Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

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929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

British Journal of Surgery ◽

10.1093/bjs/znab134.176 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

O Oyende ◽

J Jackman

Keyword(s):

White Cell Count ◽

General Surgeon ◽

High Dose ◽

General Anaesthetic ◽

Microbiological Analysis ◽

Reactive Protein ◽

Affected Tissue ◽

Life Threatening ◽

History Of ◽

High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

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Adolescent with abdominal pain poorly responsive to analgesia

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-320772 ◽

2020 ◽

pp. edpract-2020-320772

Author(s):

Neil Chanchlani ◽

Philip Jarvis ◽

James W Hart ◽

Christine H McMillan ◽

Christopher R Moudiotis

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

White Cell Count ◽

Autism Spectrum ◽

Free Fluid ◽

List Type ◽

Reactive Protein ◽

Normal Limits ◽

History Of ◽

Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

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Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s11446 ◽

2013 ◽

Vol 6 ◽

pp. OJCS.S11446 ◽

Cited By ~ 5

Author(s):

Shigeki Masuda ◽

Nobuhiro Takeuchi ◽

Masanori Takada ◽

Koichi Fujita ◽

Yoshiharu Nishibori ◽

...

Keyword(s):

Listeria Monocytogenes ◽

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Aortic Rupture ◽

Prosthetic Graft ◽

Sigmoid Colon Cancer ◽

Causative Organism ◽

Protein Levels ◽

Reactive Protein ◽

History Of

A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes.

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A toddler with a persisting limp after a minor trauma

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2019-317506 ◽

2019 ◽

pp. edpract-2019-317506

Author(s):

Andrea Trombetta ◽

Ester Conversano ◽

Giorgio Cozzi ◽

Andrea Taddio ◽

Flora Maria Murru ◽

...

Keyword(s):

White Cell Count ◽

Surgical Excision ◽

List Type ◽

Minor Trauma ◽

Normal Value ◽

Reactive Protein ◽

Oral Ibuprofen ◽

History Of ◽

Wait And See ◽

A Minor

A 3-year-old toddler was admitted for a 5-day history of worsening painful limping on his left leg. History was remarkable only for a minor trauma 2 days before the onset of symptoms; the boy fell on his buttocks but was walking normally in the following days. No fever was reported. Pain was also present at night, with no response to oral ibuprofen.On physical examination, the patient refused to stand on his left leg, palpation of the left buttock evoked pain, and exorotation and abduction of the left hip were only moderately limited, without local signs of inflammation such as redness, swelling or skin warming. Blood tests showed elevated erythrocyte sedimentation rate (ESR) (98 mm/hour, normal value <20 mm/hour) with normal C reactive protein (CRP) level (0.5 mg/dL, normal value <0.5 mg/dL). His white cell count was 12 110 x 109/L, haemoglobin was 127 g/L and PLT was 430 x 109/L. Creatine kinase values were within the normal range.An X-ray of the pelvis was unremarkable. An ultrasound of the left hip showed a 2 mm articular effusion.QuestionsBased on the clinical picture and laboratory tests, what is the most likely diagnosis?Perthes disease.Pyomyositis.Septic arthritis.Bone fracture.Leukaemia.What test could confirm the diagnosis?Bone scintigraphy.CT.Bone marrow aspirate.MRI.Intra-articular puncture.What is the mainstay of management of this condition?Wait and see.Surgical excision.Antibiotic course.Antineoplastic treatment.Answers can be found on page 2.

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C-reactive protein levels are related to suicidality in euthymic patients with bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1179 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S337-S337

Author(s):

M. Pantovic Stefanovic ◽

B. Dunjic-Kostic ◽

M. Lackovic ◽

A. Damjanovic ◽

A. Jovanovic ◽

...

Keyword(s):

