and more alert, presenting themselves for evaluation in a medical cabinet.

2.
Electronics (Switzerland) ; 12(5), 2023.
Article in English | Scopus | ID: covidwho-2282488

ABSTRACT

The COVID-19 pandemic represented a tremendous shock for both public and private sectors and put pressure on the economic environment alongside national healthcare systems. Our article examined the economic resilience during the COVID-19 pandemic in the EU Member States and assessed if countries with more intense use of digitalization instruments (e-government features, e-commerce, ITC skills, etc.) in both public and private sectors registered a lower economic decline during 2019–2020. Our approach was based firstly on statistical correlation analysis applied to several indicators obtained from Eurostat and European Commission. Secondly, we elaborated different regional models of economic and social homogenous characteristics that could be found among EU Member States based on a hierarchical cluster analysis model applied to several structural socio-economic and digitalization indicators. The main conclusion was that there is a strong positive correlation between the share of ITC employment and the share of ITC in GDP, and the level of digital skills for individuals and the share of companies with high intensity of digitalization. © 2023 by the authors.

3.
Critical Care Medicine ; 51(1 Supplement):387, 2023.
Article in English | EMBASE | ID: covidwho-2190602

ABSTRACT

INTRODUCTION: The use of ketamine as a sedative agent has increased dramatically in patients who are mechanically ventilated (MV) due to COVID-19 in intensive care units (ICU). Ketamine primarily acts as an NMDA receptor antagonist that blocks the excitatory effects of glutamate. In comparison to other sedatives, ketamine has a more favorable hemodynamic profile and does not produce significant respiratory depression. The study sought to analyze the impact of initiating ketamine continuous infusions for sedation in MV patients on co-sedation dosing. METHOD(S): This was a single-center, retrospective, observational study. All MV patients admitted to the medical intensive care unit from October 1st, 2019 to October 31st, 2021 who received ketamine continuous infusions for sedation for more than 12 hours were be eligible for inclusion. RESULT(S): Of 167 patients identified, 76 (45.5%) patients were included. The average ketamine infusion rate was 0.65 mg/kg/hr and average duration was 3.9 days. At the start of ketamine, 74 patients were on fentanyl, 27 (36.5%) of those patients were successfully weaned off fentanyl (10.8%) or had a decrease in infusion rate (25.7%). A total of 47 patients were on propofol, 39 (83%) patients were successfully weaned off propofol (55.3%) or had a decrease in infusion rate (25.7%). Seventeen patients were on midazolam infusions, of those, 12 (70.6%) patients were successfully weaned off (52.9%) or had a decrease in rate (17.6%). There were 15 patients on dexmedetomidine, 6 (40%) patients were successfully weaned off (20%) or had a decrease in infusion rate (20%). At the start of ketamine, 71 patients were on norepinephrine + vasopressin + epinephrine. Of the 71 patients, 48 (67.6%) were able to wean off vasoactive agents or had a decrease in rate. Twelve patients had documented emergence reactions or adverse reactions during infusion. CONCLUSION(S): Ketamine continuous infusion as an adjunct analgosedative agent resulted in successful weans off co-sedative agents or in decreased infusion rates. It was particularly impactful on propofol and midazolam continuous infusions as more than 50% of patients on these two agents were successfully weaned off.

