scholarly journals Severe acute respiratory SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience

2020 ◽  
Author(s):  
Francesco Fontana ◽  
Francesco Giaroni ◽  
Monica Frisina ◽  
Gaetano Alfano ◽  
Giacomo Mori ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Supplemental Oxygen ◽  
Fatality Rate ◽  
Dialysis Patients ◽  
Single Centre ◽  
Viral Shedding ◽  
Reactive Protein ◽  
Short Course ◽  
Single Centre Experience

Abstract Background Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units. Methods We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2. Results We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5–14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25–23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75–9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients). Conclusions We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.

scholarly journals A machine-learning parsimonious multivariable predictive model of mortality risk in patients with Covid-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rita Murri ◽  
Jacopo Lenkowicz ◽  
Carlotta Masciocchi ◽  
Chiara Iacomini ◽  
Massimo Fantoni ◽  
...  
Keyword(s):  
Machine Learning ◽  
High Risk ◽  
Risk Score ◽  
Case Fatality Rate ◽  
Cross Validation ◽  
Case Fatality ◽  
Fatality Rate ◽  
C Reactive Protein ◽  
Training Cohort ◽  
Reactive Protein

AbstractThe COVID-19 pandemic is impressively challenging the healthcare system. Several prognostic models have been validated but few of them are implemented in daily practice. The objective of the study was to validate a machine-learning risk prediction model using easy-to-obtain parameters to help to identify patients with COVID-19 who are at higher risk of death. The training cohort included all patients admitted to Fondazione Policlinico Gemelli with COVID-19 from March 5, 2020, to November 5, 2020. Afterward, the model was tested on all patients admitted to the same hospital with COVID-19 from November 6, 2020, to February 5, 2021. The primary outcome was in-hospital case-fatality risk. The out-of-sample performance of the model was estimated from the training set in terms of Area under the Receiving Operator Curve (AUROC) and classification matrix statistics by averaging the results of fivefold cross validation repeated 3-times and comparing the results with those obtained on the test set. An explanation analysis of the model, based on the SHapley Additive exPlanations (SHAP), is also presented. To assess the subsequent time evolution, the change in paO2/FiO2 (P/F) at 48 h after the baseline measurement was plotted against its baseline value. Among the 921 patients included in the training cohort, 120 died (13%). Variables selected for the model were age, platelet count, SpO2, blood urea nitrogen (BUN), hemoglobin, C-reactive protein, neutrophil count, and sodium. The results of the fivefold cross-validation repeated 3-times gave AUROC of 0.87, and statistics of the classification matrix to the Youden index as follows: sensitivity 0.840, specificity 0.774, negative predictive value 0.971. Then, the model was tested on a new population (n = 1463) in which the case-fatality rate was 22.6%. The test model showed AUROC 0.818, sensitivity 0.813, specificity 0.650, negative predictive value 0.922. Considering the first quartile of the predicted risk score (low-risk score group), the case-fatality rate was 1.6%, 17.8% in the second and third quartile (high-risk score group) and 53.5% in the fourth quartile (very high-risk score group). The three risk score groups showed good discrimination for the P/F value at admission, and a positive correlation was found for the low-risk class to P/F at 48 h after admission (adjusted R-squared = 0.48). We developed a predictive model of death for people with SARS-CoV-2 infection by including only easy-to-obtain variables (abnormal blood count, BUN, C-reactive protein, sodium and lower SpO2). It demonstrated good accuracy and high power of discrimination. The simplicity of the model makes the risk prediction applicable for patients in the Emergency Department, or during hospitalization. Although it is reasonable to assume that the model is also applicable in not-hospitalized persons, only appropriate studies can assess the accuracy of the model also for persons at home.

scholarly journals Oxygen and Mortality in COVID-19 Pneumonia: A Comparative Analysis of Supplemental Oxygen Policies and Health Outcomes Across 26 Countries

2021 ◽  
Vol 9 ◽  
Author(s):  
Fatma Mansab ◽  
Harry Donnelly ◽  
Albrecht Kussner ◽  
James Neil ◽  
Sohail Bhatti ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Mortality Rates ◽  
Supplemental Oxygen ◽  
Fatality Rate ◽  
National Mortality ◽  
Bivariate Association ◽  
The Uk ◽  
The Relationship ◽  
Mortality Estimates

