scholarly journals Prior fluid and electrolyte imbalance is associated with COVID-19 mortality

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Satu Nahkuri ◽  
Tim Becker ◽  
Vitalia Schueller ◽  
Steffen Massberg ◽  
Anna Bauer-Mehren
Keyword(s):  
Public Health ◽  
Renal Function ◽  
A Priori ◽  
Electrolyte Imbalance ◽  
Electrolyte Balance ◽  
Real World Data ◽  
Health Records ◽  
Risk Of Death ◽  
Increased Risk ◽  
Public Health Threat

Abstract Background The COVID-19 pandemic represents a major public health threat. Risk of death from the infection is associated with age and pre-existing comorbidities such as diabetes, dementia, cancer, and impairment of immunological, hepatic or renal function. It remains incompletely understood why some patients survive the disease, while others do not. As such, we sought to identify novel prognostic factors for COVID-19 mortality. Methods We performed an unbiased, observational retrospective analysis of real world data. Our multivariable and univariable analyses make use of U.S. electronic health records from 122,250 COVID-19 patients in the early stages of the pandemic. Results Here we show that a priori diagnoses of fluid, pH and electrolyte imbalance during the year preceding the infection are associated with an increased risk of death independently of age and prior renal comorbidities. Conclusions We propose that future interventional studies should investigate whether the risk of death can be alleviated by diligent and personalized management of the fluid and electrolyte balance of at-risk individuals during and before COVID-19.

scholarly journals Fluid, pH and electrolyte imbalance associated with COVID-19 mortality

2021 ◽  
Author(s):  
Satu Nahkuri ◽  
Tim Becker ◽  
Vitalia Schueller ◽  
Steffen Massberg ◽  
Anna Bauer-Mehren
Keyword(s):  
Multivariate Analyses ◽  
A Priori ◽  
Electrolyte Imbalance ◽  
Electrolyte Balance ◽  
Core Component ◽  
Real World Data ◽  
Health Records ◽  
Risk Of Death ◽  
Electrolyte Homeostasis ◽  
The World

Abstract The threat of COVID-19 has harried the world since early 2020. Risk of death from the infection is associated with age and pre-existing comorbidities such as diabetes, dementia, cancer, and impairment of immunological, hepatic or renal function. It still remains incompletely understood why some patients survive the disease, while others perish. Our univariate and multivariate analyses of real world data from U.S. electronic health records indicate that a priori diagnoses of fluid, pH and electrolyte imbalance are highly and independently associated with COVID-19 mortality. We propose that pre-existing homeostatic aberrations are magnified upon the loss of ACE2, which is a core component of the electrolyte management system as well as the entry point of internalizing SARS-CoV-2 viruses. Moreover, we also suggest such fragility of electrolyte homeostasis may increase the risk of plasma volume disturbances during the infection. Future interventional studies should investigate whether the risk of death can be alleviated by personalized management of the fluid and electrolyte balance of at-risk individuals before and during COVID-19.

Public health impact of PSA doubling time after radical prostatectomy on prostate cancer specific and overall survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4568-4568
Author(s):  
S. J. Freedland ◽  
E. B. Humphreys ◽  
L. A. Mangold ◽  
M. Eisenberger ◽  
D. J. George ◽  
...  
Keyword(s):  
Public Health ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Doubling Time ◽  
Health Concern ◽  
Small Subset ◽  
Risk Of Death ◽  
Psa Doubling Time ◽  
Increased Risk ◽  
Psa Recurrence