4.
Critical Care Medicine ; 51(1 Supplement):194, 2023.
Article in English | EMBASE | ID: covidwho-2190535

ABSTRACT

INTRODUCTION: Tocilizumab has been used for treatment of COVID-19 in hospitalized patients who require supplementation oxygen. Various concerns regarding its use in pregnant patients have been presented, however very limited data exists regarding the use of tocilizumab in this population. METHOD(S): Between July 2021 and November 2021, 7 pregnant patients unvaccinated against COVID-19 were admitted to the medical intensive care unit with acute hypoxemic respiratory failure secondary to COVID-19 infection. The average age of patients was 29 with average gestational term of 27 weeks and average BMI of 38kg/m2. All patients had received dexamethasone and remdesivir per standard hospital protocols and antibiotics for superimposed bacterial pneumonia in patients with infiltrates concerning for concomitant bacterial picture. However, these patients still had high oxygen requirements prompting administration of tocilizumab. Each patient received 800mg of tocilizumab as a single dose. RESULT(S): After administration of tocilizumab, oxygen requirements decreased in 6 out of 7 patients, resulting in an avoidance of mechanical ventilation. Typical serum markers used to measure inflammatory response in COVID-19, including C-reactive protein and D-dimer, showed improvement after administration of tocilizumab in 6 out of 7 patients. All pregnancies progressed to successful live birth with no notable fetal deformities or malformations. Out of the 7 patients, there were 5 preterm deliveries, defined as gestational age of 37-38 weeks. 2 of the 7 patients underwent caesarean delivery for maternal hypoxia, both in the setting of severe COVID-19 infection. All infants had a birth weight within normal limits for their gestational age. No complications were noted during vaginal birth of caesarean delivery. CONCLUSION(S): Based on this review, it appears that the use of tocilizumab provided benefit in 85.7% of patients, preventing progression to mechanical ventilation. Based on this case series, tocilizumab seems to be a safe option for pregnant woman and subsequently their babies, with no severe complications or deformities noted during birth. However, 71.4% of patients did undergo preterm labor, prompting future research into whether these is any correlation between tocilizumab and preterm labor.

5.
Journal of Investigative Dermatology ; 142(12 Supplement):S192, 2022.
Article in English | EMBASE | ID: covidwho-2131515

ABSTRACT

Leukocytoclastic vasculitis, also known as cutaneous small vessel vasculitis, embodies a challenging condition for both the physician and the patient. This condition is affecting mainly the small vessels, commonly the post-capillary venules, being characterized by presence of neutrophilic infiltration within and throughout the vessel wall with signs of leukocytoclasia, fibrinoid necrosis and local damage to the vessel wall and the surrounding tissue. Frequently, it is associated with other conditions (cryoglobulinemic vasculitis, IgA vasculitis, ANCA-associated vasculitides), infections, medication, systemic diseases (systemic lupus erythematosus, Sjogren syndrome, rheumatoid arthritis). Cutaneous leukocytoclastic vasculitis is considered a rare condition. We are presenting a 46 year old man, with history of chronic urticaria, presented in our clinic for recurrent intensely pruritic urticarian plaques, disseminated on limbs and trunk, associating bullae with serocitrin content. Petechiae and palpable purpura were observed just in a few places. Bullous lesions occurred after the patient went through COVID-19 and followed a self-treatment with paracetamol. Patch and prick tests were performed on this patient, identifying positive reactions to hydroxyisohexyl-3-cyclohexane-carboxaldehyde, fragrance mix and paracetamol. Histopathological exam evidentiated tipically aspect for leukocytoclastic vasculitis and subepidermal vesicle-bullae lesion. IgM/IgG immune complexes, C3 and fibrinogen were found positive in direct immunofluorescence exam. Through this scientific paper, we are presenting the crucial role of direct immunofluorescence exam in early diagnosis and evolution of this condition, efficacy of oral therapy with dapsone (anti-inflammatory properties, antioxidant scavenger effect, inhibitory effect on chemotaxis and function of neutrophils). Copyright © 2022

6.
Economic Computation and Economic Cybernetics Studies and Research ; 56(3):297-312, 2022.
Article in English | Scopus | ID: covidwho-2056872

ABSTRACT

The pandemic context has forced the acceleration of some major trends without developing an adequate support mechanism by the society, which determined the damage of the perception of the well-being by widely implementing teleworking. The aim of this research is to assess employee well-being correlated to professional development and competencies, autonomy, job satisfaction, commitment, emotional dimension, work-life balance and organizational climate, determined based on content analysis and customized in the context of telework. The information has been collected through a questionnaire performed in February-March 2021 and January-February 2022 in order to determine the change of perceiving in time the dimensions of evaluating the well-being and evolution trends, subject to a short period of investigation, corresponding to COVID-19 pandemic. The impact of the variables considered was quantified using the regression models. The empirical results reveal that well-being in teleworking was associated with a favorable organizational climate and with higher competencies, observing the depreciation trend of perception. We found a statistically significant positive link between job satisfaction, a favorable balance work-life and the well-being of employees. Emotional exhaustion had a negative statistically significant impact on the well-being of employees. The autonomy paradox emphasizes that a high level of it negatively affects well-being. The evolution in perceiving engagement by respondents reveals an improvement of well-being by a higher frequency of positive affects in 2022, which reconsiders the initial opinion during the analyzed period. Inclusion of the gender dimension highlights significant differences in appreciating the well-being of employees in the context of teleworking. © 2022, Bucharest University of Economic Studies. All rights reserved.

