Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 694
Filter
1.
Iran Biomed J ; 26(5): 389-97, 2022 11 01.
Article in English | MEDLINE | ID: covidwho-2115605

ABSTRACT

Background: Anemia often worsens the severity of respiratory illnesses, and few studies have so far elucidated the impact of anemia on COVID-19 infection. This study aimed to evaluate the effect of anemia at admission on the overall survival of COVID-19 patients using AFT models.Methods: This registry-based, single-center retrospective cohort study was conducted in a university hospital in Ilam, the southwest of Iran, between March 2020 and September 2021. AFT models were applied to set the data of 2,441 COVID-19 patients. Performance of AFT models was assessed using AIC and Cox-Snell residual. On-admission anemia was defined as Hb concentration <120 g/l in men, <110 g/l in women, and <100 g/l in pregnant women.Results: The median in-hospital survival times for anemic and non-anemic patients were 27 and 31 days, respectively. Based on the AIC and Cox-Snell residual graph, the Weibull model had the lowest AIC and it was the best fitted model to the data set among AFT models. In the adjusted model, the results of the Weibull model suggested that the anemia (adjusted TR: 1.04; 95% CI: 1.00-1.08; p = 0.03) was the accelerated factor for progression to death in COVID-19 patients. Each unit of increase in hemoglobin in COVID-19 patients enhanced the survival rate by 4%.Conclusion: Anemia is an independent risk factor associated with the risk of mortality from COVID-19 infection. Therefore, healthcare professionals should be more sensitive to the Hb level of COVID-19 patients upon admission.


Subject(s)
Anemia , COVID-19 , Pregnancy , Male , Humans , Female , Survival Rate , Retrospective Studies , Anemia/complications , Risk Factors
2.
J Perinat Neonatal Nurs ; 36(4): 362-370, 2022.
Article in English | MEDLINE | ID: covidwho-2114408

ABSTRACT

Survival rates for extremely low-birth-weight (ELBW) infants are improving as neurodevelopmental impairment (NDI) rates stay stable, thereby increasing the overall number of infants with NDI. Although there are many determinants of NDI in this population, nutritional factors are of interest because they are readily modifiable in the clinical setting. Nurses can influence nutritional factors such as improving access to human milk feeding, using growth monitoring, establishing feeding policies, implementing oral care with colostrum, facilitating kangaroo care, and providing lactation education for the mother. All of these measures assist in leading to a decrease in NDI rates among ELBW infants.


Subject(s)
Infant, Extremely Low Birth Weight , Mothers , Infant, Newborn , Infant , Female , Humans , Survival Rate
3.
J Surg Oncol ; 126(8): 1375-1382, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2013659

ABSTRACT

BACKGROUND AND OBJECTIVES: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex treatment used in selected patients with peritoneal surface malignancies. HIPEC procedures are time and resource intensive. The primary aim of this analysis was to compare the experience of treating advanced abdominal tumors with CRS-HIPEC before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Patients included in this analysis received CRS-HIPEC at a single center during either a prepandemic (March 18, 2019-March 17, 2020) or pandemic (March 18, 2020-February 5, 2021) interval. A retrospective chart review was performed. RESULTS: Our analysis included 67 patients: 30 (45%) treated prepandemic and 37 (55%) treated during the pandemic. Median age at the time of operation was 58 years (interquartile range: [49-65]); 53% of patients were women. Patients treated during the pandemic presented with higher peritoneal cancer index (PCI) scores with 32% (n = 12) having a PCI > 20 at the time of surgery (p = 0.01). Five patients had delays in surgery due to the pandemic. Rates of overall postoperative morbidity, reoperation, and readmission were not different between the cohorts. CONCLUSIONS: Despite presenting with more extensive disease, patients treated with CRS-HIPEC during the height of the COVID-19 pandemic had comparable perioperative outcomes to patients treated prepandemic.


