scholarly journals 436. U-shaped-aggressiveness of SARS-CoV-2: Period Between Initial Symptoms and Clinical Progression to COVID-19 Suspicion. A Population-Based Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S319-S320
Author(s):  
Bruno G Buitano ◽  
Dan Morgenstern ◽  
Juan Talavera ◽  
Andrea Zaldívar ◽  
Mercedes Martínez
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Population Based ◽  
Medical Attention ◽  
P Value ◽  
Clinical Progression ◽  
Adjusted Risk ◽  
Epidemiologic Surveillance ◽  
Risk Of Mortality ◽  
Initial Symptoms

Abstract Background Until now, studies have been focused on patient-centered risk factors, while SARS-CoV-2 aggressiveness has been established as causing 20% of severe and critical patients. However, there are still many unanswered questions concerning the clinical aggressiveness behavior of SARS-CoV-2. This study focuses on progression of symptoms as a marker of such aggressiveness, using the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) to determine the risk of severe disease and mortality. Methods Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting: Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants were subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia) Results 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in < 24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% > 7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in < 24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% > 7 days, respectively (p< 0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): < 24 hours = 1.75 [1.55–1.98], p< 0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p< 0.001; > 7 days = 1.67 [1.44–1.94], p< 0.001. For pneumonia: < 24 hours = 1.49 [1.39–1.58], p< 0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p< 0.001; > 7 days = 1.57 [1.46–1.69], p< 0.001. Risk of Mortality vs. PISYCS Logistic regression anlaysis of mortality based on PISYCS. Note that risk of mortality is significantly higher when PISYCS is > 24 hours and < 7 days Risk of Pneumonia vs. PISYCS Logistic regression anlaysis of developing pneumonia based on PISYCS. Note that risk of pneumonia is significantly higher when PISYCS is > 24 hours and < 7 days. Conclusion The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings and possibly justify use of PISYCS as an initial evaluation tool and therapies/monitoring in high-risk patients. Disclosures All Authors: No reported disclosures

scholarly journals U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243268
Author(s):  
Dan Morgenstern-Kaplan ◽  
Bruno Buitano-Tang ◽  
Mercedes Martínez-Gil ◽  
Andrea Zaldívar-Pérez Pavón ◽  
Juan O. Talavera
Keyword(s):  
Cohort Study ◽  
Management Strategies ◽  
Reference Value ◽  
Population Based ◽  
Medical Attention ◽  
P Value ◽  
Clinical Progression ◽  
Adjusted Risk ◽  
Epidemiologic Surveillance ◽  
Initial Symptoms

Background Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. Objective To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients. Design Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants Subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. Measurements We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia). Results 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55–1.98], p<0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p<0.001; >7 days = 1.67 [1.44–1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39–1.58], p<0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p<0.001; >7 days = 1.57 [1.46–1.69], p<0.001. Limitations Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. Conclusion The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.

scholarly journals U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study

2020 ◽  
Author(s):  
Dan Morgenstern-Kaplan ◽  
Bruno Buitano-Tang ◽  
Mercedes Martínez-Gil ◽  
Andrea Zaldívar-Pérez Pavón ◽  
Juan O. Talavera
Keyword(s):  
Cohort Study ◽  
Management Strategies ◽  
Reference Value ◽  
Population Based ◽  
Medical Attention ◽  
P Value ◽  
Clinical Progression ◽  
Adjusted Risk ◽  
Epidemiologic Surveillance ◽  
Initial Symptoms

AbstractBackgroundEarly identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies.ObjectiveTo determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients.DesignHistoric cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry.SettingPopulation-based. Patients registered in the Epidemiologic Surveillance System in Mexico.ParticipantsSubjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2.MeasurementsWe measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia).Results65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1-3 days, 31.87% between 4-7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1-3 days, 3.6% and 19.5% between 4-7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours= 1.75 [1.55-1.98], p<0.001; 1-3 days= 1 (reference value); 4-7 days= 1.53 [1.37-1.70], p<0.001; >7 days= 1.67 [1.44-1.94], p<0.001. For pneumonia: <24 hours= 1.49 [1.39-1.58], p<0.001; 1-3 days= 1; 4-7 days= 1.48 [1.41-1.56], p<0.001; >7 days= 1.57 [1.46-1.69], p<0.001.LimitationsUsing a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies.ConclusionThe PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.

scholarly journals Full title: COVID-19 disease progression according to initial symptoms. A telemedicine cohort study.

