scholarly journals The role of premorbid transthoracic echocardiogram in identifying adverse clinical outcomes in patients admitted with COVID-19

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Lee ◽  
N Patel ◽  
L Panepinto ◽  
M Byers ◽  
M Ambrosino ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Diastolic Function ◽  
Odds Ratio ◽  
The United States ◽  
Adverse Outcomes ◽  
Transthoracic Echocardiogram ◽  
Composite Outcome ◽  
Lateral Velocity ◽  
Initiation Of Dialysis

Abstract Background/Introduction The novel coronavirus disease (COVID-19) inpatient mortality rate is approximately 20% in the United States. Reports have described a wide pattern of abnormalities in echocardiograms performed in patients admitted with COVID-19. The role of premorbid transthoracic echocardiogram (TTE) in the prediction of COVID-19 severity and mortality is yet to be fully assessed. Purpose To assess whether a pre-COVID TTE can identify patients at high risk of adverse outcomes who are admitted with COVID-19. Methods All patients who underwent a TTE from one year to one month prior to an index inpatient admission for COVID-19 were retrospectively enrolled across five clinical sites. Demographic information, medical history, and laboratory data were included for analysis. Echocardiograms were analyzed by an observer blinded to clinical data. Linear and logistic regressions were performed to detect the association of variables with death, invasive mechanical ventilation, initiation of dialysis, and a composite of these endpoints during the COVID-19 admission. Outcomes were then adjusted for a risk score using inverse propensity weighting incorporating age, sex, diabetes, hypertension, obstructive sleep apnea, history of atherosclerotic cardiovascular disease, atrial fibrillation, diuretic use, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. Results There were 104 patients (68±15 years old, 49% male, BMI 31.4±9.1kg/m2) who met inclusion criteria (baseline characteristics in Table 1). Mean time from TTE to positive SARS-CoV-2 PCR test was 139±91 days. Twenty-nine (28%) participants died during the index COVID-19 admission. There was no association of pre-COVID echocardiographic measures of systolic ventricular function with any endpoint. Diastolic function, as assessed by LV e', was associated with mortality (Table 2). There were 25 patients (24%) with a normal lateral e' (≥10cm/s); none died. There were 35 (34%) patients with LV e' lateral velocity <8 cm/s, of whom 15 (43%) died. LV e' lateral velocity <8 cm/s was associated with an unadjusted odds ratio of 7.69 (95% confidence interval [CI] 2.26–26.19) for death and 3.25 (95% CI 1.11–9.54) for the composite outcome. The odds ratio for death was 4.76 (95% CI 1.10–20.61) and 3.78 (95% CI 0.98–14.6) for the composite outcome after adjustment for clinical risk factors (Table 2). Conclusion In patients with an echocardiogram prior to COVID-19, impaired diastolic function as represented by an abnormal LV e' lateral velocity was associated with both inpatient COVID-19 mortality and a composite outcome of death, mechanical ventilation, and initiation of dialysis, even after adjustment for multiple co-morbidities and medication use. Knowledge of the pre-COVID TTE results may help clinicians identify patients at higher risk of adverse outcomes during an admission for COVID-19. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Increased serum catalytic iron may mediate tissue injury and death in patients with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vipul Chakurkar ◽  
Mohan Rajapurkar ◽  
Suhas Lele ◽  
Banibrata Mukhopadhyay ◽  
Valentine Lobo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Active Form ◽  
Joint Model ◽  
Adverse Outcomes ◽  
Composite Outcome ◽  
Age And Gender ◽  
And Gender ◽  
Primary Composite Outcome

