Comparison of thrombotic events and mortality in patients with community-acquired pneumonia and COVID-19: a multicentre observational study

Background: It is still unclear if patients with community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) have different rate, typology, and impact of thrombosis on survival. Methods: In this multicentre observational cohort study 1.138 patients, hospitalized for CAP (n=559) or COVID-19 (n=579) from 7 clinical centres in Italy, were included in the study. Consecutive adult patients (age ≥18 years) with confirmed COVID-19 related pneumonia, with or without mechanical ventilation, hospitalized from 1st March 2020 to 30 April 2020, were enrolled. Covid-19 was diagnosed based on the WHO interim guidance. Patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events including ischemic/embolic events. Results: During the in-hospital stay, 11.4% of CAP and 15.5% of COVID-19 patients experienced thrombotic events (p=0.046). In CAP patients all the events were arterial thromboses, while in COVID-19 patients 8.3% were venous and 7.2% arterial thromboses. During the in-hospital follow-up, 3% of CAP patients and 17% of COVID-19 patients died (p<0.001). The highest mortality rate was found among COVID-19 patients with thrombotic events (47.6% vs 13.4% in thrombotic-event free patients; p<0.001). In CAP, 13.8% of patients experiencing thrombotic events died vs. 1.8% of thrombotic event-free ones (p<0.001). A multivariable COX-regression analysis confirmed a higher risk of death in COVID-19 patients with thrombotic events (HR 2.1; 95% CI: 1.4-3.3; p<0.001). Conclusions: Compared with CAP, COVID-19 is characterized by a higher burden of thrombotic events, different thrombosis typology and higher risk of thrombosis-related in-hospital mortality.

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COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany

10.21203/rs.3.rs-48983/v1 ◽

2020 ◽

Author(s):

Siegbert Rieg ◽

Maja von Cube ◽

Johannes Kalbhenn ◽

Stefan Utzolino ◽

Katharina Pernice ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Cox Regression ◽

Medical Center ◽

Tertiary Care ◽

Study Entry ◽

Hospital Death ◽

Care Model ◽

Cox Regression Analysis ◽

Hospitalised Patients

Abstract BackgroundReported mortality of hospitalised COVID-19 patients varies substantially, particularly in critically ill patients. So far COVID-19 in-hospital mortality and modes of death under optimised care conditions have not been systematically studied.MethodsThis retrospective observational monocenter cohort study was performed after implementation of a non-restricted, dynamic tertiary care model at the University Medical Center Freiburg, an experienced ARDS and ECMO referral center. All hospitalised patients with PCR-confirmed SARS-CoV-2 infection were included. The primary endpoint was in-hospital mortality, secondary endpoints included major complications and modes of death. A multistate analysis and a Cox regression analysis for competing risk models were performed. Modes of death were determined by two independent reviewers.ResultsBetween February 25, and May 8, 213 patients were included in the analysis. The median age was 65 years, 129 patients (61%) were male. 70 patients (33%) were admitted to the intensive care unit (ICU), of which 57 patients (81%) received mechanical ventilation and 23 patients (33%) extracorporeal membrane-oxygenation (ECMO) support. According to the multistate model the probability to die within 90 days after COVID-19 onset was 24% in the whole cohort. If the levels of care at time of study entry were accounted for, the probabilities to die were 16% if the patient was initially on a regular ward, 47% if in the ICU and 57% if mechanical ventilation was required at study entry. Age ≥ 65 years and male sex were predictors for in-hospital death. Predominant complications – as judged by two independent reviewers – determining modes of death were multi-organ failure, septic shock and thromboembolic and hemorrhagic complications.ConclusionIn a dynamic care model COVID-19-related in-hospital mortality remained substantial. In the absence of potent antiviral agents, strategies to alleviate or prevent the identified complications should be investigated. In this context, multistate analyses enable comparison of models-of-care and treatment strategies and allow estimation and allocation of health care resources.RegistrationGerman Clinical Trials Register (identifier DRKS00021775), retrospectively registered June 10, 2020.

