Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 523
Filter
Add filters

Year range
1.
J Infect ; 80(6): 639-645, 2020 06.
Article in English | MEDLINE | ID: covidwho-688316

ABSTRACT

OBJECTIVE: To investigate the characteristics and prognostic factors in the elderly patients with COVID-19. METHODS: Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors. RESULTS: 339 patients with COVID-19 (aged 71±8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P = 0.001), comorbidities including cardiovascular disease (HR 1.86, P = 0.031) and chronic obstructive pulmonary disease (HR 2.24, P = 0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001). CONCLUSIONS: High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Aged , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Prognosis , Survival Analysis
3.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Article in English | MEDLINE | ID: covidwho-686322

ABSTRACT

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Subject(s)
Coronavirus Infections/mortality , Hospital Mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Blood Pressure , Cerebrovascular Disorders/epidemiology , China , Comorbidity , Coronavirus , Critical Illness , Early Warning Score , Emergency Medicine , Female , Glasgow Coma Scale , Humans , Lung Diseases/epidemiology , Male , Middle Aged , Oxygen/metabolism , Pandemics , Prognosis , ROC Curve , Respiratory Rate , Retrospective Studies , Risk Assessment , Sensitivity and Specificity
4.
BMC Infect Dis ; 20(1): 549, 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-684717

ABSTRACT

BACKGROUND: We aimed to report the epidemiological and clinical characteristics of hospitalized patients with coronavirus disease-19 (COVID-19) in Zengdu District, Hubei Province, China. METHODS: Clinical data on COVID-19 inpatients in Zengdu Hospital from January 27 to March 11, 2020 were collected; this is a community hospital in an area surrounding Wuhan and supported by volunteer doctors. All hospitalized patients with COVID-19 were included in this study. The epidemiological findings, clinical features, laboratory findings, radiologic manifestations, and clinical outcomes of these patients were analyzed. The patients were followed up for clinical outcomes until March 22, 2020. Severe COVID-19 cases include severe and critical cases diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. Severe and critical COVID-19 cases were diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. RESULTS: All hospitalized COVID-19 patients, 276 (median age: 51.0 years), were enrolled, including 262 non-severe and 14 severe patients. The proportion of patients aged over 60 years was higher in the severe group (78.6%) than in the non-severe group (18.7%, p < 0.01). Approximately a quarter of the patients (24.6%) had at least one comorbidity, such as hypertension, diabetes, or cancer, and the proportion of patients with comorbidities was higher in the severe group (85.7%) than in the non-severe group (21.4%, p < 0.01). Common symptoms included fever (82.2% [227/276]) and cough (78.0% [218/276]). 38.4% (106/276) of the patients had a fever at the time of admission. Most patients (94.9% [204/276]) were cured and discharged; 3.6% (10/276) deteriorated to a critical condition and were transferred to another hospital. The median COVID-19 treatment duration and hospital stay were 14.0 and 18.0 days, respectively. CONCLUSIONS: Most of the COVID-19 patients in Zengdu had mild disease. Older patients with underlying diseases were at a higher risk of progression to severe disease. The length of hospital-stay and antiviral treatment duration for COVID-19 were slightly longer than those in Wuhan. This work will contribute toward an understanding of COVID-19 characteristics in the areas around the core COVID-19 outbreak region and serve as a reference for decision-making for epidemic prevention and control in similar areas.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Length of Stay/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Adolescent , Adult , Child , Child, Preschool , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Cough/epidemiology , Female , Fever/epidemiology , Humans , Hypertension/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Treatment Outcome , Young Adult
5.
Gastroenterol. latinoam ; 31(1): 35-38, mayo 2020.
Article in Spanish | LILACS (Americas) | ID: covidwho-678085