AbstractThe pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have not studied catalytic iron, the biologically most active form of iron. The study was done to determine the role of catalytic iron in the adverse outcomes in COVID-19. We enrolled adult patients hospitalized with a clinical diagnosis of COVID-19 and measured serum iron, transferrin saturation, ferritin, hepcidin and serum catalytic iron daily. Primary outcome was a composite of in-hospital mortality, need for mechanical ventilation, and kidney replacement therapy. Associations between longitudinal iron parameter measurements and time-to-event outcomes were examined using a joint model. We enrolled 120 patients (70 males) with median age 50 years. The primary composite outcome was observed in 25 (20.8%) patients—mechanical ventilation was needed in 21 (17.5%) patients and in-hospital mortality occurred in 21 (17.5%) patients. Baseline levels of ferritin and hepcidin were significantly associated with the primary composite outcome. The joint model analysis showed that ferritin levels were significantly associated with primary composite outcome [HR (95% CI) = 2.63 (1.62, 4.24) after adjusting for age and gender]. Both ferritin and serum catalytic iron levels were positively associated with in-hospital mortality [HR (95% CI) = 3.22 (2.05, 5.07) and 1.73 (1.21, 2.47), respectively], after adjusting for age and gender. The study shows an association of ferritin and catalytic iron with adverse outcomes in COVID-19. This suggests new pathophysiologic pathways in this disease, also raising the possibility of considering iron chelation therapy.

scholarly journals Limited Role of Bots in Spreading Vaccine-Critical Information Among Active Twitter Users in the United States: 2017–2019

2020 ◽  
Vol 110 (S3) ◽  
pp. S319-S325 ◽  
Author(s):  
Adam G. Dunn ◽  
Didi Surian ◽  
Jason Dalmazzo ◽  
Dana Rezazadegan ◽  
Maryke Steffens ◽  
...  
Keyword(s):  
United States ◽  
Confidence Interval ◽  
Odds Ratio ◽  
The United States ◽  
Median Number ◽  
Critical Information ◽  
Critical Content ◽  
Twitter Users ◽  
Vaccine Information

Objectives. To examine the role that bots play in spreading vaccine information on Twitter by measuring exposure and engagement among active users from the United States. Methods. We sampled 53 188 US Twitter users and examined who they follow and retweet across 21 million vaccine-related tweets (January 12, 2017–December 3, 2019). Our analyses compared bots to human-operated accounts and vaccine-critical tweets to other vaccine-related tweets. Results. The median number of potential exposures to vaccine-related tweets per user was 757 (interquartile range [IQR] = 168–4435), of which 27 (IQR = 6–169) were vaccine critical, and 0 (IQR = 0–12) originated from bots. We found that 36.7% of users retweeted vaccine-related content, 4.5% retweeted vaccine-critical content, and 2.1% retweeted vaccine content from bots. Compared with other users, the 5.8% for whom vaccine-critical tweets made up most exposures more often retweeted vaccine content (62.9%; odds ratio [OR] = 2.9; 95% confidence interval [CI] = 2.7, 3.1), vaccine-critical content (35.0%; OR = 19.0; 95% CI = 17.3, 20.9), and bots (8.8%; OR = 5.4; 95% CI = 4.7, 6.3). Conclusions. A small proportion of vaccine-critical information that reaches active US Twitter users comes from bots.

scholarly journals Clinical features and outcomes of COVID-19 among people living with HIV in the United States: A multicenter study from a large global health research network (TriNetX)

2021 ◽  
Author(s):  
George A Yendewa ◽  
Jaime Abraham Perez ◽  
Kayla Schlick ◽  
Heather Tribout ◽  
Grace A McComsey
Keyword(s):  
Mechanical Ventilation ◽  
African American ◽  
Severe Disease ◽  
The United States ◽  
Adverse Outcomes ◽  
Older Age ◽  
Cd4 Count ◽  
Research Network ◽  
People Living With Hiv ◽  
Risk Of Death

Abstract Background HIV infection is a presumed risk factor for severe COVID-19, yet little is known about COVID-19 outcomes in people with HIV (PLW). Methods We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV negative controls aged ≥ 18 years who sought care in 44 healthcare centers in the US from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care (ICU) and ICU admissions), mechanical ventilation, severe disease (ICU admission or death) and 30-day mortality. Results Of 297,194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with > 83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the two groups (2.9% vs 2.3%; p=0.123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, p<0.001), ICU admissions (4.2% vs 2.3%, p<0.001) and mechanical ventilation (2.4% vs 1.6%, p<0.005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use and low CD4 count; whereas severe disease was predicted by older age [adjusted odds ratio (aOR) 8.33, 95% confidence interval (CI) (1.06, 50.00); p=0.044] and CD4 <200 cells/mm 3 [aOR, 8.33, 95% CI (1.06, 50.00); p=0.044]. Conclusion PWH had higher rates of poor COVID-19 outcomes but were not more at risk of death than non-HIV infected counterparts. Older age and low CD4 count predicted adverse outcomes.