Subject(s)
COVID-19 , Hyperthermia, Induced , Peritoneal Neoplasms , Humans , Female , Middle Aged , Male , Cytoreduction Surgical Procedures/adverse effects , Peritoneal Neoplasms/pathology , COVID-19/epidemiology , Hyperthermic Intraperitoneal Chemotherapy , Chemotherapy, Cancer, Regional Perfusion/methods , Pandemics , Retrospective Studies , Feasibility Studies , Hyperthermia, Induced/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Survival Rate , Combined Modality Therapy
4.
Nature ; 609(7928): 785-792, 2022 09.
Article in English | MEDLINE | ID: covidwho-1972633

ABSTRACT

Highly pathogenic coronaviruses, including severe acute respiratory syndrome coronavirus 2 (refs. 1,2) (SARS-CoV-2), Middle East respiratory syndrome coronavirus3 (MERS-CoV) and SARS-CoV-1 (ref. 4), vary in their transmissibility and pathogenicity. However, infection by all three viruses results in substantial apoptosis in cell culture5-7 and in patient tissues8-10, suggesting a potential link between apoptosis and pathogenesis of coronaviruses. Here we show that caspase-6, a cysteine-aspartic protease of the apoptosis cascade, serves as an important host factor for efficient coronavirus replication. We demonstrate that caspase-6 cleaves coronavirus nucleocapsid proteins, generating fragments that serve as interferon antagonists, thus facilitating virus replication. Inhibition of caspase-6 substantially attenuates lung pathology and body weight loss in golden Syrian hamsters infected with SARS-CoV-2 and improves the survival of mice expressing human DPP4 that are infected with mouse-adapted MERS-CoV. Our study reveals how coronaviruses exploit a component of the host apoptosis cascade to facilitate virus replication.


Subject(s)
Aspartic Acid , Caspase 6 , Coronavirus Infections , Coronavirus , Cysteine , Host-Pathogen Interactions , Virus Replication , Animals , Apoptosis , Aspartic Acid/metabolism , Caspase 6/metabolism , Coronavirus/growth & development , Coronavirus/pathogenicity , Coronavirus Infections/enzymology , Coronavirus Infections/virology , Coronavirus Nucleocapsid Proteins/immunology , Coronavirus Nucleocapsid Proteins/metabolism , Cricetinae , Cysteine/metabolism , Dipeptidyl Peptidase 4/genetics , Dipeptidyl Peptidase 4/metabolism , Humans , Interferons/antagonists & inhibitors , Interferons/immunology , Lung/pathology , Mesocricetus , Mice , Middle East Respiratory Syndrome Coronavirus , SARS Virus , SARS-CoV-2 , Survival Rate , Weight Loss
5.
PLoS Negl Trop Dis ; 14(6): e0008407, 2020 06.
Article in English | MEDLINE | ID: covidwho-1962982

ABSTRACT

Confronted with the challenge of understanding population-level processes, disease ecologists and epidemiologists often simplify quantitative data into distinct physiological states (e.g. susceptible, exposed, infected, recovered). However, data defining these states often fall along a spectrum rather than into clear categories. Hence, the host-pathogen relationship is more accurately defined using quantitative data, often integrating multiple diagnostic measures, just as clinicians do to assess their patients. We use quantitative data on a major neglected tropical disease (Leptospira interrogans) in California sea lions (Zalophus californianus) to improve individual-level and population-level understanding of this Leptospira reservoir system. We create a "host-pathogen space" by mapping multiple biomarkers of infection (e.g. serum antibodies, pathogen DNA) and disease state (e.g. serum chemistry values) from 13 longitudinally sampled, severely ill individuals to characterize changes in these values through time. Data from these individuals describe a clear, unidirectional trajectory of disease and recovery within this host-pathogen space. Remarkably, this trajectory also captures the broad patterns in larger cross-sectional datasets of 1456 wild sea lions in all states of health but sampled only once. Our framework enables us to determine an individual's location in their time-course since initial infection, and to visualize the full range of clinical states and antibody responses induced by pathogen exposure. We identify predictive relationships between biomarkers and outcomes such as survival and pathogen shedding, and use these to impute values for missing data, thus increasing the size of the useable dataset. Mapping the host-pathogen space using quantitative biomarker data enables more nuanced understanding of an individual's time course of infection, duration of immunity, and probability of being infectious. Such maps also make efficient use of limited data for rare or poorly understood diseases, by providing a means to rapidly assess the range and extent of potential clinical and immunological profiles. These approaches yield benefits for clinicians needing to triage patients, prevent transmission, and assess immunity, and for disease ecologists or epidemiologists working to develop appropriate risk management strategies to reduce transmission risk on a population scale (e.g. model parameterization using more accurate estimates of duration of immunity and infectiousness) and to assess health impacts on a population scale.