ABSTRACT

The pandemic of the novel coronavirus SARS-CoV-2 has caused more than 2.5 millions of confirmed cases worldwide, with a mortality rate around 7%. Most cases appear to be mild with the most common symptoms being fever, dry cough, myalgia, fatigue, and dyspnea but can result in more severe disease. Also, there are described gastrointestinal manifestations: anorexia 27%, diarrhea 12%, nausea/vomiting 10%, and abdominal pain 9%. In Chile, diarrhea has been described in 7.3%, and abdominal pain 3.7%. The primary mechanism proposed is the entry of SARS-CoV-2 into the enterocytes binding the Angiotensin-converting enzyme 2 (ACE2), which is widely distributed among the gastrointestinal tract. Also, SARS-CoV-2 can cause elevated liver enzymes in up to 40% of cases. This alteration could also be caused by the binding to the ACE2 receptor in hepatocytes and cholangiocytes. Gastrointestinal symptoms and elevated liver enzymes are more frequent in severe cases. Viral RNA has been detected in stools, which may suggest a possible fecal-oral transmission. It is essential to pay attention to gastrointestinal manifestations because they are frequent and more prevalent in severe cases. The presence of viral RNA in stool forces us to take preventive measures faced with a possible mechanism of fecal-oral transmission, mainly in the gastroenterology and endoscopy services.


La pandemia por el nuevo coronavirus SARS-CoV-2 ha causado más de 2,5 millones de casos confirmados en el mundo, con una mortalidad cercana al 7%. La mayoría de los casos parecen ser leves y los síntomas más comunes son fiebre, tos seca, mialgia, fatiga y disnea, pero pueden provocar una enfermedad más grave. También se han descrito síntomas gastrointestinales: anorexia 27%, diarrea 12%, náuseas/vómitos 10%, y dolor abdominal 9%. En Chile, se ha descrito diarrea en 7,3%, y dolor abdominal 3,7%. El principal mecanismo fisiopatológico propuesto es el ingreso al enterocito utilizando la Enzima Convertidora de Angiotensina 2 (ECA2) como receptor, el cual es ampliamente distribuido a lo largo del tracto gastrointestinal. También se ha descrito alteración de pruebas hepáticas hasta en 40% de los casos. Esta alteración también podría ser causada por el ingreso a los hepatocitos y colangiocitos mediante la ECA2. Los síntomas gastrointestinales, y las alteraciones de pruebas hepáticas son más frecuentes en los pacientes graves. Se ha detectado la presencia de ARN viral en deposiciones de pacientes, lo que podría sugerir una posible vía de transmisión fecal-oral. Es importante prestar atención a las manifestaciones gastrointestinales, ya que son comunes y más frecuentes en pacientes graves. La presencia viral en las heces nos obliga a tomar medidas de precaución y prevención de un posible mecanismo de transmisión fecal-oral, especialmente en los servicios de gastroenterología y endoscopia.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Betacoronavirus , Gastrointestinal Diseases/etiology , Pneumonia, Viral/diagnosis , Comorbidity , Coronavirus Infections/diagnosis , Gastrointestinal Diseases/diagnosis
7.
Diabetes Metab Syndr ; 14(4): 303-310, 2020.
Article in English | MEDLINE | ID: covidwho-676723

ABSTRACT

BACKGROUND AND AIMS: High prevalence of diabetes makes it an important comorbidity in patients with COVID-19. We sought to review and analyze the data regarding the association between diabetes and COVID-19, pathophysiology of the disease in diabetes and management of patients with diabetes who develop COVID-19 infection. METHODS: PubMed database and Google Scholar were searched using the key terms 'COVID-19', 'SARS-CoV-2', 'diabetes', 'antidiabetic therapy' up to April 2, 2020. Full texts of the retrieved articles were accessed. RESULTS: There is evidence of increased incidence and severity of COVID-19 in patients with diabetes. COVID-19 could have effect on the pathophysiology of diabetes. Blood glucose control is important not only for patients who are infected with COVID-19, but also for those without the disease. Innovations like telemedicine are useful to treat patients with diabetes in today's times.


Subject(s)
Betacoronavirus , Comorbidity , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Pneumonia, Viral/epidemiology , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Animals , Blood Glucose/analysis , Blood Glucose/metabolism , Coronavirus Infections/mortality , Diabetes Mellitus/physiopathology , Diabetes Mellitus/therapy , Dipeptidyl Peptidase 4 , Humans , Hypoglycemic Agents/therapeutic use , Interleukin-6 , Mice , Pandemics , Peptidyl-Dipeptidase A , Pneumonia, Viral/mortality , Prognosis , PubMed , Risk Factors , Telemedicine
8.
Clin Appl Thromb Hemost ; 26: 1076029620943671, 2020.
Article in English | MEDLINE | ID: covidwho-676150

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 infection (COVID-19) is known to induce severe inflammation and activation of the coagulation system, resulting in a prothrombotic state. Although inflammatory conditions and organ-specific diseases have been shown to be strong determinants of morbidity and mortality in patients with COVID-19, it is unclear whether preexisting differences in coagulation impact the severity of COVID-19. African Americans have higher rates of COVID-19 infection and disease-related morbidity and mortality. Moreover, African Americans are known to be at a higher risk for thrombotic events due to both biological and socioeconomic factors. In this review, we explore whether differences in baseline coagulation status and medical management of coagulation play an important role in COVID-19 disease severity and contribute to racial disparity trends within COVID-19.