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AST/ALT ratio as a predictor of mortality and future exacerbations of PM/DM-ILD——a retrospective cohort study with 522 cases

10.21203/rs.3.rs-25060/v1 ◽

2020 ◽

Author(s):

Renjiao Li ◽

Wen-Jun Zhu ◽

Faping Wang ◽

Xiaoju Tang ◽

Fengming Luo

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Low Cost ◽

Cox Regression Analysis ◽

Neutrophil Lymphocyte Ratio ◽

Hazard Ratios

Abstract ObjectiveTo assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with Polymyositis/dermatomyositis associated interstitial lung disease (PM/DM-ILD).Patients and MethodsThis was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008 to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91–1.26, 1.26–1.73 and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides or low density lipoprotein.ResultsHigher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481–7.911, p = .004). Patients with higher DRR more often required use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up.ConclusionHigher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.

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Nosocomial Tuberculosis Transmission from 2006 to 2018 in Beijing Chest Hospital, China

10.21203/rs.3.rs-18459/v3 ◽

2020 ◽

Author(s):

Zhongyao Xie ◽

Ning Zhou ◽

Yuqing Chi ◽

Guofang Huang ◽

Jingping Wang ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Natural Ventilation ◽

Cox Regression ◽

Protective Effects ◽

Cox Regression Analysis ◽

Tuberculosis Transmission ◽

Regression Correlation ◽

Ventilation Systems

Abstract Introduction: Strong evidence is lacking to support effectiveness of currently implemented tuberculosis infection prevention control (TB-IPC) measures for preventing nosocomial tuberculosis (TB) transmission. This 13-year analysis is the longest follow-up investigation to date to identify risk factors underlying nosocomial TB transmission. Methods: We monitored all staff of Beijing Chest Hospital each year from 2006 to 2018. Age, gender, duration, department, education, income, respirator, ultraviolet, and ventilation were chosen as variables. Univariate cox regression, correlation analysis, and multivariate cox regression were analyzed sequentially.Results: Using multivariable cox regression analysis, variables of income, ultraviolet germicidal irradiation (UVGI), natural ventilation and mechanical ventilation conferred significant protective effects, with odds ratios (ORs) of 0.499, 0.058, 0.003, and 0.015, respectively (P<0.05). Medical N95 respirator conferred an excellent protective effect, with an associated TB infection rate of 0%. Notably, inadequately maintained mechanical ventilation systems were less protective than natural ventilation systems.Conclusions: UVGI, adequate ventilation, and use of medical N95 respirator may be risk factors of nosocomial TB transmission.

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Cox regression analysis of compositional covariates related to death of the kidney transplant-recipient in northeastern Brazil: modeling of covariates associated with renal allograft failure

Research Society and Development ◽

10.33448/rsd-v9i11.10276 ◽

2020 ◽

Vol 9 (11) ◽

pp. e84791110276

Author(s):

Ubiracé Fernando Elihimas Júnior ◽

Wallace Pereira ◽

Eduardo Eriko Tenório de França ◽

Orlando Vieira Gomes ◽

Manoel Pereira Guimarães ◽

...

Keyword(s):

Kidney Transplant ◽

Cox Regression ◽

Fasting Blood Glucose ◽

Laboratory Data ◽

Graft Function ◽

Northeastern Brazil ◽

Incidence Density ◽

Cox Regression Analysis ◽

Risk Of Death

Introduction: Kidney transplant (KT) has the highest survival rate amongst kidney replacement therapies (KRT). Objective: Analyze the incidence density of all-cause mortality in chronic kidney disease transplant-recipients and to identify covariables associated with higher risk of death. Methodology: Cohort study using medical records of 605 KT patients with seven years follow-up (2011-2018). Records with insufficient data or from patients with incomplete treatment were excluded. The variables analyzed were demographic, clinical and laboratory data, duration of KRT, type of donor, immunological compatibility, panel-reactive HLA-antibody, infections, and use of hypothermic perfusion machine (HPPM). Hazard ratio (HR) and incidence density of all-cause deaths were estimated. Results: 15 of 553 KT-recipients died during the follow-up. The survival in the first year post-KT was 98.0% and in the fifth year was 93.2%. The incidence density of deaths is 10/1,000 person-years. Variables pre- and post-KT related with higher death risk were allograft pyelonephritis ≥6-months and delayed graft function >4 weeks. Survival among KT-recipients with loss >5 mL/min/1.73m2/year in the estimated glomerular filtration rate (eGFR) were lower than the others (88% vs. 97%). Covariates associated with mortality post-transplant included pre-KT obesity, HPPM, allograft pyelonephritis, and new-onset diabetes after transplantation. Conclusion: The mortality post-KT is low in these population. Cox's modelling demonstrated that the decline in eGFR >5 mL/min/1.73m2/year, allograft pyelonephritis ≥6-months, pre-KT obesity, fasting blood glucose ≥126 mg/dL presented worst probability of survival. Rapid decline in eGFR reduces substantially the survival probability in these population.

