scholarly journals Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

2020 ◽  
Vol 35 (8) ◽  
pp. 1338-1411 ◽  
Author(s):  
Nicolas Keller ◽  
François Chantrel ◽  
Thierry Krummel ◽  
Dorothée Bazin-Kara ◽  
Anne Laure Faller ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Complete Recovery ◽  
High Rate ◽  
Atypical Symptoms ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Included Patient

Abstract Background There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. Methods All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. Results Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66–83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0–5), 7 (4–11) and 32 (26.5–35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25–106) and 690 Ly/µL (IQR 450–960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11–3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005–1.017); P < 0.0001]. Conclusions HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

scholarly journals Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura

Blood ◽  
2013 ◽  
Vol 122 (12) ◽  
pp. 2023-2029 ◽  
Author(s):  
Cassandra C. Deford ◽  
Jessica A. Reese ◽  
Lauren H. Schwartz ◽  
Jedidiah J. Perdue ◽  
Johanna A. Kremer Hovinga ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Complete Recovery ◽  
Systemic Lupus ◽  
Thrombocytopenic Purpura ◽  
Risk Of Death ◽  
Chronic Disorder ◽  
Key Points ◽  
Long Term Follow Up

Key Points After recovering from TTP, the prevalence of hypertension, depression, and systemic lupus erythematosus and risk of death are increased. TTP may be a more chronic disorder rather than a disorder of acute episodes and complete recovery.

Epidemiological and genetic characteristics of norovirus outbreaks in long-term care facilities, 2003–2006

2010 ◽  
Vol 139 (2) ◽  
pp. 286-294 ◽  
Author(s):  
N. A. ROSENTHAL ◽  
L. E. LEE ◽  
B. A. J. VERMEULEN ◽  
K. HEDBERG ◽  
W. E. KEENE ◽  
...  
Keyword(s):  
Long Term Care ◽  
Laboratory Data ◽  
Case Fatality ◽  
Term Care ◽  
Genetic Characteristics ◽  
Duration Of Illness ◽  
Care Facilities ◽  
Polymerase Chain ◽  
The Impact

SUMMARYTo identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003–2006. Faecal specimens were tested for NoV by real-time reverse transcriptase–polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3·1% and a case-fatality rate of 0·5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0·001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004–2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon.

scholarly journals Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Prosper J. Bashaka ◽  
Hendry R. Sawe ◽  
Victor Mwafongo ◽  
Juma A. Mfinanga ◽  
Michael S. Runyon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Fatality ◽  
Descriptive Study ◽  
High Rate ◽  
World Health ◽  
Mortality Data ◽  
Children Under Five ◽  
Under Five ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

scholarly journals Incidence and Outcome of Acute Myocardial Infarction in Patients With Aortic Dissection and Risk Factor Control

2021 ◽  
Vol 8 ◽  
Author(s):  
Fang Liu ◽  
Si-Chong Qian ◽  
Shuai Jing ◽  
Zhe Wang ◽  
Xin-Chun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Aortic Dissection ◽  
Laboratory Data ◽  
Patient Characteristics ◽  
Incidence Rates ◽  
Current Smoker ◽  
Long Term Outcomes

Background and Aims: The contradiction of management modality between acute myocardial infarction(AMI) and aortic dissection(AD) may result in clinical catastrophe. Data on risk factors, incidence, and outcome of AD and AMI are limited, and there have been no studies on the long-term outcomes of AMI in patients with AD. So we aimed to investigate long-term outcomes after AMI in patients with AD, and propose a useful diagnostic paradigm.Methods: Consecutively enrolled patients with AD and AMI who were referred to our center from 2010 to 2017. Baseline patient characteristics, risk factors, all medical treatments, echocardiographic parameters, laboratory data, and treatment were recorded. All patients were followed up from the first hospitalization until a first heart event, death, or 17 March, 2018.Results: 0.13% in AMI and 7.49% in AD patients had a concomitant diagnosis of AD and AMI. The average patient age was 53.3 ± 12.1 years and 84.6% were male. The most prevalent vascular risk factors were hypertension (69.2%) and current smoker (64.1%). Of all the 39 patients, 66.7% were managed surgically. Overall in-hospital mortality was 10.3%. The 30-day and 5-year fatality rates were 23.1% and 35.9%, but were higher for female than for male (66.7 vs. 30.3%, log-rank P = 0.045) on 5-year mortality. The overall survival of females was inferior to the males (log-rank P = 0.045).Conclusions: Patients with AMI and AD exhibit high 5-year fatality rates. For these patients, surgical management tends to have lower mortality. Improved management of hypertension and smoking, may reduce future incidence rates.