scholarly journals Our Daily Communicative Contexts: More Evidence for the Food Environment Puzzle

2021 ◽  
Vol 2 (3) ◽  
pp. 499-514
Author(s):  
Eulàlia P. Abril ◽  
Carrie O’Connell
Keyword(s):  
News Media ◽  
Food Environment ◽  
The United States ◽  
Adverse Outcomes ◽  
Food Environments ◽  
Direct Effects ◽  
Mediation Model ◽  
Communication Effects ◽  
Nationally Representative

Much of the research on food environments suggests that problematic access to healthy food restricts its consumption, contributing to adverse outcomes such as obesity, stroke, and heart disease. In addition to these direct relationships, we propose indirect relationships involving the Communication Mediation Model (CMM). Using nationally representative survey data from 1435 adults in the United States, we explore the multipronged role that perceived food environments play in shaping communication, attitudes, and reflective food consumption, considering communicative contexts. Results indicate a negative correlation between the perception of a difficult food environment and reflective consumption, supporting prior research. Most importantly, the food environment is also negatively correlated with news media use, discussion, and attitudes about healthy eating within the CMM. Our findings suggest that indirect communication effects of the food environment on reflective consumption compound the detrimental role of its direct effects.

Clinical outcomes related to fasting plasma glucose variability, history of diabetes mellitus and antidiabetic regimens in patients with atrial fibrillation: a subgroup analysis from the SPORTIF trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Proietti ◽  
J Gumprecht ◽  
A Farcomeni ◽  
G.F Romiti ◽  
G.Y.H Lip
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Adverse Outcomes ◽  
Composite Outcome ◽  
Oral Antidiabetics ◽  
History Of

Abstract Introduction The role of diabetes mellitus in determining of major adverse outcomes in patients with atrial fibrillation (AF) is well-established. Little is known about fasting plasma glucose (FPG) visit-to-visit variability (VVV) and its impact on outcomes. Aim To analyse the role of FPG-VVV in determining major adverse outcomes in AF patients. Second, to evaluate the prognostic impact of history of diabetes mellitus and antidiabetic regimens. Methods Warfarin-treated patients from the SPORTIF trials were considered for analysis if they had FPG evaluation at baseline and at least 4 determinations throughout follow-up. Standard deviation (SD) of the mean of FPG throughout follow-up was the main measure of VVV, according to its quartiles (SD-Qs). A composite of cardiovascular events and the occurrence of all-cause death was the adverse outcome considered. Results Among the 3665 patients originally included, 3415 (93.2%) were included in this analysis. Throughout a mean (±SD) of 577.59 (±122.09) days of follow-up patients in the highest SD-Q (SD-Q4) had the highest rate of the composite outcome and all-cause death [Figure]. A Cox multi-regression analysis confirmed that SD-Q4 had a significant independent association with occurrence of composite outcome (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.10–2.35) [Figure, Upper Panel], with a non-significant trend for all-cause death, [Figure, Lower Panel]. If no significant impact of history of diabetes mellitus was found, there was a significant impact on the composite outcome of the various antidiabetic regimes: there was no difference found in patients treated with oral antidiabetics, compared to no antidiabetic treatment, but those patients treated with insulin (±oral antidiabetics) were independently associated with the occurrence of composite outcome (HR: 2.38, 95% CI: 1.05–5.38) (Table). Conclusion In AF patients treated with warfarin, patients with the highest FPG-VVV had an increased rate of outcomes and the largest FPG-VVV being significantly associated with the composite outcome of adverse clinical events. In diabetic patients, use of insulin is independently associated with an increased risk of the composite outcome, reflecting the more severe disease in determining adverse events amongst AF patients. Major Adverse Outcomes Funding Acknowledgement Type of funding source: None

scholarly journals Pregnancy-related weight among immigrant and US-born mothers: The role of nativity, maternal duration of residence, and age at arrival