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P1182PROGNOSTIC VALUE OF CHARLSON COMORBIDITY INDEX IN PERITONEAL DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1182 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vincenzo Antonio Panuccio ◽

Rocco Tripepi ◽

Giovanni Luigi Tripepi ◽

Giovanna Parlongo ◽

Francesca Mallamaci

Keyword(s):

Peritoneal Dialysis ◽

Risk Stratification ◽

Roc Curve ◽

Cox Regression ◽

Clinical Score ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Prognostic Accuracy ◽

Dialysis Vintage

Abstract Background and Aims Mortality risk is very high in the dialysis population and the Charlson Comorbidities Index (CCI) is considered as an useful risk stratification tool in these patients. The purpose of this study was to examine the accuracy of CCI for predicting mortality in peritoneal dialysis (PD) patients and to compare the prognostic power of CCI with that of a risk prediction model jointly including a clinical score of malnutrition and the NYHA classes. Method We analyzed this problem in a series of 66 consecutive PD patients on follow-up in our unit. Their mean age was 69±14 years, 64% were male, 36% were diabetic. The median dialysis vintage was 39 months (Interquartile range 23-67 months). Results During follow-up period, 37 patients died. On univariate Cox regression analysis, CCI largely failed to predict mortality [Hazard ratio (HR): 1.08, 95% CI: 0.94-1.24, P=0.30) and this relationship did not improve (HR: 0.93, 95% CI: 0.79-1.08, P=0.32) also after data adjustment for malnutrition and NYHA classes. In the same model, malnutrition (HR: 1.98, 95% CI 1.20-3.27, P=0.007) and NYHA classes (HR: 3.15, 95% CI 1.67-5.94, P<0.001) were strongly and significantly related to the risk of death. Of note, the prognostic accuracy of the model based on malnutrition and NYHA classes (ROC curve area: 74%) was higher than that provided by CCI alone (ROC curve area: 54%) and did not materially differ from that of an expanded model including CCI, malnutrition and NYHA classes (ROC curve area: 78%) Conclusion In this study, CCI did not predict survival in PD patients whereas malnutrition and NYHA score displayed a relevant prognostic accuracy for death in the same patient-population. These results generate the hypothesis, to be confirmed in a larger PD population, that CCI solely for risk stratification is unwarranted in PD patients.

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Nosocomial tuberculosis transmission from 2006 to 2018 in Beijing Chest Hospital, China

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00831-5 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Zhongyao Xie ◽

Ning Zhou ◽

Yuqing Chi ◽

Guofang Huang ◽

Jingping Wang ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Natural Ventilation ◽

Cox Regression ◽

Protective Effects ◽

Cox Regression Analysis ◽

Tuberculosis Transmission ◽

Regression Correlation ◽

Ventilation Systems

Abstract Introduction Strong evidence is lacking to support effectiveness of currently implemented tuberculosis infection prevention control (TB-IPC) measures for preventing nosocomial tuberculosis (TB) transmission. This 13-year analysis is the longest follow-up investigation to date to identify risk factors underlying nosocomial TB transmission. Methods We monitored all staff of Beijing Chest Hospital each year from 2006 to 2018. Age, gender, duration, department, education, income, respirator, ultraviolet, and ventilation were chosen as variables. Univariate cox regression, correlation analysis, and multivariate cox regression were analyzed sequentially. Results Using multivariable cox regression analysis, variables of income, ultraviolet germicidal irradiation (UVGI), natural ventilation and mechanical ventilation conferred significant protective effects, with odds ratios of 0.499, 0.058, 0.003, and 0.015, respectively (P < 0.05). Medical N95 respirator conferred an excellent protective effect, with an associated TB infection rate of 0%. Notably, inadequately maintained mechanical ventilation systems were less protective than natural ventilation systems. Conclusion UVGI, adequate ventilation, and use of medical N95 respirator may be risk factors of nosocomial TB transmission.

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Corticosteroid therapy for corona virus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis

10.21203/rs.3.rs-52425/v1 ◽

2020 ◽

Author(s):

Chaomin Wu ◽

Dongni Hou ◽

Chunling Du ◽

Yanping Cai ◽

Junhua Zheng ◽

...