4568 Background: Among patients treated with radical prostatectomy (RP) with a PSA recurrence, we previously found men with a PSA doubling time (PSADT) <3 months were at increased risk of prostate cancer death, though these men constituted a small subset of patients. We sought to determine the actual and predicted number of prostate cancer deaths stratified by PSADT. Methods: We retrospectively studied 379 men treated with RP between 1982 and 2000 with a PSA recurrence. We calculated the actual and 15-year actuarial number of prostate cancer deaths in each of the following PSADT categories: <3, 3.0–8.9, 9.0–14.9, and ≥15.0 months. Results: Median follow-up after PSA recurrence was 7 years. During this time, there were 76 prostate cancer deaths; the majority (51%) were among men with a PSADT of 3.0–8.9 months. Though men with a PSADT <3 months were at the greatest risk of death, this group accounted for only 20% (n=15) of all prostate cancer deaths. Using actuarial 15-year estimates of prostate cancer specific survival, 50% of all prostate cancer deaths were among men with a PSADT of 3.0–8.9 months while men with a PSADT <3 months accounted for only 13% of prostate cancer deaths. Using actuarial 15-year estimates of all-cause and prostate cancer specific mortality, among men with a PSADT <15 months, prostate cancer was estimated to be the cause of death in 94% (145/155). Only among men with a PSADT >15 months was the risk of competing causes of mortality high enough such that the majority of deaths were not attributed to prostate cancer. Conclusions: Among a select cohort of men treated with RP who experienced a PSA recurrence, prostate cancer was estimated to account for 75% of all deaths. Though men with a PSADT <3 months were at the greatest risk, the majority of deaths occurred among men with a PSADT of 3.0–8.9 months. Efforts to reduce prostate cancer mortality should focus on men with intermediate PSADT times (3.0–15.0 months) as they represent the greatest public health concern among men with PSA recurrence following RP. [Table: see text] No significant financial relationships to disclose.

Association of baseline characteristics and survival in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (CPIs): Real-world evidence.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21625-e21625
Author(s):  
Danielle Crawley ◽  
Kerri Beckmann ◽  
Saranya Ravindra ◽  
Debra Hannah Josephs ◽  
James F. Spicer ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Real World ◽  
Checkpoint Inhibitors ◽  
Definitive Treatment ◽  
Real World Data ◽  
World Data ◽  
Risk Of Death ◽  
Mutational Status ◽  
Increased Risk ◽  
Baseline Characteristics

e21625 Background: CPIs including antibodies to programmed death-1 (PD-1) and its ligand anti PD-L1 are associated with superior overall survival (OS) in NSCLC. PDL1 is an imperfect predictive biomarker. We have examined real world data to identify additional factors associated with clinical benefit. Methods: 96 consecutive NSCLC patients (pts) were treated with CPIs at our institution. Multivariate cox proportional hazard regression models were used to examine the associations between OS and baseline characteristics including age, sex, histology, PDL1 status, performance status (PS), steroid use and brain metastases. Results: 93% (89/96) of pts received pembroluzimab, 6 (6%) nivolumab, and 1 (1%) atezoluzimab. All pts had metastatic disease (68% adenocarcinoma). 15% had PS 0, and 70% PS1. 11 of the 96 pts had brain metastases prior to CPI, 4 (37%) had whole brain radiotherapy, 2 (18%) targeted radiotherapy, 2 (18%) resection with radiotherapy and 3 (27%) had no definitive treatment for brain metastases. After multivariate analysis those with PS 1-2 had an increased risk of death (PS = 1 HR 2.74, 95% CI 1.11-6.72; PS = 2 3.61, 95% CI 1.28-10.15) compared with PS 0. Outcomes for pts receiving corticosteroids at the time of initiation of CPI were also inferior (HR 2.29, 95% CI 1.10-4.74) compared to those who were not. Conversely those who had brain metastasis diagnosed prior to commencing CPI had superior OS (HR 0.29 95% CI: 0.11-0.76). No statistically significant association was seen with age, gender, histology, stage at diagnosis, smoking or mutational status. PDL < 50% compared to > 50% was associated with an increased risk of death (HR 1.53 95% CI: 0.90-2.60) though it was not statistically significant. Conclusions: Here we show, using real world data, that PS and use at baseline of oral corticosteroids are associated with inferior OS with CPI treatment for NSCLC, in line with reports from large clinical trials. We show that baseline brain metastases are associated with improved outcomes. This may be explained by survivor bias, in that those who are successfully treated for brain disease, remain PS ≤2 and are able to commence CPI represent a highly selected group.