Suicide Attempts ◽

Previous History ◽

Control Group ◽

Healthy Controls ◽

C Reactive Protein ◽

Course Of Illness ◽

Protein Levels ◽

Reactive Protein ◽

History Of ◽

Competing Interest

IntroductionImmune alterations are believed to be an important part in etiopathogenesis of affective disorders. However, it is not clear if the altered immune mediators are related to distinct disorders or particular psychopathology.AimsThe aim of our study was to explore the differences in C-reactive protein levels (CRP) between euthymic BD patients and healthy controls, as well as to explore the relationship between CRP and lifetime presented psychopathology within BD.MethodsThe study group consisted of 83 patients diagnosed with BD, compared to the healthy control group (n = 73) and matched according to age, gender, and body mass index (BMI). Lifetime psychopathology has been assessed according to predominant polarity as well as previous history of suicide attempts and psychotic episodes.ResultsThe CRP levels were significantly higher in BD patients when compared to healthy controls. After covarying for confounders, we observed that CRP levels, in euthymic BD patients, were related to number of previous suicide attempts, but not other indicators of lifetime psychopathology.ConclusionsBD patients per se, and particularly those with more suicide attempts, are more likely to present with proinflammatory state, even when in remission. Previous history of suicide attempts could bear specifically vulnerable endophenotype within BD. Systemic, longitudinal monitoring of the course of illness, and potential inflammatory mediators that underlie its systemic nature is warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Physical Inactivity is Related to Unheralded Myocardial Infarction More Than Uncomplicated Stable Angina

Journal of Clinical Exercise Physiology ◽

10.31189/2165-6193-7.3.46 ◽

2018 ◽

Vol 7 (3) ◽

pp. 46-52

Author(s):

Ali Vasheghani-Farahani ◽

Somayeh Afshar ◽

Maryam Salimnejad ◽

Ebrahim Kasaian ◽

Mohammad Ali Boroumand ◽

...

Keyword(s):

Stable Angina ◽

Physical Inactivity ◽

Positive Family History ◽

Chronic Stable Angina ◽

Premature Coronary Artery Disease ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

History Of ◽

Artery Disease

ABSTRACT Background: Ischemic heart disease can vary substantially in its clinical presentation. Some patients have acute myocardial infarction (MI) without any previous signs of myocardial ischemia, whereas other patients may have stable angina pectoris for years without periods of acute instability; this suggests the possibility of different risk influence in these 2 groups of patients. Methods: Cardiovascular risk factors were compared in 112 consecutive patients with unheralded MIs (81 men; 59.9 ± 11.6 years) and in 168 consecutive patients with chronic stable angina (108 men; 58.2 ± 10.5 years) with at least 60% occlusion in lumen diameter in 1 of the coronary vessels. Results: Logistic-regression analysis revealed that physical inactivity (odds ratio [OR]: 4.32, 95% CI = 2.07, 8.99; P < 0.0001), the values of high sensitive-C-reactive protein levels (OR: 1.05, 95% CI = 1.00, 1.11; P = 0.043), diabetes (OR: 2.88, 95% CI = 1.42, 5.83; P = 0.003), and positive family history of premature coronary artery disease (OR: 1.96, 95% CI: 1.04, 3.71; P = 0.038) were independent predictors of unheralded MI versus chronic stable angina. Conclusion: In our subjects, sedentary life, diabetes mellitus, positive family history of premature coronary artery disease, and higher high sensitive-C-reactive protein levels were important independent predictors for unheralded MI, which suggests that these factors are involved in thrombosis, plaque rupture, or both.

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Sequential C-reactive protein: a cheap and a valuable biomarker in patients with sepsis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191687 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1837

Author(s):

Vinod Dhakad ◽

Sushma Trikha ◽

Neelima Singh ◽

Archana Kansal

Keyword(s):

Diabetes Mellitus ◽

Protein A ◽

Response To Therapy ◽

Age Group ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Patients With Diabetes ◽

Observational Cohort ◽

Time Of Admission

Background: C-reactive protein (CRP) is a valuable biomarker of sepsis. Levels of CRP increase very rapidly in response to infection, and decrease just as rapidly with the resolution of the condition. The aim of the research was to study, C-reactive protein levels in patients of sepsis and to study the pattern of CRP levels in patients of Sepsis with hypertension, diabetes, smokers and alcoholics.Methods: This prospective observational cohort study was conducted from December 2016 to September 2018 in 100 cases of sepsis. Patients presenting in emergency with sepsis were included as subjects. C- reactive protein was measured in every patient at the time of admission and after 72 hours. Facts related to history, clinical examination and biochemical parameters were recorded in a pretyped proforma. Data were analyzed using SPSS software.Results: Males outnumbered females. Most of the patients40(40%) were in the age group of less than 30 years age group. CRP levels were markedly elevated in patients with diabetes mellitus (92.2±102.63) as compared to patients with hypertension (36.66±26.97) or both (24.20±12.87). CRP levels were higher in alcoholics (60.59±44.20) as compared to smokers (13.37±10.96). CRP levels decreased significantly after 72 hours compared to CRP levels at the time of admission (p <0.001) across all patients suggestive of acute infection.Conclusions: Serial CRP measurement, rather than a single determination at the time of admission, is cheap and valuable in the diagnosis of sepsis and in monitoring the response to therapy. CRP levels shows exaggerated response in diabetes mellitus and alcoholics with sepsis in this study.

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