Subject(s)
Biomarkers/blood , Host-Pathogen Interactions/physiology , Leptospira/pathogenicity , Leptospirosis/diagnosis , Leptospirosis/veterinary , Sea Lions/microbiology , Animal Diseases/diagnosis , Animal Diseases/immunology , Animal Diseases/microbiology , Animals , Antibodies, Bacterial/blood , Bacterial Shedding , California , Cross-Sectional Studies , Host-Pathogen Interactions/immunology , Immunity , Kinetics , Leptospira interrogans , Leptospirosis/immunology , Survival Rate
6.
J Indian Soc Pedod Prev Dent ; 40(2): 112-117, 2022.
Article in English | MEDLINE | ID: covidwho-1954367

ABSTRACT

Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and Methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.


Subject(s)
COVID-19 , Dental Atraumatic Restorative Treatment , Dental Caries , Child , Dental Atraumatic Restorative Treatment/methods , Dental Caries/therapy , Dental Restoration, Permanent/methods , Humans , Randomized Controlled Trials as Topic , Survival Rate , Tooth, Deciduous
7.
BMC Geriatr ; 22(1): 523, 2022 06 25.
Article in English | MEDLINE | ID: covidwho-1910274

ABSTRACT

BACKGROUND: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. METHODS: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. RESULTS: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson's Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). CONCLUSION: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.


Subject(s)
Anesthesiology , COVID-19 , Aged , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Female , Humans , Indonesia/epidemiology , Intensive Care Units , Male , Pandemics , Prospective Studies , Survival Rate
8.
PLoS One ; 17(2): e0263417, 2022.
Article in English | MEDLINE | ID: covidwho-1910515

ABSTRACT

BACKGROUND: Given the rapid spread of COVID-19 and its associated morbidity and mortality, healthcare providers throughout the world have been forced to constantly update and change their care delivery models. OBJECTIVE: To assess the outcomes of COVID-19 hospitalized patients during the course of the pandemic in a well-integrated health system. METHODS: The study used data from the electronic health medical records to assess trends in clinical profile and outcomes of hospitalized adult COVID-19 patients hospitalized in our 5-hospital health system from March 2020-May 2021 (n = 6865). Integration of the health system began in February 2020 and was fully actualized by March 30, 2020. RESULTS: Mortality decreased from 15% during first peak (March-May 2020; the rate includes 19% in March-April and 10% in May 2020) to 6% in summer-fall 2020, increased to 13% during the second peak (November 2020-January 2021), and dropped to 7% during the decline period (February-May 2021) (p<0.01). Resource utilization followed a similar pattern including a decrease in ICU use from 35% (first peak) to 16% (decline period), mechanical ventilation from 16% (first peak, including 45% in March 2020) to 9-11% in subsequent periods (p<0.01). Independent predictors of inpatient mortality across multiple study periods included older age, male sex, higher multi-morbidity scores, morbid obesity, and indicators of severe illness on admission such as oxygen saturation ≤90% and high qSOFA score (all p<0.05). However, admission during the first peak remained independently associated with increased mortality even after adjustment for patient-related factors: odds ratio = 1.8 (1.4-2.4) (p<0.0001). CONCLUSIONS: The creation of a fully integrated health system allowed us to dynamically respond to the everchanging COVID-19 landscape. In this context, despite the increasing patient acuity, our mortality and resource utilization rates have improved during the pandemic.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated , Hospitalization , Intensive Care Units , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Survival Rate , Treatment Outcome
9.
Circulation ; 143(8): 837-851, 2021 02 23.
Article in English | MEDLINE | ID: covidwho-1883363

ABSTRACT

More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.


