Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study.

BACKGROUND: Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown. METHODS: In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis. RESULTS: In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p<  0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome. CONCLUSIONS: Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities. TRIAL REGISTRATION: CAPACITY-COVID ( NCT04325412 ).

['Ecstasy-light' - not as light as its name suggests: toxic effects of 4-fluoroamphetamine]. / 'Ecstasy-light': niet zo onschuldig als het lijkt.

BACKGROUND: The use of 4-fluoroamphetamine (4-FA) has shown a marked increase, especially because users perceive its effects to be relatively mild. 4-FA is also known as ecstacy-light, but is probably not as light as its name suggests. From April 2017 its use has therefore been forbidden in the Netherlands. CASE DESCRIPTION: In a short time, we saw three patients at our emergency department who had signs of a severe intoxication with 4-FA. A 21-year-old male developed a tonic-clonic seizure, bruxism, mydriasis, and rhabdomyolysis. A 19-year-old female was confused and was longing for death. A 22-year-old male needed to be admitted to intensive care to be intubated, sedated and cooled due to tachycardia, hypertension and hyperthermia. CONCLUSION: Because of its relatively mild effects, 4-FA is gaining in popularity in the Netherlands. However, the use of this designer drug can lead to severe problems such as severe confusion, hyperthermia and tonic-clonic seizures.

Registering complications at admission via the emergency department: an opportunity for improvement.

BACKGROUND: To monitor and improve the quality of care we provide it is important to register complications. Complications occurring after discharge or after treatment at outpatient clinics are usually not registered and complications occurring in domains other than where they originated may be missed. The emergency department (ED) may offer an opportunity to register these complications. This study assesses the prevalence and nature of complications in patients at the moment of acute admission by internists. METHODS: A retrospective cohort study over a five-month period was performed in which we reviewed the charts of all patients who were admitted to our hospital via the ED by internists. We investigated the number, nature, preventability and severity of complications present at the moment of admission. RESULTS: In total, there were 1128 admissions. Of these, 284 patients were admitted 324 times (28.7%) due to a complication. The most common complication was medication-related (43.5%), in particular bleeding while using anticoagulants. The second most prevalent complication was chemotherapy-related (26.9%), while 17.3% were due to a procedure. Up to 27.8% of all complications were considered preventable. Eighteen (6.3%) patients died during their admission, seven (2.5%) did not recover completely. A total of 23.1% of all complications originated in specialities other than internal medicine. CONCLUSION: Complications are a major reason for hospitalisation. Registering complications present at admission gives broad insight into the complications following the care doctors provide. It is important to understand these complications better to prevent such admissions.