Introduction: Hypoxia is the main cause of morbidity and mortality in COVID-19. During the COVID-19 pandemic, some countries have reduced access to supplemental oxygen, whereas other nations have maintained and even improved access to supplemental oxygen. We examined whether variation in the nationally determined oxygen guidelines had any association with national mortality rates in COVID-19.Methods: Three independent investigators searched for, identified, and extracted the nationally recommended target oxygen levels for the commencement of oxygen in COVID-19 pneumonia from the 29 worst affected countries. Mortality estimates were calculated from three independent sources. We then applied both parametric (Pearson's R) and non-parametric (Kendall's Tau B) tests of bivariate association to determine the relationship between case fatality rate (CFR) and target SpO2, and also between potential confounders and CFR.Results: Of the 26 nations included, 15 had employed conservative oxygen strategies to manage COVID-19 pneumonia. Of them, Belgium, France, USA, Canada, China, Germany, Mexico, Spain, Sweden, and the UK guidelines advised commencing oxygen when oxygen saturations (SpO2) fell to 91% or less. A statistically significant correlation was found between SpO2 and CFR both parametrically (R = −0.53, P < 0.01) and non-parametrically (−0.474, P < 0.01).Conclusion: Our study highlights the disparity in oxygen provision for COVID-19 patients between the nations analysed. In those nations that pursued a conservative oxygen strategy, there was an association with higher national mortality rates. We discuss the potential reasons for such an association.

Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study

2015 ◽  
Vol 128 (3-4) ◽  
pp. 95-101 ◽  
Author(s):  
Murat Yalçınsoy ◽  
Cuneyt Salturk ◽  
Hurıye Berk Takır ◽  
Semra Batı Kutlu ◽  
Ayşegul Oguz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Ventilator Associated Pneumonia ◽  
Fatality Rate ◽  
Single Centre

Impact of hydroxychloroquin/azithromycin protocol on COVID-19 case-fatality rate reduction in Algeria. (Preprint)

2020 ◽  
Author(s):  
Ahmed Youssef Kada
Keyword(s):  
Case Fatality Rate ◽  
Doubling Time ◽  
Case Fatality ◽  
World Health ◽  
Fatality Rate ◽  
Therapeutic Protocol ◽  
First Case ◽  
The World ◽  
The Impact ◽  
At Home

BACKGROUND Covid-19 is an emerging infectious disease like viral zoonosis caused by new coronavirus SARS CoV 2. On December 31, 2019, Wuhan Municipal Health Commission in Hubei province (China) reported cases of pneumonia, the origin of which is a new coronavirus. Rapidly extendable around the world, the World Health Organization (WHO) declares it pandemic on March 11, 2020. This pandemic reaches Algeria on February 25, 2020, date on which the Algerian minister of health, announced the first case of Covid-19, a foreign citizen. From March 1, a cluster is formed in Blida and becomes the epicentre of the coronavirus epidemic in Algeria, its total quarantine is established on March 24, 2020, it will be smoothly alleviated on April 24. A therapeutic protocol based on hydroxychloroquine and azithromycin was put in place on March 23, for complicated cases, it was extended to all the cases confirmed on April 06. OBJECTIVE This study aimed to demonstrate the effectiveness of hydroxychloroquin/azithromycin protocol in Algeria, in particular after its extension to all patients diagnosed COVID-19 positive on RT-PCR test. We were able to illustrate this fact graphically, but not to prove it statistically because the design of our study, indeed in the 7 days which followed generalization of therapeutic protocol, case fatality rate decrease and doubling time increase, thus confirming the impact of wide and early prescription of hydroxychloroquin/azithromycin protocol. METHODS We have analyzed the data collected from press releases and follow-ups published daily by the Ministry of Health, we have studied the possible correlations of these data with certain events or decisions having a possible impact on their development, such as confinement at home and its reduction, the prescription of hydroxychloroquine/azithromycin combination for serious patients and its extension to all positive COVID subjects. Results are presented in graphics, the data collection was closed on 31/05/2020. RESULTS Covid-19 pandemic spreads from February 25, 2020, when a foreign citizen is tested positive, on March 1 a cluster is formed in the city of Blida where sixteen members of the same family are infected during a wedding party. Wilaya of Blida becomes the epicentre of coronavirus epidemic in Algeria and lockdown measures taken, while the number of national cases diagnosed begins to increases In any event, the association of early containment measures combined with a generalized initial treatment for all positive cases, whatever their degree of severity, will have contributed to a reduction in the fatality rate of COVID 19 and a slowing down of its doubling time. CONCLUSIONS In Algeria, the rapid combination of rigorous containment measure at home and early generalized treatment with hydroxychloroquin have demonstrated their effectiveness in terms of morbidity and mortality, the classic measures of social distancing and hygiene will make it possible to perpetuate these results by reducing viral transmission, the only unknown, the reopening procedure which can only be started after being surrounded by precautions aimed at ensuring the understanding of the population. CLINICALTRIAL Algeria, Covid-19, pandemic, hydroxychloroquin, azithromycin, case fatality rate

scholarly journals Author Correction: Calcium channel blocker amlodipine besylate therapy is associated with reduced case fatality rate of COVID-19 patients with hypertension

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Lei-Ke Zhang ◽  
Yuan Sun ◽  
Haolong Zeng ◽  
Qingxing Wang ◽  
Xiaming Jiang ◽  
...  
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Case Fatality Rate ◽  
Channel Blocker ◽  
Case Fatality ◽  
Fatality Rate ◽  
Amlodipine Besylate