Subject(s)
Cardiovascular Diseases/mortality , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/pathology , Congresses as Topic , Coronary Disease/epidemiology , Coronary Disease/mortality , Coronary Disease/pathology , Diabetes Complications/epidemiology , Humans , Morbidity/trends , Obesity/complications , Obesity/epidemiology , Risk Factors , Stroke/epidemiology , Stroke/mortality , Stroke/pathology , Survival Rate/trends , United States/epidemiology , Urbanization
11.
Ann Intern Med ; 174(9): 1240-1251, 2021 09.
Article in English | MEDLINE | ID: covidwho-1789654

ABSTRACT

BACKGROUND: Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. OBJECTIVE: To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT04688372). SETTING: 558 U.S. hospitals in the Premier Healthcare Database. PARTICIPANTS: Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. MEASUREMENTS: Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. RESULTS: Of 144 116 inpatients with COVID-19 at 558 U.S. hospitals, 78 144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25 344 (17.6%) died; crude COVID-19 mortality decreased over time across all surge index strata. However, compared with nonsurging (<50th surge index percentile) hospital-months, aORs in the 50th to 75th, 75th to 90th, 90th to 95th, 95th to 99th, and greater than 99th percentiles were 1.11 (95% CI, 1.01 to 1.23), 1.24 (CI, 1.12 to 1.38), 1.42 (CI, 1.27 to 1.60), 1.59 (CI, 1.41 to 1.80), and 2.00 (CI, 1.69 to 2.38), respectively. The surge index was associated with mortality across ward, intensive care unit, and intubated patients. The surge-mortality relationship was stronger in June to August than in March to May (slope difference, 0.10 [CI, 0.033 to 0.16]) despite greater corticosteroid use and more judicious intubation during later and higher-surging months. Nearly 1 in 4 COVID-19 deaths (5868 [CI, 3584 to 8171]; 23.2%) was potentially attributable to hospitals strained by surging caseload. LIMITATION: Residual confounding. CONCLUSION: Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to survival and potentially eroded benefits gained from emerging treatments. Bolstering preventive measures and supporting surging hospitals will save many lives. PRIMARY FUNDING SOURCE: Intramural Research Program of the National Institutes of Health Clinical Center, the National Institute of Allergy and Infectious Diseases, and the National Cancer Institute.


Subject(s)
COVID-19/mortality , Hospitalization/statistics & numerical data , Adrenal Cortex Hormones/therapeutic use , Adult , COVID-19/therapy , Critical Care/statistics & numerical data , Female , Hospital Bed Capacity/statistics & numerical data , Hospital Mortality , Humans , Male , Odds Ratio , Respiration, Artificial , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Survival Rate , United States/epidemiology
12.
Int J Environ Res Public Health ; 19(7)2022 04 04.
Article in English | MEDLINE | ID: covidwho-1776226