2022 ◽  
Author(s):  
Karla Murillo-Villanueva ◽  
Blanca Velazquez-Hernandez ◽  
Jose A Jacome-Mondragon ◽  
Judit J Cervantes-Llamas ◽  
Juan O Talavera
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Disease Progression ◽  
Signs And Symptoms ◽  
Medical Attention ◽  
Clinical Progression ◽  
Symptom Index ◽  
Initial Symptoms ◽  
Asymptomatic Subjects

Abstract Objective COVID-19 progression to severe or critical illness may be related to initial clinical presentation. Main objective was to identify initial symptoms related to highest risk of disease progression, in mild or moderate suspected or confirmed COVID-19 patients or in asymptomatic subjects in contact with a recently diagnosed patient. Design and methods Historic cohort study of Mexican patients with suspected or confirmed mild or moderate COVID-19 or asymptomatic subjects in recent contact with positive patients. They sought medical attention in Centro Medico ABC or claimed for remote attention, and daily telemedicine follow up until recovery or illness progression, from April 17th to October 08th 2020. Data excerpted for analysis were sex, age, body mass index, comorbidities, and signs, and symptoms presented in first day of disease manifestations and during follow up. We used logistic regression to identify initial symptoms associated with progression disease and through a conjunctive consolidation analysis a symptom index was created. Results 120 of 1635 patients (7.2%) had clinical progression disease. By logistic regression we found as initial symptoms related to progression: fever OR 3 (1.89-4.77, p<0.001), cough OR 2.34 (1.56-3.52, p<0.001), myalgias or arthralgias OR 1.69 (1.09-2.63, p=0.018), and fatigue OR 1.65 (1.08-2.53, p=0.019). Conjunctive consolidation was processed with the previous symptoms, and a 3 groups score resulted C-19PAIS Index: 1) Fever with cough or fever with fatigue, with a probability of progression disease of 29% (31/106 patients), 2) Fever or cough or fatigue or cough with fatigue, 10.7% (66/615 patients) and 3) No fever, no cough, no fatigue, 2% (23/914). Conclusions Initial symptoms predict clinical progression in COVID-19 patients.

The Difference in Sibling Birthweight and Neonatal Death: A Population-Based Cohort Study

2018 ◽  
Vol 36 (05) ◽  
pp. 498-504
Author(s):  
Maya Tabet ◽  
Louise Flick ◽  
Hong Xian ◽  
Jen Chang
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Neonatal Death ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Growth Potential ◽  
Live Births ◽  
The Difference ◽  
Second Births ◽  
Half Sibling

Background There has been a call for customized rather than population-based birthweight standards that would classify smallness based on an infant's own growth potential. Thus, this study aimed to examine the association between the difference in sibling birthweight and the likelihood of neonatal death among second births in a U.S. population. Study Design This was a population-based cohort study including 179,300 women who delivered their first two nonanomalous singleton live births in Missouri (1989–2005). We performed binary logistic regression to evaluate the association between being relatively smaller than the elder full- or half-sibling (i.e., smaller by at least 500 g) and neonatal death (i.e., deaths in the first 28 days of life) among second births after controlling for sociodemographic and pregnancy-related variables in the second pregnancy. Results The adjusted odds of neonatal death were 2.54-times higher among second births who were relatively smaller than their elder sibling. Among relatively small second births, every 100-g increase in the difference in sibling birthweight was associated with a 13% increase in the odds of neonatal death. Conclusion The deviation from the elder sibling's birthweight predicts neonatal death. Taking into consideration the elder sibling's birthweight may be warranted in clinical and research settings.