2021 ◽  
Vol 17 ◽  
pp. 174550652110036
Author(s):  
Tiffany L Green ◽  
Muloongo Simuzingili ◽  
Mandar Bodas ◽  
Hong Xue
Keyword(s):  
United States ◽  
Weight Gain ◽  
Confidence Interval ◽  
Gestational Weight Gain ◽  
Odds Ratio ◽  
The United States ◽  
Duration Of Residence ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain

Objectives: The goals of this study were to examine the associations between nativity and pregnancy-related weight and to assess the associations between maternal duration of residence and age at arrival in the United States on pregnancy-related weight among immigrants. Methods: Using logistic regression and data from the Early Childhood Longitudinal Study–Birth Cohort, we assessed differences in preconception weight and gestational weight gain between US-born and immigrant women (N = 7000). We then analyzed differences in both outcomes by duration of residence among immigrants (n = 1850) and examined whether the identified relationships varied by age at arrival in the United States. Results: Compared to US-born mothers, immigrants were less likely to be classified as obese prior to pregnancy (odds ratio 0.435, 95% confidence interval, 0.321–0.590) or experience excessive gestational weight gain (odds ratio 0.757, 95% confidence interval, 0.614–0.978). Among the immigrant sub-sample, living in the United States for 10–15 years (odds ratio 2.737, 95% confidence interval, 1.459–5.134) or 16+ years was positively associated with both preconception obesity (odds ratio 2.918, 95% confidence interval, 1.322–6.439) and excessive gestational weight gain (odds ratio 1.683, 95% confidence interval, 1.012–2.797, 16+ years only). There was some evidence that the duration of residence was positively associated with preconception obesity, but only among women who had moved to the United States at age 18 years and older. Conclusion: In sum, while immigrants are less likely than US-born mothers to experience preconception obesity or excessive gestational weight gain, these outcomes vary among the former group by duration of US residence.

Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes

2016 ◽  
Vol 125 (4) ◽  
pp. 690-699 ◽  
Author(s):  
Maxim A. Terekhov ◽  
Jesse M. Ehrenfeld ◽  
Richard P. Dutton ◽  
Oscar D. Guillamondegui ◽  
Barbara J. Martin ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Care Transitions ◽  
Postoperative Mortality ◽  
Adverse Outcomes ◽  
Anesthesia Care ◽  
Composite Outcome ◽  
Improvement Program ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
The Relationship

Abstract Background Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear. Methods The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events. Results A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers). Conclusions In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.

The Role of Gender and Sensation Seeking in Film Choice

2008 ◽  
Vol 20 (3) ◽  
pp. 97-105 ◽  
Author(s):  
Smita C. Banerjee ◽  
Kathryn Greene ◽  
Marina Krcmar ◽  
Zhanna Bagdasarov ◽  
Dovile Ruginyte
Keyword(s):  
United States ◽  
Undergraduate Students ◽  
Sensation Seeking ◽  
Negative Mood ◽  
Positive Mood ◽  
The United States ◽  
High Arousal ◽  
Subject Design ◽  
Happy Mood

This study demonstrates the significance of individual difference factors, particularly gender and sensation seeking, in predicting media choice (examined through hypothetical descriptions of films that participants anticipated they would view). This study used a 2 (Positive mood/negative mood) × 2 (High arousal/low arousal) within-subject design with 544 undergraduate students recruited from a large northeastern university in the United States. Results showed that happy films and high arousal films were preferred over sad films and low-arousal films, respectively. In terms of gender differences, female viewers reported a greater preference than male viewers for happy-mood films. Also, male viewers reported a greater preference for high-arousal films compared to female viewers, and female viewers reported a greater preference for low-arousal films compared to male viewers. Finally, high sensation seekers reported a preference for high-arousal films. Implications for research design and importance of exploring media characteristics are discussed.

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