ABSTRACT

In the COVID-19 pandemic context, numerous concerns have been raised regarding the hygienic status of certain objects we interact with on a daily basis, and especially cash money and their potential to harbor and transmit pathogenic bacteria. Therefore, in the present study, we analyzed different currency bills represented by British pounds (5 £, 10 £ and 20 £), Romanian lei (1 leu, 5 lei and 10 lei), U.S. dollars (1 $, 5 $ and 10 $) and Euros (5 €, 10 € and 20 €) in order to evaluate the bacterial survival rate and bacterial adherence. We used five reference microorganisms by American Type Culture Collection (ATCC, Manassas, VA, USA): Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Enterococcus sp. ATCC 19952, Salmonella enterica subsp. enterica serovar Typhi ATCC 6539, and Listeria monocytogenes ATCC 7644. Microorganisms were selected in accordance with the criteria of prevalence, pathogenicity, opportunism, and incidence. However, Maldi-TOF analysis from samples taken from the banknotes revealed only a few of the common pathogens that are traditionally thought to be found on banknotes. Some of the most important factors for the survival of pathogenic agents on surfaces are the presence of organic matter, temperature and humidity. Our data showed that Salmonella enterica survived 72 h on every banknote tested, while L. monocytogenes tended to improve persistence in humid conditions. Survival rate is also influenced by the substrate composition, being lower for polymer-based banknotes especially for Salmonella enterica, Listeria monocytogenes and Enterococcus sp. The adherence of bacterial strains was lower for polymer-based banknotes British pounds and Romanian Leu, in contrast to the cotton-based U.S dollars and Euro banknotes. The risk of bacterial contamination from the banknote bills is high as indicated by both a strong survival capacity and low adherence of tested bacteria with differences between the two types of materials used for the tested banknotes.


Subject(s)
COVID-19 , Listeria monocytogenes , Salmonella enterica , Escherichia coli , Humans , Pandemics , Polymers , Survival Rate
13.
Expert Rev Hematol ; 14(12): 1147-1153, 2021 12.
Article in English | MEDLINE | ID: covidwho-1735463

ABSTRACT

BACKGROUND: The demographic characteristics, performance status, frequency of comorbidities and survival rate of patients with multiple myeloma (MM) show variability geographically and different risk scoring systems have been used to assess this population. Here, we present data from a Turkish cohort, focusing on identifying similarities and differences, relative to other reports in the literature. RESEARCH DESIGN AND METHODS: A total of 310 patients diagnosed with MM were enrolled. Their demographic characteristics were investigated retrospectively. For performance assessment; the ECOG-IMWG Myeloma Frailty Score, R-MCI and HCT-SCI scoring indexes were used. PFS and OS periods, as well as the causes of deaths, were determined. RESULTS: The mean age of all study participants was 65 ± 10 years. The mean PFS and OS periods were 24.14± 26.11 and 65.3 ± 4.4 months, respectively. The median R-MCI, CCI and HCT-CI scores were five, four and three points, respectively. Myeloma-related complications were the leading cause of death, with a frequency of 51%. CONCLUSION: Among the scoring systems utilised, R-MCI was more convenient to apply due to its ease of use and practicality. Our study supports the heterogeneous course of myeloma and highlights geographic differences including comorbidities, causes of death and overall survival.


Subject(s)
Frailty , Multiple Myeloma , Aged , Comorbidity , Frailty/diagnosis , Frailty/epidemiology , Humans , Middle Aged , Prognosis , Retrospective Studies , Survival Rate
14.
Clin Lab ; 68(3)2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1732442