scholarly journals Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032964
Author(s):  
Charlotte Slagelse ◽  
H Gammelager ◽  
Lene Hjerrild Iversen ◽  
Kathleen D Liu ◽  
Henrik T Toft Sørensen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Population Based ◽  
Adjusted Risk ◽  
Increased Risk ◽  
The Impact ◽  
Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

scholarly journals Variation in timely surgery for hip fracture by day and time of presentation: a nationwide prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland

2020 ◽  
pp. bmjqs-2020-011196
Author(s):  
Anjali Shah ◽  
Gulraj S Matharu ◽  
Dominic Inman ◽  
Elizabeth Fagan ◽  
Antony Johansen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Northern Ireland ◽  
Population Based ◽  
Quality Healthcare ◽  
Adjusted Risk ◽  
Hip Fracture Surgery ◽  
Average Patient ◽  
American Society ◽  
American Society Of Anesthesiologists

Background and ObjectiveSeveral studies report poorer quality healthcare for patients presenting at weekends. Our objective was to examine how timely surgery for patients with hip fracture varies with day and time of their presentation.MethodsThis population-based cohort study used 2017 data from the National Hip Fracture Database, which recorded all patients aged 60 years and over who presented with a hip fracture at a hospital in England, Wales and Northern Ireland. Provision of prompt surgery (surgery within 36 hours of presentation) was examined, using multivariable logistic regression with generalised estimating equations to derive adjusted risk ratios (RRs). Time was categorised into three 8-hour intervals (day: 08:00–15:59, evening: 16:00–23:59 and night: 00:00–07:59) for each day of the week. The model accounted for clustering by hospital and was adjusted by sex, age, fracture type, operation type, American Society of Anesthesiologists grade, preinjury mobility and location.ResultsWe studied 68 977 patients from 177 hospitals. The average patient presenting during the day on Friday or Saturday was significantly less likely to undergo prompt surgery (Friday during 08:00–15:59, RR=0.93, 95% CI 0.91 to 0.96; Saturday during 08:00–15:59, RR=0.91, 95% CI 0.88 to 0.94) than patients in the comparative category (Thursday, during the day). Patients presenting during the evening (16:00–23:59) were consistently significantly less likely to undergo prompt surgery, and the effect was more marked on Fridays and Saturdays (Friday during 16:00-23:59, RR=0.83, 95% CI 0.80 to 0.85; Saturday during 16:00–23:59, RR=0.81, 95% CI 0.78 to 0.85). Patients presenting overnight (00:00–07:59), except on Saturdays, were significantly more likely to undergo surgery within 36 hours (RR>1.07).ConclusionThe provision of prompt hip fracture surgery was complex, with evidence of both an ‘evening’ and a ‘night’ effect. Investigation of weekly variation in hip fracture care is required to help implement strategies to reduce the variation in timely surgery throughout the entire week.

scholarly journals Association of pre-existing comorbidities with mortality and disease severity among 167,500 individuals with COVID-19 in Canada: A population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258154
Author(s):  
Erjia Ge ◽  
Yanhong Li ◽  
Shishi Wu ◽  
Elisa Candido ◽  
Xiaolin Wei
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Regression Models ◽  
Age Groups ◽  
Organ Transplant ◽  
Population Based ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Risk Of Mortality

