123 Prophylactic anticoagulation and aspirin therapy for hospitalized patients with COVID-19: a propensity score-matched analysis of the hope-COVID-19 registry

Abstract Aims Standard therapy for Corona-virus-19 disease (COVID-19) is mainly developed for critical ill patients. Autopsy studies showed high prevalence of platelet-fibrin rich micro-thrombi in several organs. Aim of the study was to evaluate safety and efficacy of antiplatelet therapy (APT) in COVID-19 hospitalized patients and its impact on survival. Methods and results 7824 consecutive patients with COVID-19 were enrolled in a multicentre-international prospective registry (HOPE-COVID-19). Clinical data and in-hospital complications were recorded. Antiplatelet (AP) regimen, including aspirin and other antiplatelet drugs, was obtained for each patient. During hospitalization 730 (9%) patients received AP drugs with single (93%, n = 680) or dual APT (7%, n = 50). Patients treated with APT were older (74 ± 12 vs. 63 ± 17 years, P < 0.01), more frequently male (68% vs. 57%, P < 0.01) and had higher prevalence of diabetes (39% vs. 16%, P < 0.01). Patients treated with APT compared with no APT showed no differences in terms of in-hospital mortality (18% vs. 19%, P = 0.64, Log Rank P = 0.23), need of invasive ventilation (8.7% vs. 8.5%, P = 0.88), embolic events (2.9% vs. 2.5% P = 0.34) and bleeding (2.1% vs. 2.4%, P = 0.43) but shorter duration of mechanical ventilation (8 ± 5 vs. 11 ± 7 days, P = 0.01); however, when comparing patients with APT vs. no APT and no anticoagulation therapy, APT was associated with lower mortality rates (Log Rank P < 0.01, relative risk 0.79, 95% CI: 0.70–0.94). At multivariable analysis in-hospital APT was associated with a lower mortality risk (relative risk 0.39, 95% CI: 0.32–0.48, P < 0.01). Conclusions APT during hospitalization for COVID-19 could be associated with lower mortality risk and shorter duration of mechanical ventilation, without increased risk of bleeding.

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Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

10.21203/rs.3.rs-149669/v1 ◽

2021 ◽

Author(s):

Jung Hwa Lee ◽

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Secondary Outcome ◽

Cardiac Events ◽

Clinical Prognosis ◽

Adverse Cardiac Events ◽

Neurosurgical Patients ◽

Enzyme Elevation

Abstract To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.747527 ◽

2021 ◽

Vol 8 ◽

Author(s):

David M. Smadja ◽

Guillaume Bonnet ◽

Nicolas Gendron ◽

Orianne Weizman ◽

Lina Khider ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Standard Dose ◽

Matched Cohort ◽

Time To Death ◽

Kaplan Meier ◽

Significant Difference ◽

Medical Wards ◽

Prophylactic Anticoagulation ◽

Intermediate Dose

Background: Microthrombosis and large-vessel thrombosis are the main triggers of COVID-19 worsening. The optimal anticoagulant regimen in COVID-19 patients hospitalized in medical wards remains unknown.Objectives: To evaluate the effects of intermediate-dose vs. standard-dose prophylactic anticoagulation (AC) among patients with COVID-19 hospitalized in medical wards.Methods and results: We used a large French multicentric retrospective study enrolling 2,878 COVID-19 patients hospitalized in medical wards. After exclusion of patients who had an AC treatment before hospitalization, we generated a propensity-score-matched cohort of patients who were treated with intermediate-dose or standard-dose prophylactic AC between February 26 and April 20, 2020 (intermediate-dose, n = 261; standard-dose prophylactic anticoagulation, n = 763). The primary outcome of the study was in-hospital mortality; this occurred in 23 of 261 (8.8%) patients in the intermediate-dose group and 74 of 783 (9.4%) patients in the standard-dose prophylactic AC group (p = 0.85); while time to death was also the same in both the treatment groups (11.5 and 11.6 days, respectively, p = 0.17). We did not observe any difference regarding venous and arterial thrombotic events between the intermediate dose and standard dose, respectively (venous thrombotic events: 2.3 vs. 2.4%, p=0.99; arterial thrombotic events: 2.7 vs. 1.2%, p = 0.25). The 30-day Kaplan–Meier curves for in-hospital mortality demonstrate no statistically significant difference in in-hospital mortality (HR: 0.99 (0.63–1.60); p = 0.99). Moreover, we found that no particular subgroup was associated with a significant reduction in in-hospital mortality.Conclusion: Among COVID-19 patients hospitalized in medical wards, intermediate-dose prophylactic AC compared with standard-dose prophylactic AC did not result in a significant difference in in-hospital mortality.