Subject(s)
African Americans , Betacoronavirus , Coronavirus Infections/ethnology , Pandemics , Pneumonia, Viral/ethnology , Thrombophilia/ethnology , Venous Thromboembolism/ethnology , African Americans/genetics , Anemia, Sickle Cell/blood , Anemia, Sickle Cell/ethnology , Anticoagulants/therapeutic use , Blood Proteins/analysis , Blood Proteins/genetics , Clinical Trials as Topic , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/complications , Factor VIII/analysis , Female , Fibrin Fibrinogen Degradation Products/analysis , Genetic Association Studies , Genetic Predisposition to Disease , Healthcare Disparities , Humans , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/ethnology , Male , Patient Selection , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Polymorphism, Single Nucleotide , Prevalence , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/ethnology , Risk Factors , Social Determinants of Health , Socioeconomic Factors , Thrombophilia/blood , Thrombophilia/drug therapy , Thrombophilia/etiology , Venous Thromboembolism/blood , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
9.
Lancet ; 395(10223): 497-506, 2020 02 15.
Article in English | MEDLINE | ID: covidwho-665705

ABSTRACT

BACKGROUND: A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. METHODS: All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. FINDINGS: By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. INTERPRETATION: The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. FUNDING: Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , Age Distribution , Aged , China/epidemiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/transmission , Cough/epidemiology , Cough/virology , Female , Fever/epidemiology , Fever/virology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Myalgia/epidemiology , Myalgia/virology , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Prognosis , Radiography, Thoracic , Respiratory Distress Syndrome, Adult/epidemiology , Respiratory Distress Syndrome, Adult/virology , Time Factors , Tomography, X-Ray Computed , Young Adult
10.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Article in Spanish | MEDLINE | ID: covidwho-663764

ABSTRACT

Introduction: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/diet therapy , Critical Care/methods , Critical Illness , Malnutrition/diet therapy , Pandemics , Pneumonia, Viral/diet therapy , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Dietary Proteins/administration & dosage , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Gastrointestinal Diseases/complications , Humans , Inflammation/epidemiology , Inflammation/physiopathology , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/prevention & control , Meta-Analysis as Topic , Micronutrients/administration & dosage , Nutrition Assessment , Nutritional Requirements , Nutritional Support , Obesity/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Refeeding Syndrome/prevention & control , Respiration, Artificial , Sarcopenia/epidemiology
13.
Emergencias ; 32(4): 242-252, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-659965

ABSTRACT

OBJECTIVES: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. MATERIAL AND METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases. CONCLUSION: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Adult , Cause of Death , Comorbidity , Confidence Intervals , Coronavirus Infections/complications , Coronavirus Infections/therapy , Diagnosis-Related Groups , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Polymerase Chain Reaction/statistics & numerical data , Registries/statistics & numerical data , Spain/epidemiology , Symptom Assessment , Time Factors , Treatment Outcome
14.
Emergencias ; 32(4): 253-257, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-659492

ABSTRACT

OBJECTIVES: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. MATERIAL AND METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSION: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Pulmonary Embolism/diagnostic imaging , Aged , Comorbidity , Computed Tomography Angiography/statistics & numerical data , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Emergency Service, Hospital/statistics & numerical data , Female , Hospital Mortality , Humans , Intensive Care Units , Intubation, Intratracheal , Length of Stay , Male , Odds Ratio , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Retrospective Studies , Risk Factors , Spain/epidemiology
15.
Emergencias ; 32(4): 233-241, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-659182