Abstract WP369: Case-Fatality of Cortical Superficial Siderosis in Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason Mackey ◽  
Kelsey Gagesch ◽  
Ashley D Blatsioris ◽  
Elizabeth A Moser ◽  
Chandan Saha ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Case Fatality ◽  
Clinical Trial Design ◽  
Index Admission ◽  
Superficial Siderosis ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Hemosiderin Deposition ◽  
Cortical Superficial Siderosis

Introduction: Cortical superficial siderosis (CSS) is a neuroimaging biomarker of interest in intracerebral hemorrhage (ICH) and represents hemosiderin deposition in the supratentorial sulci. CSS increases risk for recurrent ICH and is associated with cognitive impairment, but the long-term outcomes of ICH patients with CSS are unknown. We sought to characterize the long-term case-fatality of ICH patients with CSS. Methods: We performed a retrospective convenience study of primary ICH patients who underwent MRI during the index admission. We evaluated each hemisphere for presence of CSS, as well as other SVD markers, and performed Kaplan-Meier analysis to compare the survival curves of those with and without CSS. Vital status was ascertained via chart review and a National Death Index query when necessary. Results: Of 121 patients who underwent an MRI in our cohort, 95 had usable GRE or SWI sequences. Overall CSS prevalence was 11.6% (11/95): 18.2% (10/55) in lobar ICH and 2.5% (1/40) in deep ICH. Univariate predictors of CSS presence included older age (75.6 vs. 63.8, p=.01), larger hematoma volume (10.5mL vs. 4.6, p=.02), and prior ICH (54.5% vs. 10.7%, p=.002). There were no differences between the groups in MBs, EPVS, WMD scores, or DWI lesions. Patients with CSS had a significantly different survival history than those without CSS (log-rank p=.034). Twenty-five percent of the patients with CSS died by 4.4 months after index admission, compared with 45.1 months for those without CSS. The risk of death for the patients with CSS was 2.6 times (95% CI: 1.06-6.41) higher than those without. Four of 11 (36.4%) CSS patients lived at least 4 years after index ICH. Conclusions: Characterization of CSS in ICH patients may improve disease subtyping and clinical trial design. Future studies with larger and more generalizable cohorts are needed to assess how CSS focality vs. dissemination affects case-fatality and whether CSS is an independent predictor of case-fatality.

Determinants of enhanced vulnerability to Covid-19 in U.K. cancer patients: Results from the OnCovid study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1574-1574
Author(s):  
David James Pinato ◽  
Lorenza Scotti ◽  
Alessandra Gennari ◽  
Emeline Colomba ◽  
Ailsa Sita-Lumsden ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Cox Regression ◽  
Risk Mitigation ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Risk Groups ◽  
Risk Of Death ◽  
Anti Cancer ◽  
The Uk

1574 Background: Despite high contagiousness and rapid spread, SARS-Cov-2 has led to heterogeneous outcomes across affected nations. Within Europe, the United Kingdom is the most severely affected country, with a death toll in excess of 100.000 as of February 2021. We aimed to compare the national impact of Covid-19 on the risk of death in UK cancer patients versus those in continental Europe (EU). Methods: We performed a retrospective analysis of the OnCovid study database, a European registry of cancer patients consecutively diagnosed with Covid-19 in 27 centres from February 27 to September 10, 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline, oncological and Covid-19 specific therapy across cohorts and tested these in multivariable Cox regression models to identify predictors of adverse outcome in UK versus EU patients. Results: Compared to EU patients (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001), higher risk of death at 30 days (hazard ratio, HR 1.64 [95%CI 1.36-1.99]) and 6 months after Covid-19 diagnosis (47.64% versus 33.33%, p < 0.0001, HR 1.59 [95%CI 1.33-1.88]). UK patients were more often males, of older age and more co-morbid than EU counterparts (p < 0.01). Receipt of anti-cancer therapy was lower in UK versus EU patients (p < 0.001). Despite equal proportions of complicated Covid-19, rates of intensive care admission and use of mechanical ventilation, UK cancer patients were less likely to receive anti-Covid-19 therapies including corticosteroids, anti-virals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of patient’s age, gender, tumour stage and status, number of co-morbidities, Covid-19 severity, receipt of anti-cancer and anti-Covid-19 therapy. Rates of permanent cessation of anti-cancer therapy post Covid-19 were similar in UK versus EU. Conclusions: UK cancer patients have been more severely impacted by the unfolding of the Covid-19 pandemic despite societal risk mitigation factors and rapid deferral of anti-cancer therapy. The increased frailty of UK cancer patients highlights high-risk groups that should be prioritised for anti-SARS-Cov-2 vaccination. Continued evaluation of long-term outcomes is warranted.