7.
Acta Cybernetica ; 25(3):733-749, 2022.
Article in English | Web of Science | ID: covidwho-1928904

ABSTRACT

Currently there are many attempts around the world to use computers, smartphones, tablets and other electronic devices in order to stop the spread of COVID-19. Most of these attempts focus on collecting information about infected people, in order to help healthy people avoid contact with them. However, social distancing decisions are still taken by the governments empirically. That is, the authorities do not have an automated tool to recommend which decisions to make in order to maximize social distancing and to minimize the impact for the economy. In this paper we address the aforementioned problem and we design an algorithm that provides social distancing methods (i.e., what schools, shops, factories, etc. to close) that are efficient (i.e., that help reduce the spread of the virus) and have low impact on the economy. On short: a) we propose several models (i.e., combinatorial optimization problems);b) we show some theoretical results regarding the computational complexity of the formulated problems;c) we give an algorithm for the most complex of the previously formulated problems;d) we implement and test our algorithm.

8.
17th IEEE International Wireless Communications and Mobile Computing, IWCMC 2021 ; : 475-480, 2021.
Article in English | Scopus | ID: covidwho-1735820

ABSTRACT

Wireless body area networks (WBANs) play a paramount role in modern health-care systems and bring numerous benefits. Modern WBANs provide a promising service especially for elderly people suffering from heart disease, Alzheimer, etc., which enable them to live safely and independently. Medical institutions tend to use WBANs to provide real-time monitoring of remote patients outside hospitals, which helps saving their lives by means of instant and proper responses at emergency situations. However, in 2020, the world was affected by COVID-19 pandemic and thousands of new cases are discovered daily all over the world. The pandemic provoked a serious lack in professional staff and in many countries there were not enough beds in hospitals for patients with COVID-19 symptoms. This in turn increases the demand for WBANs, which can help medical institutions to withstand harmful consequences of the pandemic and to ensure regular patients monitoring. In this context, very recently, Fotouhi et al. proposed a new lightweight authentication scheme to secure patient's sensitive data in WBANs. The authors claimed that their scheme is secure against various known attacks and is efficient to be applied in practice. However, we analyze Fotouhi et al.'s scheme and find out that their scheme is prone to several attacks. In this paper, we point out the weaknesses associated with their proposed lightweight authentication scheme. © 2021 IEEE

9.
Analele Universitatii din Oradea, Fascicula: Ecotoxicologie, Zootehnie si Tehnologii de Industrie Alimentara ; 20(B):203-207, 2021.
Article in English | GIM | ID: covidwho-1717359

ABSTRACT

Obesity has emerged as an important risk factor for severe disease during the COVID-19 pandemic. This pandemic strongly influenced the public health policy. The measurements approved to limit the extension of the virus, induced a national lockdown associated with important loss of physical activity. The persistence of the lack of movement (especially outside) determined the increase of obesity prevalence.

10.
IOP Conference Series. Materials Science and Engineering ; 1182(1), 2021.
Article in English | ProQuest Central | ID: covidwho-1483341

ABSTRACT

Nowadays, humanity is facing serious challenges due to the disruption of the COVID-19 pandemic, affecting dramatically our healthcare system along with the economic structure, social and cultural life. Healthcare personnel treating patients with infections like COVID-19 are exposed themselves to infection. Therefore, it is compulsory to be protected from contaminated body fluids using personal protective equipment (PPE). This equipment made of synthetic fibers proved to be uncomfortable. Therefore, we developed a reusable suit composed of a blend of wool and silk to be wear under full-body protective clothing aiming to improve their comfort and safety. Firstly, we focused on the analysis of some dimensional characteristics: specific mass, porosity, thickness followed by comfort characteristics of knitted fabrics. Accordingly, the test methods comprise measurements for hydrophilic properties, air and water vapour permeability, thermal conductivity and dimensional stability to repetitive washing. After material analysis, a significant number of two-piece suits composed of blouse and trousers were industrially manufactured and delivered to healthcare personnel to be tested. The results are completed and supported with the perception of the healthcare staff involved in the study via a survey. Finally, the results and implications for future research are presented.