scholarly journals Novel risk stratification algorithm for estimating the risk of death in patients with relapsed multiple myeloma: external validation in a retrospective chart review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034209 ◽  
Author(s):  
Roman Hájek ◽  
Sebastian Gonzalez-McQuire ◽  
Zsolt Szabo ◽  
Michel Delforge ◽  
Lucy DeCosta ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Risk Stratification ◽  
Real World ◽  
Goodness Of Fit ◽  
Cox Regression ◽  
External Validation ◽  
Risk Groups ◽  
Real World Data ◽  
Risk Of Death ◽  
Increased Risk

Objectives and designA novel risk stratification algorithm estimating risk of death in patients with relapsed multiple myeloma starting second-line treatment was recently developed using multivariable Cox regression of data from a Czech registry. It uses 16 parameters routinely collected in medical practice to stratify patients into four distinct risk groups in terms of survival expectation. To provide insight into generalisability of the risk stratification algorithm, the study aimed to validate the risk stratification algorithm using real-world data from specifically designed retrospective chart audits from three European countries.Participants and settingPhysicians collected data from 998 patients (France, 386; Germany, 344; UK, 268) and applied the risk stratification algorithm.MethodsThe performance of the Cox regression model for predicting risk of death was assessed by Nagelkerke’s R2, goodness of fit and the C-index. The risk stratification algorithm’s ability to discriminate overall survival across four risk groups was evaluated using Kaplan-Meier curves and HRs.ResultsConsistent with the Czech registry, the stratification performance of the risk stratification algorithm demonstrated clear differentiation in risk of death between the four groups. As risk groups increased, risk of death doubled. The C-index was 0.715 (95% CI 0.690 to 0.734).ConclusionsValidation of the novel risk stratification algorithm in an independent ‘real-world’ dataset demonstrated that it stratifies patients in four subgroups according to survival expectation.

scholarly journals The Combination of Physical Exercise with Muscle-Directed Antioxidants to Counteract Sarcopenia: A Biomedical Rationale for Pleiotropic Treatment with Creatine and Coenzyme Q10

2017 ◽  
Vol 2017 ◽  
pp. 1-19 ◽  
Author(s):  
Michele Guescini ◽  
Luca Tiano ◽  
Maria Luisa Genova ◽  
Emanuela Polidori ◽  
Sonia Silvestri ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Exercise ◽  
Coenzyme Q10 ◽  
Ros Production ◽  
Oxygen Species ◽  
Risk Of Death ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Muscle Impairment ◽  
And Function

Sarcopenia represents an increasing public health risk due to the rapid aging of the world’s population. It is characterized by both low muscle mass and function and is associated with mobility disorders, increased risk of falls and fractures, loss of independence, disabilities, and increased risk of death. Despite the urgency of the problem, the development of treatments for sarcopenia has lagged. Increased reactive oxygen species (ROS) production and decreased antioxidant (AO) defences seem to be important factors contributing to muscle impairment. Studies have been conducted to verify whether physical exercise and/or AOs could prevent and/or delay sarcopenia through a normalization of the etiologically relevant ROS imbalance. Despite the strong rationale, the results obtained were contradictory, particularly with regard to the effects of the tested AOs. A possible explanation might be that not all the agents included in the general heading of “AOs” could fulfill the requisites to counteract the complex series of events causing/accelerating sarcopenia: the combination of the muscle-directed antioxidants creatine and coenzyme Q10 with physical exercise as a biomedical rationale for pleiotropic prevention and/or treatment of sarcopenia is discussed.

scholarly journals Comparison of COVID-19 outcomes among shielded and non-shielded populations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bhautesh D. Jani ◽  
Frederick K. Ho ◽  
David J. Lowe ◽  
Jamie P. Traynor ◽  
Sean P. MacBride-Stewart ◽  
...  
Keyword(s):  
High Risk ◽  
A Priori ◽  
Case Fatality ◽  
The Elderly ◽  
Low Risk ◽  
Family Practitioner ◽  
Moderate Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Population Mortality

AbstractMany western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44–9.59), case-fatality (RR 5.62, 95% CI 4.47–7.07) and population mortality (RR 57.56, 95% 44.06–75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82–4.42) and population mortality (RR 25.41, 95% CI 20.36–31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age ≥ 70 years accounted for 49.55% of deaths. In conclusion, in spite of the shielding strategy, high risk individuals were at increased risk of death. Furthermore, to be effective as a population strategy, shielding criteria would have needed to be widely expanded to include other criteria, such as the elderly.