Keyword(s):

Propensity Score ◽

Corticosteroid Therapy ◽

Cox Regression ◽

Propensity Score Analysis ◽

Corticosteroid Treatment ◽

Hospital Death ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Systemic Corticosteroids ◽

The Impact

Abstract Background The impact of corticosteroid therapy on outcomes of patients with Coronavirus disease-2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. Methods In this single-centre retrospective observational study, patients with ARDS caused by COVID-19 between 24 December 2019 and 24 February 2020 were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. Results A total of 382 patients including 226 (59.2%) patients who received systemic corticosteroids and 156 (40.8%) patients with standard treatment were analyzed. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days (HR, 0.48; 95% CI, 0.25, 0.93; p = 0.0285). The association remained significantly after adjusting for age, sex, Sequential Organ Failure Assessment score at hospital admission, propensity score of corticosteroid treatment, and comorbidities (HR: 0.51; CI: 0.27, 0.99; p = 0.0471). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. Conclusion In this clinical practice setting, low-to-moderate dose corticosteroid treatment was associated with reduced risk of death in COVID-19 patients who developed ARDS.

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Nosocomial Tuberculosis Transmission from 2006 to 2018 in Hospital, China

10.21203/rs.3.rs-18459/v1 ◽

2020 ◽

Author(s):

ZHONGYAO XIE ◽

NING ZHOU ◽

YUQING CHI ◽

GUOFANG HUANG ◽

JINGPING WANG ◽

...

Keyword(s):

Mechanical Ventilation ◽

Infection Prevention ◽

Natural Ventilation ◽

Cox Regression ◽

Protective Effects ◽

Cox Regression Analysis ◽

Tuberculosis Transmission ◽

Medical University ◽

Regression Correlation

Abstract Background: Strong evidence is lacking to support effectiveness of currently implemented tuberculosis infection prevention control (TB-IPC) measures for preventing nosocomial tuberculosis (TB) transmission. This 13-year analysis is the longest follow-up investigation to date to identify risk factors underlying nosocomial TB transmission. Methods: We monitored all staff of Beijing Chest Hospital each year from 2006 to 2018. Age, gender, duration, department, education, income, respirator, ultraviolet, and ventilation were chosen as variables. Univariate cox regression, correlation analysis, and multivariate cox regression were analyzed sequentially.Results: Using multivariable cox regression analysis, variables of income, ultraviolet germicidal irradiation (UVGI), natural ventilation and mechanical ventilation conferred significant protective effects, with odds ratios (ORs) of 0.499, 0.058, 0.003, and 0.015, respectively (P<0.05). Medical N95 respirator conferred an excellent protective effect, with an associated TB infection rate of 0%. Notably, inadequately maintained mechanical ventilation systems were less protective than natural ventilation systems.Conclusions: UVGI, adequate ventilation, and medical N95 respirator use may be protective factors against nosocomial TB transmission. Adequate ventilator system training, monitoring, and regular maintenance are critical for achieving effective TB-IPC.Corresponding author equally to this paper: Naihui Chu: Tuberculosis Department, Beijing Chest Hospital affiliated to Capital Medical University, No 9, Beiguan street, Tongzhou District, Beijing 101149, P.R.China. Email: [email protected]

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Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa321 ◽

2020 ◽

Vol 75 (11) ◽

pp. 3359-3365 ◽

Cited By ~ 3

Author(s):

Zeno Pasquini ◽

Roberto Montalti ◽

Chiara Temperoni ◽

Benedetta Canovari ◽

Mauro Mancini ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cox Regression ◽

Compassionate Use ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Time Period ◽

Significant Difference ◽

Comorbidity Index

Abstract Background Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated. Methods This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period. Results A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59–75.5) years, 92% were men and symptom onset was 10 (8–12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46–57) days. Kaplan–Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P < 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027–1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768–6.954; P < 0.001). Conclusions In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.

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The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Critical Care ◽

10.1186/s13054-021-03727-x ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Antoni Torres ◽

Anna Motos ◽

Jordi Riera ◽

Laia Fernández-Barat ◽

Adrián Ceccato ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Prognostic Factor ◽

Hospital Mortality ◽

Clinical Data ◽

Observational Cohort Study ◽

Mechanically Ventilated ◽

Icu Admission ◽

Risk Of Death ◽

Observational Cohort

Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.

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