11.
IOP Conference Series. Materials Science and Engineering ; 1182(1), 2021.
Article in English | ProQuest Central | ID: covidwho-1483340

ABSTRACT

In the current context of involvement in the fight against COVID 19 wearing protective masks are strictly necessary to limit the spread of the virus SARS-CoV2. Since the appearance of this virus, solutions have been sought to cover the needs of masks for the population and also to improve their wearing comfort compared to nonwoven fabric (TNT) masks. These masks are made of chemical fibres and it is recommended to be worn for a maximum of 4-8 hours and then they must be discarded. In this study, two types of masks from wool and silk blended knitted fabrics were manufactured and analysed. The masks were initially subjected to manual ironing sterilization and disinfection. Subsequently, several analyses were performed: specific mass, density, abrasion and pilling resistance, colourfastness to crocking, colour fastness to accelerated laundering, air permeability, bacterial filtration efficiency and breathability. The analysed masks can be washed and disinfected at home and are reusable. This aspect offers a strong sense of safety for the user, but also has beneficial effects on environmental protection. Even so, they do not correspond to bacterial filtration efficiency. Eventually, the comfort perception of about 300 volunteers was also taken into consideration.

12.
IEEE Symposium Series on Computational Intelligence (IEEE SSCI) ; : 1837-1844, 2020.
Article in English | Web of Science | ID: covidwho-1431358

ABSTRACT

Communicating smart entities in the Internet of Things (IoT) environment using cloud technology makes human daily life more convenient and brings benefits in various fields. After the occurrence of the novel coronavirus, the demand for remotely managed systems will significantly raise up to mitigate the harmful consequences of social distancing and to increase the systems' efficiency as well. In such systems, sharing relevant information among honest entities over public connection brings numerous security risks. In this context, in 2020, Wazid et al. proposed a new lightweight authentication mechanism for cloud-based IoT environment called LAM-CIoT. Their mechanism uses multi-factor authentication and provides real-time data access from the deployed IoT-sensors. Wazid et al. argued that the mechanism they proposed is stable, efficient and scalable. However, we find out that Wazid et al.'s mechanism shows weaknesses and is incomplete. In this paper, we brielly introduce Wazid et al.'s mechanism and expound that their mechanism is still unstable and not suitable to be applied in practice.

13.
Medicina Moderna ; 27(3):167-170, 2020.
Article in English | Scopus | ID: covidwho-1342145

ABSTRACT

Diagnosis, tratament and follow-up of patients with melanoma during COVID-19 pandemic is quite challenging. These patients are often immunocompromised, but, on the other hand, management of this malignant skin cancer should not be delayed. It is necessary to diagnose and stage the melanoma as soon as possible, in an attempt to provide a better prognosis. There are few data regarding the treatament of melanoma during COVID-19 pandemia. However, the general recommandations suggest testing all cancer patients prior administration of the therapy. The European Society for Medical Oncology (ESMO) provided guidelines regarding therapy of this skin cancer during COVID-19 pandemic. Every patient is different, and it is always important to evaluate the risks and benefits. © 2020 Universidade do Porto - Faculdade de Engenharia. All rights reserved.

14.
Sustainability ; 13(11):14, 2021.
Article in English | Web of Science | ID: covidwho-1285403

ABSTRACT

Social protection systems are a key factor for ensuring the long-term sustainability and stability of economies in the European Union, their reform being nowadays present in the political agenda of member states. Aging and the dependence on mandatory levies applied to the employed population on the labor market represent a threat for the sustainability of public social protection systems. In terms of sustainability, our purpose was to highlight the factors influencing social insurance budgets, considering the fiscal policies implemented in six countries of Central and Eastern Europe and their particular labor market characteristics. Therefore, a panel study based on a regression model using the Ordinary Least Squares method (OLS) with cross section random effects was used to determine the correlations between funding sources and labor market specific indicators. The data analyzed led to relevant results that emphasize the dependence of social insurance budgets on positive factors such as the average level of salaries, the share of compulsory social contributions, the unemployment rate, and the human development index, suggesting the continuing need for professional and personal development of the workforce.