scholarly journals Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study

2020 ◽  
Author(s):  
Chris Wilkinson ◽  
Andrew Clegg ◽  
Oliver Todd ◽  
Kenneth Rockwood ◽  
Mohammad E Yadegarfar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Electronic Health Records ◽  
Older People ◽  
Oral Anticoagulation ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Health Records ◽  
Risk Of Death ◽  
Increased Risk ◽  
Electronic Health

Abstract Background Atrial fibrillation (AF) is common in older people and is associated with increased stroke risk that may be reduced by oral anticoagulation (OAC). Frailty also increases with increasing age, yet the extent of OAC prescription in older people according to extent of frailty in people with AF is insufficiently described. Methods An electronic health records study of 536,955 patients aged ≥65 years from ResearchOne in England (384 General Practices), over 15.4 months, last follow-up 11th April 2017. OAC prescription for AF with CHA2DS2-Vasc ≥2, adjusted (demographic and treatments) risk of all-cause mortality, and subsequent cerebrovascular disease, bleeding and falls were estimated by electronic frailty index (eFI) category of fit, mild, moderate and severe frailty. Results AF prevalence and mean CHA2DS2-Vasc for those with AF increased with increasing eFI category (fit 2.9%, 2.2; mild 11.2%, 3.2; moderate 22.2%, 4.0; and severe 31.5%, 5.0). For AF with CHA2DS2-Vasc ≥2, OAC prescription was higher for mild (53.2%), moderate (55.6%) and severe (53.4%) eFI categories than fit (41.7%). In those with AF and eligible for OAC, frailty was associated with increased risk of death (HR for severe frailty compared with fit 4.09, 95% confidence interval 3.43–4.89), gastrointestinal bleeding (2.17, 1.45–3.25), falls (8.03, 4.60–14.03) and, among women, stroke (3.63, 1.10–12.02). Conclusion Among older people in England, AF and stroke risk increased with increasing degree of frailty; however, OAC prescription approximated 50%. Given competing demands of mortality, morbidity and stroke prevention, greater attention to stratified stroke prevention is needed for this group of the population.

scholarly journals COVID-19 and tuberculosis

2020 ◽  
Vol 8 (2) ◽  
pp. 59-65
Author(s):  
Heng Yang ◽  
Shuihua Lu
Keyword(s):  
Public Health ◽  
Clinical Characteristics ◽  
Communicable Disease ◽  
Severe Disease ◽  
Emerging Infectious Diseases ◽  
Single Infection ◽  
Limited Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Health And Economic Development

AbstractOn March 11, 2020, the WHO declared that coronavirus disease 2019 (COVID-19) can be characterized as a pandemic based on the alarming levels of spread and severity and on the alarming levels of inaction. COVID-19 has received worldwide attention as emergency, endangering international public health and economic development. There is a growing body of literatures regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as COVID-19. This review will focus on the latest advance of epidemiology, pathogenesis, and clinical characteristics about COVID-19. Meanwhile, tuberculosis (TB) remains the leading representative respiratory tract communicable disease threatening public health. There are limited data on the risk of severe disease or outcomes in patients with concurrence of TB and COVID-19. Nevertheless, co-infection of some virus would aggravate TB, such as measles. And tuberculosis and influenza co-infection compared with tuberculosis single infection was associated with increased risk of death in individuals. This review will also introduce the characteristics about the concurrence of TB and emerging infectious diseases to provide a hint to manage current epidemic.

scholarly journals 1.E. Workshop: Addressing vulnerability within climate change related health impacts

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Climate Change ◽  
Scientific Evidence ◽  
Well Being ◽  
Vulnerable Population ◽  
Electrolyte Imbalance ◽  
Health Impacts ◽  
Adaptation Measures ◽  
Health Vulnerability ◽  
Increased Risk

