Prediction of COVID-19 severity from clinical and biochemical markers: a single-center study from Saudi Arabia.

OBJECTIVE: It is known that the severity of COVID-19 is linked to the prognosis of patients; therefore, an early identification is required for patients who are likely to develop severe or critical COVID-19 disease. The purpose of this study is to propose a statistical method for identifying the severity of COVID-19 disease by using clinical and biochemical laboratory markers. PATIENTS AND METHODS: A total of 48 clinically and laboratory-confirmed cases of COVID-19 were obtained from King Fahad Hospital, Medina (KFHM) between 27th April 2020 to 25th May 2020. The patients' demographics and severity of COVID-19 disease were assessed using 39 clinical and biochemical features. After excluding the demographics, 35 predicting features were included in the analysis (diabetes, chronic disease, viral and bacterial co-infections, PCR cycle number, ICU admission, clot formation, cardiac enzymes elevation, hematology profile, sugar levels in the blood, as well as liver and kidney tests, etc.). Logistic regression, stepwise logistic regression, L-2 logistic regression, L-2 stepwise logistic regression, and L-2 best subset logistic regression were applied to model the features. The consistency index was used with kernel Support-Vector Machines (SVM) for the identification of associated markers. RESULTS: L-2 best subset logistic regression technique outperformed all other fitted models for modeling COVID-19 disease severity by achieving an accuracy of 88% over the test data. Consistency index over L-2 best subset logistic regression identified 14 associated markers that can best predict the COVID-19 severity among COVID-19 patients. CONCLUSIONS: By combining a variety of laboratory markers with L-2 best subset logistic regression, the current study has proposed a highly accurate and clinically interpretable model of predicting COVID-19 severity.

Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland.

BACKGROUND: We have previously reported that immigrants in Ireland have poorer glycemic control compared with a matched population of Irish patients. This may be associated with poor diabetes self-care and low health literacy. AIM: To compare the diabetes self-care profile of non-Irish-national patients i.e. immigrant patients (IM) and Irish patients (IR) attending a hospital diabetes clinic and to evaluate differences in health literacy between the two cohorts. METHODS: We studied the differences in diabetes self-management between 52 randomly selected non-Irish-national patients with type 2 diabetes and 48 randomly selected Irish/Caucasian patients. Rapid Estimate of Adult Literacy in Medicine (REALM) was used to assess health literacy. RESULTS: IM had poorer glycemic control than IR (HbA1c 8.0 +/- 1.9 vs. 6.9 +/- 1.4%, P < 0.005). A significant proportion of IM forget to monitor their daily blood glucose (42.1% vs. 12.5%, P < 0.05). Family support is more important amongst IM in performing daily blood glucose monitoring (75% vs. 47.7%, P < 0.05), taking medications (81.7% vs. 42.2%, P = 0.01) and following an appropriate meal plan (87.6% vs. 62.2%, P < 0.05). Fifty-three percent can only understand simple or familiar questions about their diabetes care; 65.9% can only provide information on simple or familiar topics about their diabetes. Health literacy was found to be lower in the IM groups when assessed using REALM (52.7 vs. 61.4, P = 0.01). CONCLUSION: Those providing diabetes education and care need to be aware of differing patient expectations regarding family involvement in the care of their diabetes and the possible contribution of language problems and lower health literacy to a limited understanding of diabetes self-care.

Immigrant patients with type 2 diabetes mellitus have poorer initial and on-going glycemic control than a matched population of Irish patients.

We compared the glycemic and cardiovascular risk status of non-Caucasian patients with type 2 diabetes mellitus (T2DM) who recently emigrated to Ireland with a matched population of Irish patients. We identified 105 non-Caucasian patients with T2DM who recently emigrated to Ireland and compared them with 105 Irish patients with T2DM, who were matched for age, sex and duration of diabetes. Immigrants with T2DM had significantly worse initial (9.8% vs 9.1%, p<0.05) and on-going (8.3% vs 7.1, p<0.05) glycemic control and higher microalbumin to creatinine ratio compared to the Irish patients. A greater proportion of immigrants with T2DM were on insulin therapy for their diabetes. Irish patients had significantly higher fasting triglyceride concentrations compared to the immigrants (1.9+/-0.1 mmol/l vs 1.6+/-0.1 mmol/l, p<0.05). This vulnerable population of immigrants with T2DM is currently at higher risk of complications of diabetes and warrants greater attention to glycemic control and control of other risk factors.