Patient characteristics and predictors of mortality in 470 adults admitted to a district general hospital in England with Covid-19.

Understanding risk factors for death from Covid-19 is key to providing good quality clinical care. We assessed the presenting characteristics of the 'first wave' of patients with Covid-19 at Royal Oldham Hospital, UK and undertook logistic regression modelling to investigate factors associated with death. Of 470 patients admitted, 169 (36%) died. The median age was 71 years (interquartile range 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n = 218, 46.4%), diabetes (n = 143, 30.4%) and chronic neurological disease (n = 123, 26.1%). The most frequent complications were acute kidney injury (AKI) (n = 157, 33.4%) and myocardial injury (n = 21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation. Independent risk factors for death were increasing age (odds ratio (OR) per 10 year increase above 40 years 1.87, 95% confidence interval (CI) 1.57-2.27), hypertension (OR 1.72, 95% CI 1.10-2.70), cancer (OR 2.20, 95% CI 1.27-3.81), platelets <150 × 103/µl (OR 1.93, 95% CI 1.13-3.30), C-reactive protein ≥100 µg/ml (OR 1.68, 95% CI 1.05-2.68), >50% chest radiograph infiltrates (OR 2.09, 95% CI 1.16-3.77) and AKI (OR 2.60, 95% CI 1.64-4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2, lymphopoenia or other comorbidities. These findings will inform clinical and shared decision making, including use of respiratory support and therapeutic agents.

Case Report: Acute Limb Ischaemia and Gangrene associated with Peripartum Cardiomyopathy.

UNLABELLED: Thromboembolic complications are frequent in patients with peripartum cardiomyopathy (PPCM). Peripheral artery occlusions are however rare. This case report describes a 30-year-old grand multiparous woman with PPCM complicated by acute lower limb ischaemia and gangrene. This followed left intraventricular thrombi despite maintenance of sinus rhythm. We suspect that the thrombosis is caused by the hypercoagulable state of peripartum period, ventricular dilatation and hypokinesis. The impacts of economic and sociocultural factors in the management of this rare complication of PPCM in a resource depleted nation are highlighted. KEYWORDS: peripartum cardiomyopathy, limb ischaemia.