Abstract   Climate change (CCh) is having an impact on people's health and health systems, directly and indirectly. Drastic and sudden changes in climatic conditions with heat waves and rapid temperature variations, an increased risk of floods, droughts and forest fires are some of the direct impacts related to CCh, with important consequences on health (e.g. heatstroke, electrolyte imbalance, kidney, respiratory as well as infectious related diseases) and mental well-being (e.g. stress and anxiety for an uncertain future). Some indirect effects include the alteration of natural ecosystems, changing vector patterns, air pollution and aeroallergens, or increased food insecurity. For certain sectors of the population and some regions, these direct and indirect impacts overlap with many other environmental and socioeconomic stressors (e.g. overcrowded megacities, poverty and poor nutrition, living in highly contaminated sites, increased dependence on a remote global market, growing gender and class inequalities), increasing the already large vulnerability of those affected populations. Low- and middle-income countries are under greater threat, but more developed economies can be- and in fact are- severely affected as well. This is of particular concern in relation to children together with the elderly, both considered the most vulnerable population groups affected by CCh as highlighted by the Intergovernmental Panel on Climate Change (IPCC). Adverse effects of altered environments during fetal or child developmental stages can result in irreversible and long-lasting health sequelae; uncertainty and loss of control in the face of CCh can have mental health consequences. Gathering best scientific evidence-based information on current and future health threats related to CCh from the perspective of the most vulnerable population subgroups is essential for an effective preparedness of the public health system, and therefore for lessening or avoiding many of those health impacts by applying well-designed and innovative adaptation measures. Health vulnerability and adaptation assessments to CCh requires establishing partnerships among different scientific domains (e.g. public health experts, environmentalists, meteorologists, social scientists), and stakeholders, including community representatives and policy makers. Present workshop, with 3 presenters and one panellist, aims at analysing and sharing expertise on the following aspects: Approaches for characterising health and well-being vulnerability and adaptation measures in the context of CCh by integrating future climatic and socio-economic drivers. Analysis of children's health vulnerability in a CCh context. European initiatives for promoting multidisciplinary scientific evidence analysis, and the interconnection with the decision-making process for the development of innovative and effective adaptation programs that enables diminishing health vulnerability against CCh. Key messages Expanded efforts in the health impact assessment of vulnerable groups against growing risks from climate change is needed for developing effective public health adaptation and preparedness programs. Addressing climate change health vulnerability requires of gathering scientific evidence and collaboration from multiple sectors and stakeholders adapted to regional/local context.

scholarly journals Latin American Origin Is Not Associated with Worse Outcomes among Hospitalized Patients with COVID-19 in a Public Healthcare System

2021 ◽  
Vol 9 (8) ◽  
pp. 1772
Author(s):  
Silvia Otero-Rodriguez ◽  
Oscar Moreno-Pérez ◽  
Jose Manuel Ramos ◽  
Mar García ◽  
Vicente Boix ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Healthcare System ◽  
Latin American ◽  
Odds Ratio ◽  
Invasive Mechanical Ventilation ◽  
Public Healthcare ◽  
Health Records ◽  
Public Healthcare System ◽  
Risk Of Death ◽  
Increased Risk

Exploring differences in clinical outcomes based on race and origin among patients hospitalized for COVID-19 is a controversial issue. The ALC COVID-19 Registry includes all confirmed COVID-19 patients admitted to hospital from 3 March 2020 to 17 December 2020. The data were obtained from electronic health records in order to evaluate the differences in the clinical features and outcomes among European and Latin American patients. The follow-ups occurred after 156 days. A propensity score weighting (PSW) logistic regression model was used to estimate the odds ratio (OR, 95% CI) for Latin American origin and outcome associations. Of the 696 patients included, 46.7% were women, with a median age of 65 (IQR 53–67) years, 614 (88.2%) were European, and 82 (11.8%) were Latin American. Latin American patients were younger, with fewer comorbidities, and a higher incidence of extensive pneumonia. After adjusting for residual confounders, Latin American origin was not associated with an increased risk of death (PSW OR 0.85 (0.23–3.14)) or with the need for invasive mechanical ventilation (PSW OR 0.35 (0.12–1.03)). Latin American origin was associated with a shorter hospital stay, but without differences in how long the patient remained on mechanical ventilation. In a public healthcare system, the rates of death or mechanical ventilation in severe COVID-19 cases were found to be comparable between patients of European and Latin American origins.

Sign in / Sign up

Export Citation Format

Share Document