Effects of Mediterranean diet on hospital length of stay, medical expenses, and mortality in elderly, hospitalized patients: A 2-year observational study

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Download Full-text

Pre- and intra-operative predictors of postoperative hospital length of stay in patients undergoing radical prostatectomy for prostate cancer in China: a retrospective observational study

BMC Urology ◽

10.1186/s12894-018-0351-6 ◽

2018 ◽

Vol 18 (1) ◽

Author(s):

Qingmei Huang ◽

Ping Jiang ◽

Lina Feng ◽

Liping Xie ◽

Shuo Wang ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Length Of Stay ◽

Observational Study ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Retrospective Observational Study

Download Full-text

Nursing Diagnoses as Predictors of Hospital Length of Stay: A Prospective Observational Study

Journal of Nursing Scholarship ◽

10.1111/jnu.12444 ◽

2018 ◽

Vol 51 (1) ◽

pp. 96-105 ◽

Cited By ~ 3

Author(s):

Fabio D'Agostino ◽

Ercole Vellone ◽

Antonello Cocchieri ◽

John Welton ◽

Massimo Maurici ◽

...

Keyword(s):

Length Of Stay ◽

Observational Study ◽

Prospective Observational Study ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Nursing Diagnoses

Download Full-text

Association of Guideline-concordant Acute Asthma Care in the Emergency Department With Shorter Hospital Length of Stay: A Multicenter Observational Study

Academic Emergency Medicine ◽

10.1111/acem.12920 ◽

2016 ◽

Vol 23 (5) ◽

pp. 616-622 ◽

Cited By ~ 8

Author(s):

Kohei Hasegawa ◽

Barry E. Brenner ◽

Richard M. Nowak ◽

Stacy A. Trent ◽

Vivian Herrera ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Observational Study ◽

Acute Asthma ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Asthma Care ◽

Multicenter Observational Study

Download Full-text

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Annals of Nutrition and Metabolism ◽

10.1159/000481355 ◽

2017 ◽

Vol 71 (3-4) ◽

pp. 183-194 ◽

Cited By ~ 4

Author(s):

Marina Verçoza Viana ◽

Luciana Verçoza Viana ◽

Ana Laura Tavares ◽

Mirela Jobim de Azevedo

Keyword(s):

Length Of Stay ◽

Nutritional Support ◽

Randomized Clinical Trials ◽

Regular Insulin ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Insulin Regimen ◽

Nph Insulin ◽

Meta Analyses

Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I2 = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I2 = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

Download Full-text

No associations between physical activity and clinical outcomes among hospitalized patients with severe COVID-19

10.1101/2020.11.25.20237925 ◽

2020 ◽

Author(s):

Ana J. Pinto ◽

Karla F. Goessler ◽

Alan L. Fernandes ◽

Igor H. Murai ◽

Lucas P. Sales ◽

...

Keyword(s):

Physical Activity ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Clinical Outcomes ◽

Hospital Length ◽

Sao Paulo ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Activity Levels ◽

Physical Activity Levels

AbstractPurposeThis small-scale, prospective cohort study nested within a randomized controlled trial aimed to investigate the possible associations between physical activity levels and clinical outcomes among hospitalized patients with severe COVID-19.MethodsHospitalized patients with severe COVID-19 were recruited from Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital), and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. Physical activity levels were assessed by Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were: mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsMean hospital length of stay was 8.5 ± 7.1 days; 3.3% of patients died, 13.8% were admitted to ICU, and 8.6% required mechanical ventilation. Linear regression models showed that physical activity indexes were not associated with hospital length of stay (work index: β=-0.57 [95%CI: −1.80 to 0.65], p=0.355; sport index: β=0.43 [95%CI: −0.94 to 1.80], p=0.536; leisure-time index: β=1.18 [95%CI: −0.22 to 2.59], p=0.099; total activity index: β=0.20 [95%CI: −0.48 to 0.87], p=0.563. Physical activity indexes were not associated with mortality, admission to ICU and mechanical ventilation requirement (all p>0.05).ConclusionsAmong hospitalized patients with COVID-19, physical activity did not associate with hospital length of stay or any other clinically-relevant outcomes. These findings suggest that previous physical activity levels may not change the prognosis of severe COVID-19.

Download Full-text

Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7385 ◽

2020 ◽

Vol 18 (6) ◽

pp. 747-754 ◽

Cited By ~ 1

Author(s):

Daniel E. Lage ◽

Areej El-Jawahri ◽

Charn-Xin Fuh ◽

Richard A. Newcomb ◽

Vicki A. Jackson ◽

...

Keyword(s):

Length Of Stay ◽

Functional Status ◽

Clinical Outcomes ◽

Advanced Cancer ◽

Functional Impairment ◽

Symptom Burden ◽

Hospital Length ◽

Hospitalized Patients ◽

Assessment System ◽

Hospital Length Of Stay

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

Download Full-text