15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277608

ABSTRACT

Rationale Severe acute respiratory syndrome coronavirus 2 can cause an uncontrolled release of proinflammatory cytokines, such as interleukin-6 (IL-6), leading to cytokine release syndrome. Tocilizumab, a humanized monoclonal antibody that inhibits the IL-6 receptor, has been proposed as a treatment option to prevent clinical worsening in coronavirus disease 2019 (Covid-19). There is limited data regarding the safety of using tocilizumab in patients with Covid-19. The objective of this study was to evaluate the pneumonia at University Hospitals Cleveland Medical Center. Methods This was an institutional review board approved, singlecenter, retrospective chart review of all patients who received tocilizumab for Covid-19 between March 1, 2020 and October 31, 2020. Patients less than 18 years old were excluded. The primary outcome was incidence of secondary infection within 28 days or until end of hospitalization. Secondary outcomes included incidence of adverse events, length of stay in the intensive care unit, length of hospitalization, progression to invasive mechanical ventilation, duration of mechanical ventilation, and death. Results There were eighteen patients who received tocilizumab for the treatment of Covid-19. Within the first 28 days after receiving tocilizumab, nine (50%) patients developed a secondary infection and ten (55.6%) patients were given antibiotics. Liver enzyme elevations also occurred in nine (50%) of the patients who received tocilizumab. At 28 days, seven (38.9%) patients were discharged from the hospital, four (22.2%) were mechanically ventilated, two (11.1%) were receiving oxygen via nasal cannula, and five (27.8%) were dead. Median ICU and hospital length of stay were 10.5 and 14 days, respectively. Five (27.8%) patients received a second dose of tocilizumab and all five patients were alive at 28 days after receiving first dose of tocilizumab. Conclusion In this retrospective chart review of patients with Covid-19 who received tocilizumab as part of their management, half developed secondary infections and half developed transient liver enzyme elevations. These adverse events may be associated with the use of tocilizumab in these patients. As of now, there is a lack of consensus on the role of tocilizumab in the treatment of Covid-19.

16.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277447

ABSTRACT

Rationale: Elevated risk of thrombotic events is a major concern in patients with Coronavirus Disease-2019 (COVID-19). Studies investigating these patients demonstrate high rates of venous and arterial thrombosis. A proposed strategy for prevention of these events involves intensified prophylactic anticoagulation. Retrospective studies have revealed improved outcomes in COVID-19 patients receiving therapeutic anticoagulation, showing potential benefits of escalated prophylactic dosing. At University Hospitals Cleveland Medical Center, an anticoagulation guideline for patients with COVID-19 was developed. It stratifies thrombotic risk based on DDimer concentrations, with a threshold for intensifying anticoagulation at 1,000 ng/mL, and further intensification to full anticoagulation at 3,000 ng/mL. This study's purpose was to quantify risks and benefits of this anticoagulation strategy in critically ill patients. Methods: This institution review board approved, single-center, retrospective chart review was performed between March 1, 2020 and July 31, 2020. It included all patients with COVID-19 admitted to the intensive care unit during their admission. Patients were excluded if they had an indication for therapeutic anticoagulation or an active hemorrhagic event on hospital admission. Primary endpoints included the incidence of thrombotic events and hemorrhagic events. Guideline adherence on initiation of anticoagulation was also assessed. Results: Of the 131 patients screened for inclusion, 101 were included in the final analysis. Baseline characteristics include male gender in 51% of patients and median age of 61. Median baseline D-Dimer was 1,361 ng/mL, with a peak of 4,876 ng/mL. High-flow oxygenation or mechanical ventilation was utilized in 73% of patients, with 21% requiring continuous renal replacement therapy (CRRT). Anticoagulation was initiated in accordance with institutional guidelines in 84% of patients. Thrombotic complications (Table 1) were observed in 24% of patients, with a majority of events involving CRRT circuit thrombosis. Hemorrhagic complications (Table 1) were detected in 12% of patients, with several different bleeding sources observed. Increased rates of both thrombotic and hemorrhagic events were noted in patients requiring mechanical ventilation or CRRT. Conclusions: In critically ill COVID-19 patients managed using an institutional COVID-19 anticoagulation guideline, thrombosis occurred in 24% of patients. This incidence is lower than thrombosis rates in COVID-19 literature, and may be associated with the use of our D-Dimer driven guideline. The hemorrhagic event rate of 12% has limited comparable data in literature at this time. These data provide insight on the use of intensified prophylactic anticoagulation in COVID-19 patients. Prospective, randomized trials will be useful in determining optimal anticoagulation management in this patient population.