International Subarachnoid Trial in the Long Run

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1166-1169 ◽  
Author(s):  
Daniel M. S. Raper ◽  
Rodney Allan
Keyword(s):  
Intracranial Aneurysms ◽  
Randomized Study ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Long Run ◽  
Long Term Follow Up ◽  
Neurosurgical Treatment ◽  
Methodological Problems ◽  
Ruptured Intracranial Aneurysms

Abstract The International Subarachnoid Trial (ISAT), the largest prospective randomized study into endovascular and neurosurgical treatment of ruptured intracranial aneurysms, recently reported long-term follow-up in The Lancet Neurology. In this cohort, the risk of death at 5 years was significantly lower in the coiled group, but the proportion of survivors who were independent was not statistically different between the groups, and rebleeding was higher in the coiled group. This article critically evaluates the long-term ISAT data from an evidence-based perspective and places it in the context of the overall approach to treatment of ruptured intracranial aneurysms. ISAT has been a strong driver of change in the management of ruptured aneurysms. Nevertheless, the evidence for the superiority in coiling in the long term should not be assumed from ISAT data alone. Potential biases of patient characteristics and national referral patterns, as well as the methodological problems already described from the original trial, contribute to the difficulty in interpreting differences in long-term outcomes. These new data should be regarded as Level 2b evidence, suitable for treatment recommendations but not guidelines.

scholarly journals Emergency room comprehensive assessment of demographic, radiological, laboratory and clinical data of patients with COVID-19: determination of its prognostic value for in-hospital mortality

2021 ◽  
Author(s):  
Marco Gatti ◽  
Marco Calandri ◽  
Andrea Biondo ◽  
Carlotta Geninatti ◽  
Clara Piatti ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Emergency Room ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Binary Logistic Regression ◽  
Integrated Approach ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Risk Of Death

AbstractMortality risk in COVID-19 patients is determined by several factors. The aim of our study was to adopt an integrated approach based on clinical, laboratory and chest x-ray (CXR) findings collected at the patient’s admission to Emergency Room (ER) to identify prognostic factors. Retrospective study on 346 consecutive patients admitted to the ER of two North-Western Italy hospitals between March 9 and April 10, 2020 with clinical suspicion of COVID-19 confirmed by reverse transcriptase-polymerase reaction chain test (RT-PCR), CXR performed within 24 h (analyzed with two different scores) and recorded prognosis. Clinical and laboratory data were collected. Statistical analysis on the features of 83 in-hospital dead vs 263 recovered patients was performed with univariate (uBLR), multivariate binary logistic regression (mBLR) and ROC curve analysis. uBLR identified significant differences for several variables, most of them intertwined by multiple correlations. mBLR recognized as significant independent predictors for in-hospital mortality age > 75 years, C-reactive protein (CRP) > 60 mg/L, PaO2/FiO2 ratio (P/F) < 250 and CXR “Brixia score” > 7. Among the patients with at least two predictors, the in-hospital mortality rate was 58% against 6% for others [p < 0.0001; RR = 7.6 (4.4–13)]. Patients over 75 years had three other predictors in 35% cases against 10% for others [p < 0.0001, RR = 3.5 (1.9–6.4)]. The greatest risk of death from COVID-19 was age above 75 years, worsened by elevated CRP and CXR score and reduced P/F. Prompt determination of these data at admission to the emergency department could improve COVID-19 pretreatment risk stratification.

scholarly journals Canine Tick-Borne Encephalitis: Clinical Features, Survival Rate and Neurological Sequelae: A Retrospective Study of 54 Cases (1999–2016)

2021 ◽  
Vol 8 ◽  
Author(s):  
Christina Kleeb ◽  
Lorenzo Golini ◽  
Katrin Beckmann ◽  
Paul Torgerson ◽  
Frank Steffen
Keyword(s):  
Survival Rate ◽  
Clinical Signs ◽  
Case Fatality ◽  
Clinical Aspects ◽  
Fatality Rate ◽  
Long Term Outcome ◽  
Neurological Sequelae ◽  
Risk Of Death ◽  
Tick Borne Encephalitis

Tick-borne encephalitis (TBE) is one of the most important infectious diseases of the central nervous system in dogs from endemic areas. While in humans survival rate and long-term outcomes are well described, these data are lacking in veterinary literature. The aim of the present paper is to characterize the clinical aspects of TBE and to investigate fatality rate, long-term outcome and the long-term neurological sequelae in a population of dogs infected with TBE. We performed a retrospective analysis of 54 dogs diagnosed with TBE at the veterinary hospital of the University of Zurich between 1999 and 2016. Medical data such as signalment, clinical presentation, results of diagnostic procedures, treatment and outcome were collected and analyzed. Statistical analysis including a cox proportional hazard model using a backward stepwise regression approach was performed. In 62% of the TBE cases unspecific signs were described before the onset of neurological signs, resembling a biphasic appearance that is well known in human TBE. Case fatality rate was 33% and all dogs died within the first 4 months after diagnosis. Long-term neurological sequalae were detected in 17% of the TBE cases. For each day of clinical signs before hospital entry the odds of sequalae increased by a factor of 1.88 (CI 1.04–3.15). Older dogs and dogs presented with seizure activity had an increased hazard risk of death (Hazard ration = 1.2, p = 0.03; and 9.38, p = 0.001, respectively). In conclusion, despite TBE being a life-threatening disease with severe clinical signs, the survival rate in our study was 67%. However, long-term sequalae can be of concern especially in dogs with longer clinical course.

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