scholarly journals 387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
Kok Hoe Chan ◽  
Bhavik Patel ◽  
Iyad Farouji ◽  
Addi Suleiman ◽  
Jihad Slim
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prognostic Markers ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Significant Difference ◽  
New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

scholarly journals 60. New Prognostic Markers for COVID-19 Disease

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S161-S162
Author(s):  
Amr Ramahi ◽  
Kok Hoe Chan ◽  
Laxminarayan Prabhakar ◽  
Iyad Farouji ◽  
Divya Thimmareddygari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Prognostic Markers ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Prognostic Indicators ◽  
Blood Profile ◽  
New Model ◽  
D Dimer

Abstract Background A few COVID-19 related retrospective studies have established that older age, elevated neutrophil-lymphocyte ratio (NLR), and decreased lymphocyte-CRP ratio (LCR) were associated with worse outcome. Herein, we aim to identify new prognostic markers associated with mortality. Methods We conducted a retrospective hospital cohort study on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Study individuals were recruited if they had a complete CBC profile and inflammatory markers such as CRP, ferritin, D-dimer and LDH, as well as a well-defined clinical outcomes (discharged alive or expired). Demographic, clinical and laboratory data were reviewed and retrieved. Univariate and multivariate logistic regression methods were employed to identify prognostic markers associated with mortality. Results Out of the 344 confirmed COVID-19 hospitalized patients during the study period, 31 who did not have a complete blood profile were excluded; 303 patients were included in the study, 89 (29%) expired, and 214 (71%) were discharged alive. Demographic analysis was tabulated in Table 1. The univariate analysis showed a significant association of death with absolute neutrophil count (ANC, p=0.022), NLR (p=002), neutrophil-monocyte ratio (NMR, p=< 0.0001), LCR (p=0.007), lymphocyte-LDH ratio (LLR, p=< 0.0001), lymphocyte-D-dimer ratio (LDR, p=< 0.0001), lymphocyte-ferritin ratio (LFR, p=< 0.0001), and platelets (p=0.037) with mortality. With multivariable logistic regression analysis, the only values that had an odds of survival were high LDR (odds ratio [OR] 1.763; 95% confidence interval [CI], 1.20–2.69), and a high LFR (OR 1.136, CI 1.01–1.34). We further build up a model which can predict >85% mortality in our cohorts with the utilization of D-dimer (>500 ng/ml), Ferritin (>200 ng/ml), LDR (< 1.6), LFR (< 4) and ANC (>2.5). This new model has a ROC of 0.68 (p< 0.0001). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 suggests LDR and LFR as potential independent prognostic indicators. A new model with combination of D-dimer, Ferritin, LDR, LFR and ANC, was able to predict >85% mortality in our cohort with ROC of 0.68, it will need to be validated in a prospective cohort study. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

scholarly journals The Mortality of Older Adult Inpatients with Kidney Cancer during the Pandemic: A Retrospective Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1058-1058
Author(s):  
Kendall Brune ◽  
Cheng Yin ◽  
Rongfang Zhan ◽  
Liam O'Neill
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Kidney Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Binary Logistic Regression ◽  
Older Age ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Significant Difference

Abstract Background Elderly patients are a vulnerable group during the Covid-19 pandemic, especially those with cancer. Our study aims to identify how Covid-19 impacts elderly inpatients with kidney cancer and determine risk factors associated with increased mortality. Methods Our retrospective cohort study utilized the PUDF dataset and included inpatients over 60-year-old, diagnosed with kidney cancer, and hospitalized within 30-day. Person’s Chi-Square was used to measure the differences between survivors and non-survivors, and the Mann-Whitney test was for non-normality distribution for continuous variables. Then, a binary logistic regression was employed to identify the association between independent variables and mortality. Results Five hundred and twenty-two patients were included in the study, of which 7 (1.4%) died during hospitalization. According to the univariate analysis and Mann-Whitney test, expired patients were more likely to experience older age (p = 0.005), longer length of stay (p = 0.009), ICU (p = 0.012), HMO Medicare Risk (p = 0.005), Covid-19 (p < 0.001), paralysis (p < 0.001), and higher illness severity (p < 0.001). The binary logistic regression revealed that older age (OR = 1.120, 95% CI: 1.004-1.249, p = 0.042) and the SOI (OR = 4.635, 95% CI: 1.339-16.052, p = 0.016) had significantly high odds of mortality. Conclusion The retrospective cohort study reveals that although Covid-19 was not a predictive factor associated with increased mortality, there was a statistically significant difference between the survivor and non-survivor groups. Further studies need to assess its association with kidney cancer or other various types of cancer.

A Retrospective Cohort Study of Glossopharyngeal Nerve Taste in Children with Recurrent Acute Tonsillitis

2016 ◽  
Vol 156 (1) ◽  
pp. 189-193 ◽  
Author(s):  
Courtney A. Hill ◽  
Suveera Dang ◽  
Michael Beach ◽  
Eunice Y. Chen
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Healthy Children ◽  
Acute Tonsillitis ◽  
Insurance Type ◽  
Significant Difference

Objective To compare glossopharyngeal taste between healthy children and those with recurrent acute tonsillitis. Study Design Retrospective cohort study. Setting Pediatric clinics in a tertiary care medical center and satellite location. Subjects and Methods Smell and taste testing was administered to 80 well children and 64 children with recurrent acute tonsillitis (age range, 6-17 years). Smell testing was performed with the NIH Toolbox Odor Identification Test, with scores based on national averages for age and sex. Validated Taste Strips were placed on the midline of the tongue at the circumvallate papillae in random tastant order and in increasing concentrations to test sweet, salty, sour, and bitter. Ordinal logistic regression was used for multivariate analysis. Results The healthy and tonsillitis groups were similar, with mean ages of 11.3 and 10.8 years ( P = .34), respectively. The tonsillitis group had fewer boys (n = 18 vs 43, P = .002), higher mean body mass index (BMI) percentile (n = 72.2 vs 59.8, P = .01), and more subjects with public or no insurance (n = 24 vs 13, P = .004). Univariate analysis revealed no statistically significant differences in rate of normal overall taste (67.2% vs 60%, P = .39) and in sweet (79.7% vs 82.5%, P = .67), salty (85.9% vs 82.8%, P = .82), sour (64.1% vs 70%, P = .48), and bitter (90.6% vs 86.3%, P = .45). In multivariate analysis, smell ability, sex, BMI percentile, parent BMI, and insurance type did not affect overall taste or sweet, salty, sour, or bitter alone. Conclusion Despite controlling for potential intrinsic (sex, smell, BMI) and extrinsic (parent BMI, insurance type) confounders, there was no statistically significant difference in taste among children with recurrent acute tonsillitis as compared with healthy children.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
L. L. Li ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

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