ABSTRACT

BACKGROUND: In the course of SARS-CoV-2 infection, early prognostic evaluation is important since clinical symptoms may worsen rapidly and may be fatal. Inflammation plays an important role in the pathogenesis of COVID-19 and can cause myocardial damage which is common in severe COVID-19 patients. Therefore, novel inflammatory indexes and myocardial damage may be predictive of prognosis in patients with COVID-19. The aim of the study was to evaluate the role of cardiac troponin I (cTnI), modified Glasgow prognostic score (mGPS), systemic immune inflammation index (SII), prognostic nutritional index (PNI), and CRP to albumin ratio (CAR) in the outcome estimation of COVID-19 and to develop a risk model predicting the survival probability of COVID-19 survivors during early post-discharge. METHODS: This was a single-center, observational, retrospective cohort study. Laboratory confirmed COVID-19 patients (n = 265) were included and grouped according to in-hospital mortality. ROC curve analysis was performed and Youden's J index was used to obtain optimal cutoff values for inflammatory indexes in discriminating survivors and non-survivors. Cox regression analysis was performed to assess the possible predictors of in-hospital mortality. A nomogram was constructed based on the Cox regression model, to calculate 7- and 14-day survival. RESULTS: The area under the ROC curve (AUC) of the variables ranged between 0.79 and 0.92 with the three highest AUC values for albumin, PNI, and cTnI (0.919, 0.918, and 0.911, respectively). Optimal threshold value for cTnI was 9.7 pg/mL. Univariate analysis showed that gender, albumin, CRP, CAR, PNI, SII, cTnI, and mGPS were significantly related to in-hospital mortality. The Cox regression analysis indicated that mGPS (p = 0.001), CRP (p = 0.026), and cTnI (p = 0.001) were significant prognostic factors. CONCLUSIONS: cTnI should not be considered merely as an indicator of myocardial damage. It also reflects the inflammatory phase and, along with other inflammatory markers, it should be included in risk models as a prognostic factor for COVID-19.


Subject(s)
COVID-19 , Aftercare , Humans , Nomograms , Patient Discharge , Prognosis , Retrospective Studies , SARS-CoV-2 , Survival Rate
15.
Clin Transplant ; 36(4): e14634, 2022 04.
Article in English | MEDLINE | ID: covidwho-1731123

ABSTRACT

There has been a shift over decades in the diagnostic indications for lung transplantation in children; in particular, there has been a reduction in the proportion of pediatric cystic fibrosis (CF) patients undergoing lung transplantation early in life, and more transplants occurring in other diagnostic groups. Here, we examine trends in pediatric lung transplantation with regards to indications by analyzing data from the United Network of Organ Sharing, the International Society for Heart and Lung Transplantation Thoracic Transplant Registry, and other sources. Over the past two years, there has been a precipitous decline in both the number of transplants due to CF and the proportion of CF cases relative to the total number of transplants, likely not solely due to the COVID-19 pandemic. In 2020, primary pulmonary arterial hypertension for the first-time surpassed CF as main indication for pediatric lung transplantation in the United States, a finding that is also reflected in international data. We discuss the effect of novel CFTR modulator therapies as a major factor leading to this shifting landscape. Based on our trending, pulmonary hypertension-related diagnoses and pediatric interstitial lung diseases are rising indications, for which we suggest adjustments of consensus guidelines around candidate selection criteria.


Subject(s)
COVID-19 , Cystic Fibrosis , Heart Transplantation , Heart-Lung Transplantation , Lung Transplantation , COVID-19/epidemiology , Child , Cystic Fibrosis/surgery , Humans , Lung Transplantation/adverse effects , Pandemics , Survival Rate , Tissue Donors , United States
16.
Eur J Cancer ; 160: 261-272, 2022 01.
Article in English | MEDLINE | ID: covidwho-1719649

ABSTRACT

AIM OF THE STUDY: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19. METHODS: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. RESULTS: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. CONCLUSION: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.


Subject(s)
COVID-19/mortality , Hospitalization/statistics & numerical data , Life Support Care/statistics & numerical data , Mortality/trends , Neoplasms/mortality , SARS-CoV-2/isolation & purification , Withholding Treatment/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/therapy , COVID-19/virology , Female , Humans , Male , Middle Aged , Neoplasms/epidemiology , Neoplasms/therapy , Neoplasms/virology , Netherlands/epidemiology , Prognosis , Risk Factors , Survival Rate
17.
South Med J ; 115(3): 175-180, 2022 03.
Article in English | MEDLINE | ID: covidwho-1718124