17.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277380

ABSTRACT

Background: Coronavirus disease 19 is a complex multisystem disease that continues to spread rapidly across the world. It is associated with elevations in inflammatory markers including the one produced during fibrinolysis, namely D-Dimer. Reports have shown marked elevations in this protein fragment particularly in severe disease. We report our observations regarding change in D-Dimer and effect on mortality over time. Methods: We analyzed all adults between March and September 2020 who were admitted or managed in the emergency department for COVID19 infection within the University Hospitals Health System in Northeast Ohio. Delta d-dimer was defined as the change in d-dimer (Δd-dimer) from day of presentation to the maximum value between day 1 to 6 post admissions. Kaplan-Meier and cox regression analyses were performed to explore the association with mortality. Receiver operating characteristics were used to estimate discrimination power for mortality. Results: A total of 442 patients were included. Mean age was 64±16 years. A total of 93 patients were managed in the intensive care unit, 324 were managed as inpatient, and 25 patients were managed in the emergency department. The median admission d-dimer was 1169 [645-2208] ng/ml, and Δd-dimer was 75 [-334 to 717]. At a median follow-up of 108 days, 100 patients died (30-day mortality of 21%). The 30-day mortality was 12.3% for tertile 1, 12.2% for tertile 2, and 39.1% for tertile 3 of Δd-dimer, (Figure). Compared with tertile 1, patients in tertile 3 of Δd-dimer had 4-fold higher mortality (age-adjusted HR 3.77 [2.30-6.18], P<0.001). In multivariable analysis, Δd-dimer but not admission d-dimer (P=0.36) was associated with mortality after adjusting for age (per 1000 ng/mL increase: HR 1.017 [1.008-1.027], P<0.001). Δd-dimer had a good discriminative power for mortality (AUC=0.70). An increase in d-dimer of 540 ng/ml was determined to be the best threshold for mortality (sensitivity of 62% and specificity of 80%). Conclusions: Serial monitoring of D-Dimer during hospitalization to assess for change over time is a reliable prognostic marker for mortality in COVID-19 patients. Using it as an indicator to initiate therapeutic anticoagulation requires investigation.

18.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277377

ABSTRACT

Background: Coronavirus disease 19 is known to be associated with increased incidence of thromboembolic disease. D-Dimer elevation is commonly identified on presentation. We looked at discharge D-Dimer if it correlated with mortality Methods: We analyzed all adults between March and September 2020 who were discharged alive after presentation to the emergency department or admission to the hospital for COVID19 infection within the University Hospitals Health System in Northeast Ohio. Discharge d-dimer was defined as the last d-dimer within 15 days of discharge from hospital. Kaplan-Meier and cox regression analyses were performed to explore the association with mortality. Results: A total of 560 patients were included. Mean age was 58±18 years. A total of 97 patients were managed in the intensive care unit, 424 were managed as inpatient, and 39 patients were managed in the emergency department. The median time between last d-dimer and discharge date was 0 [-2 to 0] days. The median discharge d-dimer was 840 [505-1580] ng/ml. At a median follow-up of 124 days, 100 patients died (90-day mortality of 5%). The 90-day mortality was 1% for tertile 1, 3% for tertile 2, and 12% for tertile 3 of last d-dimer, figure. Compared with tertile 1, patients in tertile 3 of discharge d-dimer had 10-fold higher mortality (age-adjusted HR 9.62 [2.11-43.92], P<0.001). In Discharge d-dimer had a good discriminative power for mortality (AUC=0.80). A discharge d-dimer of 1717 ng/ml was determined to be the best threshold for mortality (sensitivity of 70% and specificity of 81%). Conclusions: Patients discharged with high D-Dimer are at increased risk of death. We speculate that this elevation is a reflection of hypercoagulability resulting in thromboembolic events and poor outcome. Further studies to determine the role of out-patient anticoagulation in reducing this risk are needed.

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