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Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

10.21203/rs.3.rs-127682/v4 ◽

2021 ◽

Author(s):

Jung Hwa Lee ◽

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Secondary Outcome ◽

Rank Test ◽

Cardiac Events ◽

Clinical Prognosis ◽

Neurosurgical Patients

Abstract Background: To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results: cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001).Conclusions: In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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Clinical Outcomes Associated with Degree of Hypernatremia in Neurocritically Ill Patients

10.21203/rs.3.rs-568017/v1 ◽

2021 ◽

Author(s):

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Serum Sodium ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Propensity Score Matching Analysis ◽

Neurosurgical Patients ◽

The Impact

Abstract Background: Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia.Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis.Results: Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) and 28-day mortality (adjusted OR: 3.51, 95% CI: 1.54 – 7.98 and adjusted OR: 10.60, 95% CI: 5.10 – 21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p = 0.720 and p = 0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate.Conclusions: Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

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Association between cardiac enzyme elevation and clinical prognosis of neurosurgical and neurocritically ill patients

10.21203/rs.3.rs-139861/v1 ◽

2021 ◽

Author(s):

Jung Hwa Lee ◽

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Secondary Outcome ◽

Rank Test ◽

Cardiac Events ◽

Clinical Prognosis ◽

Neurosurgical Patients

Abstract Background To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95–3.95 and adjusted OR: 1.77, 95% CI: 1.20–2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43–5.78 and adjusted OR: 4.04, 95% CI: 2.24–7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001). Conclusions In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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Is mild hypernatremia an independent predictor of poor clinical outcome in neurocritically ill patients?

10.21203/rs.3.rs-116867/v1 ◽

2020 ◽

Author(s):

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Odds Ratio ◽

Sodium Level ◽

Serum Sodium Level ◽

Independent Predictor ◽

Multivariable Analysis ◽

Poor Clinical Outcome ◽

Neurosurgical Patients ◽

The Impact

Abstract We investigated the impact of hypernatremia on mortality of neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, the patients who were hospitalized in the ICU for more than 5 days included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were analyzed. Hypernatremia group had higher rates of in-hospital mortality compared with non-hypernatremia group in overall and matched population (p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) compared with the absence of hypernatremia. However, in-hospital mortality was not significantly different between non-hypernatremia and mild hypernatremia groups (p = 0.720). Interestingly, mild hypernatremia group of matched population showed the best survival rate. Eventually, moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, prognosis of the patients with mild hypernatremia was similar with those without hypernatremia.

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Association between cardiac enzyme elevation and clinical prognosis of neurosurgical and neurocritically ill patients

10.21203/rs.3.rs-127682/v2 ◽

2021 ◽

Author(s):

Jung Hwa Lee ◽

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Secondary Outcome ◽

Rank Test ◽

Cardiac Events ◽

Clinical Prognosis ◽

Neurosurgical Patients

Abstract Background To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95–3.95 and adjusted OR: 1.77, 95% CI: 1.20–2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43–5.78 and adjusted OR: 4.04, 95% CI: 2.24–7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001). Conclusions In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

10.21203/rs.3.rs-127682/v1 ◽

2020 ◽

Author(s):

Jung Hwa Lee ◽

Yun Im Lee ◽

Joonghyun Ahn ◽

Jeong-Am Ryu

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Secondary Outcome ◽

Rank Test ◽

Cardiac Events ◽

Clinical Prognosis ◽

Neurosurgical Patients

Abstract Background: To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results: cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001).Conclusions: In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

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Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients

Anesthesiology ◽

10.1097/aln.0000000000003999 ◽

2021 ◽

Author(s):

Xu Zhao ◽

Chan Gao ◽

Feng Dai ◽

Miriam M. Treggiari ◽

Ranjit Deshpande ◽

...

Keyword(s):

Intensive Care ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Critically Ill ◽

Multivariable Analysis ◽

Hazard Ratio ◽

Lower Mortality ◽

Multiple Testing Correction ◽

Propensity Score Matching Analysis

Background Mortality in critically ill COVID-19 patients remains high. Although randomized controlled trials must continue to definitively evaluate treatments, further hypothesis-generating efforts to identify candidate treatments are required. This study’s hypothesis was that certain treatments are associated with lower COVID-19 mortality. Methods This was a 1-yr retrospective cohort study involving all COVID-19 patients admitted to intensive care units in six hospitals affiliated with Yale New Haven Health System from February 13, 2020, to March 4, 2021. The exposures were any COVID-19–related pharmacologic and organ support treatments. The outcome was in-hospital mortality. Results This study analyzed 2,070 patients after excluding 23 patients who died within 24 h after intensive care unit admission and 3 patients who remained hospitalized on the last day of data censoring. The in-hospital mortality was 29% (593 of 2,070). Of 23 treatments analyzed, apixaban (hazard ratio, 0.42; 95% CI, 0.363 to 0.48; corrected CI, 0.336 to 0.52) and aspirin (hazard ratio, 0.72; 95% CI, 0.60 to 0.87; corrected CI, 0.54 to 0.96) were associated with lower mortality based on the multivariable analysis with multiple testing correction. Propensity score–matching analysis showed an association between apixaban treatment and lower mortality (with vs. without apixaban, 27% [96 of 360] vs. 37% [133 of 360]; hazard ratio, 0.48; 95% CI, 0.337 to 0.69) and an association between aspirin treatment and lower mortality (with vs. without aspirin, 26% [121 of 473] vs. 30% [140 of 473]; hazard ratio, 0.57; 95% CI, 0.41 to 0.78). Enoxaparin showed similar associations based on the multivariable analysis (hazard ratio, 0.82; 95% CI, 0.69 to 0.97; corrected CI, 0.61 to 1.05) and propensity score–matching analysis (with vs. without enoxaparin, 25% [87 of 347] vs. 34% [117 of 347]; hazard ratio, 0.53; 95% CI, 0.367 to 0.77). Conclusions Consistent with the known hypercoagulability in severe COVID-19, the use of apixaban, enoxaparin, or aspirin was independently associated with lower mortality in critically ill COVID-19 patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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