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in unprecedented hospitalizations, ventilator use, and deaths. Because of concerns for resource utilization and surges in hospital capacity use, Texas Executive Order GA-29 required statewide mask wear beginning July 3, 2020. Our objective was to compare COVID-19 case load, hospital bed use, and deaths before and after implementation of this mask order. METHODS: This was a retrospective observational study using publicly reported statewide data to perform a mixed-methods interrupted time series analysis. We compared outcomes before and after the statewide mask wear mandate per Executive Order GA-29. The preorder period was from June 19 to July 2, 2020. The postorder period was July 17 to September 17, 2020. Outcomes included daily COVID-19 case load, hospitalizations, and mortality. RESULTS: The daily case load before the mask order per 100,000 individuals was 187.5 (95% confidence interval [CI] 157.0-217.0) versus 200.7 (95% CI 179.8-221.6) after GA-29. The number of daily hospitalized patients with COVID-19 was 171.4 (95% CI 143.8-199.0) before GA-29 versus 225.1 (95% CI 202.9-247.3) after. Daily mortality was 2.4 (95% CI 1.9-2.9) before GA-29 versus 5.2 (95% CI 4.6-5.8). There was no material impact on our results after controlling for economic activity. CONCLUSIONS: In both adjusted and unadjusted analyses, we were unable to detect a reduction in case load, hospitalization rates, or mortality associated with the implementation of an executive order requiring a statewide mask order. These results suggest that during a period of rapid virus spread, additional public health measures may be necessary to mitigate transmission at the population level.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Hospitalization/statistics & numerical data , Mandatory Programs , Masks , Workload/statistics & numerical data , COVID-19/diagnosis , COVID-19/prevention & control , Facilities and Services Utilization , Hospital Mortality , Humans , Interrupted Time Series Analysis , Retrospective Studies , Survival Rate , Texas
18.
PLoS One ; 17(2): e0263680, 2022.
Article in English | MEDLINE | ID: covidwho-1714773

ABSTRACT

To date, literature has depicted an increase in mortality among patients with hip fractures, directly related to acute coronavirus disease 2019 (COVID-19) infection and not due to underlying comorbidities. Usual orthogeriatric pathway in our Department was disrupted during the pandemic. This study aimed to evaluate early mortality within 30 days, in 2019 and 2020 in our Level 1 trauma-center. We compared two groups of patients aged >60 years, with osteoporotic upper hip fractures, in February/March/April 2020 and February/March/April 2019, in our level 1 trauma center. A total of 102 and 79 patients met the eligibility criteria in 2019 and 2020, respectively. Mortality was evaluated, merging our database with the French open database for death from the INSEE, which is prospectively updated each month. Causes of death were recorded. Charlson Comorbidity Index was evaluated for comorbidities, Instrumental Activity of Daily Living (IADL), and Activity of Daily Living (ADL) scores were assessed for autonomy. There were no differences in age, sex, fracture type, Charlson Comorbidity Index, IADL, and ADL. 19 patients developed COVID-19 infection. The 30-day survival was 97% (95% CI, 94%-100%) in 2019 and 86% (95% CI, 79%-94%) in 2020 (HR = 5, 95%CI, 1.4-18.2, p = 0.013). In multivariable Cox'PH model, the period (2019/2020) was significantly associated to the 30-day mortality (HR = 6.4, 95%CI, 1.7-23, p = 0.005) and 6-month mortality (HR = 3.4, 95%CI, 1.2-9.2, p = 0.01). COVID infection did not modify significantly the 30-day and 6-month mortality. This series brought new important information, early mortality significantly increased because of underlying disease decompensation. Minimal comprehensive care should be maintained in all circumstances in order to avoid excess of mortality among elderly population with hip fractures.


Subject(s)
COVID-19 , Hip Fractures/mortality , Activities of Daily Living , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Survival Rate , Trauma Centers , Virulence
19.
J Am Coll Cardiol ; 79(4): 311-323, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1708070