Background The novel coronavirus disease 2019 (COVID-19) has infected 1.9% of the world population by May 2, 2021. Since most previous studies that examined risk factors for mortality and severity were based on hospitalized individuals, population-based cohort studies are called for to provide evidence that can be extrapolated to the general population. Therefore, we aimed to examine the associations of comorbidities with mortality and disease severity in individuals with COVID-19 diagnosed in 2020 in Ontario, Canada. Methods and findings We conducted a retrospective cohort study of all individuals with COVID-19 in Ontario, Canada diagnosed between January 15 and December 31, 2020. Cases were linked to health administrative databases maintained in the ICES which covers all residents in Ontario. The primary outcome is all-cause 30-day mortality after the first COVID-19 diagnosis, and the secondary outcome is a composite severity index containing death and hospitalization. To examine the risk factors for the outcomes, we employed Cox proportional hazards regression models and logistic regression models to adjust for demographic, socio-economic variables and comorbidities. Results were also stratified by age groups. A total of 167,500 individuals were diagnosed of COVID-19 in 2020 and included in the study. About half (43.8%, n = 73,378) had at least one comorbidity. The median follow-up period were 30 days. The most common comorbidities were hypertension (24%, n = 40,154), asthma (16%, n = 26,814), and diabetes (14.7%, n = 24,662). Individuals with comorbidity had higher risk of mortality compared to those without (HR = 2.80, 95%CI 2.35–3.34; p<0.001), and the risk substantially was elevated from 2.14 (95%CI 1.76–2.60) to 4.81 (95%CI 3.95–5.85) times as the number of comorbidities increased from one to five or more. Significant predictors for mortality included comorbidities such as solid organ transplant (HR = 3.06, 95%CI 2.03–4.63; p<0.001), dementia (HR = 1.46, 95%CI 1.35–1.58; p<0.001), chronic kidney disease (HR = 1.45, 95%CI 1.34–1.57; p<0.001), severe mental illness (HR = 1.42, 95%CI%, 1.12–1.80; p<0.001), cardiovascular disease (CVD) (HR = 1.22, 95%CI, 1.15–1.30), diabetes (HR = 1.19, 95%, 1.12–1.26; p<0.001), chronic obstructive pulmonary disease (COPD) (HR = 1.19, 95%CI 1.12–1.26; p<0.001), cancer (HR = 1.17, 95%CI, 1.09–1.27; p<0.001), hypertension (HR = 1.16, 95%CI, 1.07–1.26; p<0.001). Compared to their effect in older age groups, comorbidities were associated with higher risk of mortality and severity in individuals under 50 years old. Individuals with five or more comorbidities in the below 50 years age group had 395.44 (95%CI, 57.93–2699.44, p<0.001) times higher risk of mortality compared to those without. Limitations include that data were collected during 2020 when the new variants of concern were not predominant, and that the ICES databases do not contain detailed individual-level socioeconomic and racial variables. Conclusion We found that solid organ transplant, dementia, chronic kidney disease, severe mental illness, CVD, hypertension, COPD, cancer, diabetes, rheumatoid arthritis, HIV, and asthma were associated with mortality or severity. Our study highlights that the number of comorbidities was a strong risk factor for deaths and severe outcomes among younger individuals with COVID-19. Our findings suggest that in addition of prioritizing by age, vaccination priority groups should also include younger population with multiple comorbidities.

scholarly journals Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Seo Young Sohn ◽  
Gi Hyeon Seo ◽  
Jae Hoon Chung
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Population Based ◽  
Overt Hypothyroidism ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Korean National Health Insurance ◽  
Hypothyroid Patients

BackgroundAlthough hypothyroidism is associated with various comorbidities, its relationship with increased all-cause mortality remains controversial. The aim of this nationwide retrospective cohort study was to investigate whether hypothyroid patients treated with levothyroxine had increased mortality compared to controls.MethodsHypothyroid subjects were identified through the Korean National Health Insurance Service Claims database between 2008 and 2017. Hypothyroidism in this study was defined as overt hypothyroidism treated with long-term prescription of levothyroxine (&gt;6 months). After 1:3 age-, sex- and index year-matching, 501,882 patients with newly diagnosed hypothyroidism and 1,505,646 controls without hypothyroidism were included.ResultsDuring a mean follow-up of 6 years, 25,954 (5.2%) hypothyroid patients and 59,105 (3.9%) controls died. Hypothyroidism was significantly associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI] 1.12–1.16) even with levothyroxine treatment. When stratified by age, sex, and cardiovascular disease risk, independent associations between hypothyroidism and mortality remained significant in all subgroups. The risk of mortality was higher in the &lt; 65 age group (HR: 1.25, 95% CI: 1.22–1.29), men (HR: 1.28, 95% CI: 1.25–1.31), and the high cardiovascular disease risk group (HR: 1.31, 95% CI: 1.29–1.34). The mortality rate of hypothyroid patients was highest within 1 year of treatment and decreased with time.ConclusionThis nationwide, population-based cohort study showed that all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls. This association remained significant regardless of age, sex, and cardiovascular disease risk.

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