ABSTRACT

OBJECTIVES: To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes. MATERIAL AND METHODS: Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments. RESULTS: The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood. CONCLUSION: This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Symptom Assessment , Adolescent , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Child , Child, Preschool , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Female , Hospital Mortality , Humans , Infant , Infant, Newborn , Intubation, Intratracheal/statistics & numerical data , Logistic Models , Male , Middle Aged , Neoplasms/epidemiology , Obesity/complications , Odds Ratio , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Prospective Studies , Respiration Disorders/epidemiology , Respiration, Artificial/statistics & numerical data , Sex Distribution , Spain/epidemiology , Young Adult
16.
Rev Bras Ginecol Obstet ; 42(6): 349-355, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-657176
17.
Respir Res ; 21(1): 172, 2020 Jul 06.
Article in English | MEDLINE | ID: covidwho-656136

ABSTRACT

BACKGROUND: Previous studies have shown that Coronavirus Disease 2019 (COVID-19) patients with underlying comorbidities can have worse outcomes. However, the effect of hypertension on outcomes of COVID-19 patients remains unclear. RESEARCH QUESTION: The aim of this study was to explore the effect of hypertension on the outcomes of patients with COVID-19 by using propensity score-matching (PSM) analysis. STUDY DESIGN AND METHODS: Participants enrolled in this study were patients with COVID-19 who had been hospitalized at the Central Hospital of Wuhan, China. Chronic comorbidities and laboratory and radiological data were reviewed; patient outcomes and lengths of stay were obtained from discharge records. We used the Cox proportional-hazard model (CPHM) to analyze the effect of hypertension on these patients' outcomes and PSM analysis to further validate the abovementioned effect. RESULTS: A total of 226 patients with COVID-19 were enrolled in this study, of whom 176 survived and 50 died. The proportion of patients with hypertension among non-survivors was higher than that among survivors (26.70% vs. 74.00%; P < 0.001). Results obtained via CPHM showed that hypertension could increase risk of mortality in COVID-19 patients (hazard ratio 3.317; 95% CI [1.709-6.440]; P < 0.001). Increased D-dimer levels and higher ratio of neutrophils to lymphocytes (N/L) were also found to increase these patients' mortality risk. After matching on propensity score, we still came to similar conclusions. After we applied the same method in critically ill patients, we found that hypertension also increased risk of death in patients with severe COVID-19. CONCLUSION: Hypertension, increased D-dimer and the ratio of neutrophil to lymphocyte increased mortality in patients with COVID-19, with hypertension in particular.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Hospital Mortality , Hypertension/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , Age Factors , Aged , China/epidemiology , Clinical Laboratory Techniques/methods , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Hypertension/diagnosis , Kaplan-Meier Estimate , Male , Middle Aged , Pandemics , Propensity Score , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Survival Analysis , Survivors , Tertiary Care Centers
19.
Am J Manag Care ; 26(7): e202-e204, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-652038

ABSTRACT

Factors worsening the opioid epidemic during the coronavirus disease 2019 (COVID-19) pandemic provide valuable insight for strategy change where we have historically suffered great loss, bodily and financially.


Subject(s)
Coronavirus Infections/epidemiology , Health Services Accessibility/statistics & numerical data , Opioid Epidemic/statistics & numerical data , Opioid-Related Disorders/epidemiology , Pneumonia, Viral/epidemiology , Analgesics, Opioid/adverse effects , Comorbidity , Drug Overdose/epidemiology , Health Status Disparities , Humans , Opioid Epidemic/prevention & control , Pandemics , United States/epidemiology
20.
Int J Environ Res Public Health ; 17(14)2020 Jul 14.
Article in English | MEDLINE | ID: covidwho-649210

ABSTRACT

COVID-19 infection has a broad spectrum of severity ranging from an asymptomatic form to a severe acute respiratory syndrome that requires mechanical ventilation. Starting with the description of our case series, we evaluated the clinical presentation and evolution of COVID-19. This article is addressed particularly to physicians caring for patients with COVID-19 in their clinical practice. The intent is to identify the subjects in whom the infection is most likely to evolve and the best methods of management in the early phase of infection to determine which patients should be hospitalized and which could be monitored at home. Asymptomatic patients should be followed to evaluate the appearance of symptoms. Patients with mild symptoms lasting more than a week, and without evidence of pneumonia, can be managed at home. Patients with evidence of pulmonary involvement, especially in patients over 60 years of age, and/or with a comorbidity, and/or with the presence of severe extrapulmonary manifestations, should be admitted to a hospital for careful clinical-laboratory monitoring.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Adult , Aged , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/virology , Humans , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Research Design , Respiration, Artificial
SELECTION OF CITATIONS
SEARCH DETAIL