ABSTRACT

BACKGROUND: Recently, the number of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) has reduced, whereas increased mortality was reported. A plausible explanation for increased mortality was prehospital delay because of patients' reticence of their symptoms. OBJECTIVES: The purpose of this study was to investigate the association between prehospital delay and clinical outcomes in patients with NSTEMI METHODS: Among 13,104 patients from the Korea-Acute-Myocardial-Infarction-Registry-National Institutes of Health, the authors evaluated 6,544 patients with NSTEMI. Study patients were categorized into 2 groups according to symptom-to-door (StD) time (<24 or ≥24 hours). The primary outcome was 3-year all-cause mortality, and the secondary outcome was 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure. RESULTS: Overall, 1,827 (27.9%) patients were classified into the StD time ≥24 hours group. The StD time ≥24 hours group had higher all-cause mortality (17.0% vs 10.5%; P < 0.001) and incidence of secondary outcomes (23.3% vs 15.7%; P < 0.001) than the StD time <24 hours group. The higher all-cause mortality in the StD time ≥24 hours group was observed consistently in the subgroup analysis regarding age, sex, atypical chest pain, dyspnea, Q-wave in electrocardiogram, use of emergency medical services, hypertension, diabetes mellitus, chronic kidney disease, left ventricle dysfunction, TIMI (Thrombolysis In Myocardial Infarction) flow, and the GRACE risk score. In the multivariable analysis, independent predictors of prehospital delay were the elderly, women, nonspecific symptoms such as atypical chest pain or dyspnea, diabetes, and no use of emergency medical services. CONCLUSIONS: Prehospital delay is associated with an increased risk of 3-year all-cause mortality in patients with NSTEMI. (iCReaT Study No. C110016).


Subject(s)
Hospitalization , Non-ST Elevated Myocardial Infarction/mortality , Non-ST Elevated Myocardial Infarction/therapy , Time-to-Treatment , Aged , Emergency Medical Services , Female , Humans , Male , Middle Aged , Myocardial Revascularization , Non-ST Elevated Myocardial Infarction/complications , Registries , Republic of Korea , Risk Factors , Survival Rate , Symptom Assessment
20.
Resuscitation ; 173: 71-75, 2022 04.
Article in English | MEDLINE | ID: covidwho-1707007

ABSTRACT

BACKGROUND: Early studies found low survival rates for adults with COVID-19 infection and in-hospital cardiac arrest (IHCA). We evaluated the association of COVID-19 infection on survival outcomes in pediatric patients undergoing cardiopulmonary resuscitation (CPR). METHODS: Within Get-With-The-Guidelines®-Resuscitation, we identified pediatric patients who underwent CPR for an IHCA or bradycardia with poor perfusion between March and December, 2020. We compared survival outcomes (survival to discharge and return of spontaneous circulation for ≥20 minutes [ROSC]) between patients with suspected/confirmed COVID-19 infection and non-COVID-19 patients using multivariable hierarchical regression, with hospital site as a random effect and patient and cardiac arrest variables with a significant (p < 0.05) bivariate association as fixed effects. RESULTS: Overall, 1328 pediatric in-hospital CPR events were identified (590 IHCA, 738 bradycardia with poor perfusion), of which 46 (32 IHCA, 14 bradycardia) had suspected/confirmed COVID-19 infection. Rates of survival to discharge were similar between those with and without COVID-19 infection (39.1% vs. 44.9%; adjusted RR, 1.14 [95% CI: 0.55-2.36]), and these estimates were similar for those with IHCA and bradycardia with poor perfusion (adjusted RRs of 1.03 and 1.05; interaction p = 0.96). Rates of ROSC were also similar between pediatric patients with and without COVID-19 overall (67.4% vs. 76.9%; adjusted RR, 0.87 [0.43, 1.77]), and for the subgroups with IHCA or bradycardia requiring CPR (adjusted RRs of 0.95 and 0.86, interaction p = 0.26). CONCLUSIONS: In a large multicenter national registry of CPR events, COVID-19 infection was not associated with lower rates of ROSC or survival to hospital discharge in pediatric patients undergoing CPR.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Adult , COVID-19/therapy , Child , Heart Arrest/therapy , Hospitals, Pediatric , Humans , Survival Rate
SELECTION OF CITATIONS
SEARCH DETAIL