A Correction to this paper has been published: https://doi.org/10.1038/s41421-021-00267-0

scholarly journals Early determination of case fatality rate of COVID-19 pandemic during the ongoing Yemeni armed conflict

2021 ◽  
pp. 1-15
Author(s):  
Abdulla Salem Bin Ghouth ◽  
Ali Ahmed Al-Waleedi ◽  
Marhami Fahriani ◽  
Firzan Nainu ◽  
Harapan Harapan
Keyword(s):  
Young Adults ◽  
Intensive Care ◽  
Armed Conflict ◽  
Case Fatality Rate ◽  
Preventive Measures ◽  
Case Fatality ◽  
Fatality Rate ◽  
Mechanical Ventilators ◽  
Poor Outcomes

Abstract Objectives: To determine the case-fatality rate (CFR) of coronavirus disease 2019 (COVID-19) and its associated determinants in order to understand the true magnitude of the problem during ongoing conflict in Yemen. Methods: The CFR among confirmed COVID-19 cases in Yemen was calculated. The data was retrieved from national COVID-19 surveillance between April 10, when the first COVID-19 case reported, and May 31, 2020. Results: A total of 419 confirmed COVID-19 cases were reported. There were 14.1% and 5.7% of cases who required intensive care and mechanical ventilators, respectively. Out of total cases, 95 deaths were reported, giving CFR of 22.6% which is much higher compared to other countries. CFR was significantly higher among elderly compared to young adults and varied between governorates. Mortality was associated with preexisting hypertension (OR: 2.30; 95%CI: 1.58, 3.54) and diabetes (OR: 1.68; 95%CI: 1.08, 2.61). Conclusions: Elderly and those with comorbidities, in particular hypertension and diabetes, have higher risk for poor outcomes and therefore should receive more attention in the clinical setting. Preventive measures should also be prioritized to protect those groups in order to reduce the severe cases and deaths-associated COVID-19 in armed-conflict.

scholarly journals Regional Variability in COVID-19 Case Fatality Rate in Canada, February–December 2020

2021 ◽  
Vol 18 (4) ◽  
pp. 1839
Author(s):  
Eunha Shim
Keyword(s):  
British Columbia ◽  
Case Fatality Rate ◽  
Case Reports ◽  
Case Fatality ◽  
Health Interventions ◽  
Fatality Rate ◽  
Older Individuals ◽  
Regional Variability ◽  
Provincial Level ◽  
Mortality Burden

A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)—where the proportion of deaths among older individuals was also the highest among the four provinces—followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.

scholarly journals Age and Infectious Dose Significantly Affect Disease Progression after RHDV2 Infection in Naïve Domestic Rabbits

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1184
Author(s):  
Robyn N. Hall ◽  
Tegan King ◽  
Tiffany O’Connor ◽  
Andrew J. Read ◽  
Jane Arrow ◽  
...  
Keyword(s):  
New Zealand ◽  
Disease Progression ◽  
Case Fatality Rate ◽  
Low Dose ◽  
Case Fatality ◽  
Wild Rabbit ◽  
Fatality Rate ◽  
Infectious Dose ◽  
Welfare Impacts ◽  
Rabbit Haemorrhagic Disease

Rabbit haemorrhagic disease virus 2 (RHDV2 or GI.2, referring to any virus with lagovirus GI.2 structural genes) is a recently emerged calicivirus that causes generalised hepatic necrosis and disseminated intravascular coagulation leading to death in susceptible lagomorphs (rabbits and hares). Previous studies investigating the virulence of RHDV2 have reported conflicting results, with case fatality rates ranging from 0% to 100% even within a single study. Lagoviruses are of particular importance in Australia and New Zealand where they are used as biocontrol agents to manage wild rabbit populations, which threaten over 300 native species and result in economic impacts in excess of $200 million AUD annually to Australian agricultural industries. It is critically important that any pest control method is both highly effective (i.e., virulent, in the context of viral biocontrols) and has minimal animal welfare impacts. To determine whether RHDV2 might be a suitable candidate biocontrol agent, we investigated the virulence and disease progression of a naturally occurring Australian recombinant RHDV2 in both 5-week-old and 11-week-old New Zealand White laboratory rabbits after either high or low dose oral infection. Objective measures of disease progression were recorded through continuous body temperature monitoring collars, continuous activity monitors, and twice daily observations. We observed a 100% case fatality rate in both infected kittens and adult rabbits after either high dose or low dose infection. Clinical signs of disease, such as pyrexia, weight loss, and reduced activity, were evident in the late stages of infection. Clinical disease, i.e., welfare impacts, were limited to the period after the onset of pyrexia, lasting on average 12 h and increasing in severity as disease progressed. These findings confirm the high virulence of this RHDV2 variant in naïve rabbits. While age and infectious dose significantly affected disease progression, the case fatality rate was consistently 100% under all conditions tested.

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