High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit

Abstract Background We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n=91) or critical (66%, n=315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P=.011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91–0.95; P<.001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00–1.02; P=.042). The risk of death was 1.4-fold higher in female participants compared with their male counterparts (hazards ratio, 1.4; 95% CI, 1.0–2.0; P=.025). Conclusions In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.

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The elderly age criterion for increased in-hospital mortality in trauma patients: a retrospective cohort study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00950-x ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Ji Hwan Lee ◽

Min Joung Kim ◽

Ju Young Hong ◽

Jinwoo Myung ◽

Yun Ho Roh ◽

...

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Hospital Mortality ◽

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

The Elderly ◽

Trauma Patients ◽

Elderly Age ◽

Traumatic Injuries

Abstract Background With an aging population, the number of elderly individuals exposed to traumatic injuries is increasing. The elderly age criterion for traumatic injuries has been inconsistent in the literature. This study aimed at specifying the elderly age criterion when the traumatic mortality rate increases. Methods This is a multicenter retrospective cohort study that was conducted utilizing the data from the Emergency Department-based Injury In-depth Surveillance Registry of the Korea Disease Control and Prevention Agency, collected between January 2014 and December 2018 from 23 emergency departments. The outcome variable was in-hospital mortality. Multivariable logistic regression analysis was used to calculate the adjusted mortality rate for each age group. By using the shape-restricted regression splines method, the relationship between age and adjusted traumatic mortality was plotted and the point where the gradient of the graph had the greatest variation was calculated. Results A total of 637,491 adult trauma patients were included. The number of in-hospital deaths was 6504 (1.0%). The age at which mortality increased the most was 65.06 years old. The adjusted odds ratio for the in-hospital mortality rate with age in the ≤ 64-year-old subgroup was 1.038 (95% confidence interval (CI) 1.032–1.044) and in the ≥ 65-year-old subgroup was 1.059 (95% CI 1.050–1.068). The adjusted odds ratio for in-hospital mortality in the ≥ 65-year-old compared to the ≤ 64-year-old subgroup was 4.585 (95% CI 4.158–5.055, p < 0.001). Conclusions This study found that the in-hospital mortality rate rose with increasing age and that the increase was the most rapid from the age of 65 years. We propose to define the elderly age criterion for traumatic injuries as ≥ 65 years of age.

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An Analysis of Dental Implants Survival and Success

Revista de Chimie ◽

10.37358/rc.18.9.6554 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2465-2466

Author(s):

Iustin Olariu ◽

Roxana Radu ◽

Teodora Olariu ◽

Andrada Christine Serafim ◽

Ramona Amina Popovici ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Medical History ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Demographic Data ◽

Kaplan Meier ◽

Number Of Patients ◽

Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Outcomes of Neutropenic Patients with Clostridium difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.950 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s339-s340

Author(s):

Roopali Sharma ◽

Deepali Dixit ◽

Sherin Pathickal ◽

Jenny Park ◽

Bernice Lee ◽

...

Keyword(s):

Clostridium Difficile ◽

Length Of Stay ◽

Hospital Mortality ◽

Treatment Failure ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hospital Length ◽

Hospital Length Of Stay ◽

End Point ◽

Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

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P1529MORTALITY PREDICTORS IN INCIDENT HEMODIALYSIS PATIENTS - HAVE HEY CHANGED IN TEN YEARS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1529 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Cátia Raquel Figueiredo ◽

Rachele Escoli ◽

Hernâni Gonçalves ◽

Karina Lopes ◽

Flora Sofia ◽

...

Keyword(s):

Elderly Patients ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Demographic Data ◽

Venous Catheter ◽

Early Mortality ◽

Risk Of Death ◽

Cardiovascular Comorbidities ◽

Causes Of Mortality ◽

Mortality Predictors

Abstract Background and Aims In the last years there has been an increase in elderly patients with multiple comorbidities inducing hemodialysis (HD). Since dialysis treatment itself may be associated with a further deterioration in functional status, nephrologists are increasingly careful in selecting these patients for HD. Concerned with this reality we tried to understood if early mortality predictors (in the first 6 months) in incident HD patients have changed in almost 10 years, in the same hospital HD unit. Method This is a retrospective observational study of incident HD patients between 01 January 2017 and 30 June 2019. We evaluated similar clinical, analytical and demographic data to those used to predict mortality in the same HD unit from 1 January 2010 to 30 September 2014. Logistic regression analysis was used to evaluate 6 month mortality predictors. Statistical analysis was performed using SPSS version 25 for Windows. Results The average age of 163 incident HD patients were 70.63±3.9 years (similar to the previous population: n= 235; 70.7 ± 14.9 years) and 57.1% were male. During this study we observed 26 (16%) deaths, 12 of which (46.15%) occurred in the first 6 months of hemodialysis. Pneumonia and cachexia were the major causes of mortality, unlike the previous population, in which majority of deaths were attributed to cardiovascular events. Between January 2010 to 30 September 2014 the strongest predictors of early mortality were dementia [adjusted odds ratio (OR) 15.94 (CI: 4.09–62.10)], central venous catheter use [(OR) 12.29; (CI: 3.54-42.65)], cancer [(OR) 4.64 (CI: 1.48-14.54)] and heart failure [(OR) 3.57 (CI: 1.08-11.75)]. Differently, in this study, the institutionalization and the presence of metastases were the predictors that showed a higher risk of death [p=0.005; adjusted odds ratio [(OR) 10.4 (CI: 2.017–49.9) and p=0.01; (OR): 14.9 (CI: 1.89-42), respectively]. Longer hospitalizations at the time of HD induction [(p=0.044; (OR):1.103; CI: 1.003-1.213)] and albumin values <2.5 mg/dL [(p=0.03; (OR): 3.8 (CI: 1.14-13)] were also strong mortality predictors. which were not previously observed. Conclusion Nowadays, nephrologists are less liberal in initiating dialysis to elderly patients with dementia and cardiovascular comorbidities. However, the population is getting older and our recent mortality predictors may reflect the aging of chronic kidney disease patients, who have multiple comorbidities as cachexia, requiring institutionalization and longer hospitalizations. It is increasingly important to evaluate patients prior to dialysis initiation, so our goal is to create an adjusted mortality score in our HD unit to help make the decision about inducing or not HD in our patients.

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Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up

BMJ Open ◽

10.1136/bmjopen-2020-038302 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038302

Author(s):

Tao Tian ◽

Changdong Guan ◽

Lijian Gao ◽

Lei Song ◽

Jiansong Yuan ◽

...

Keyword(s):

Cohort Study ◽

Primary Endpoint ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Chronic Total Occlusion ◽

Secondary Outcome ◽

Total Occlusion ◽

Risk Of Death ◽

Kaplan Meier

ObjectivesThis study sought to investigate the relationship between occlusion length and long-term outcomes of patients with recanalised chronic total occlusion (CTO) lesion.DesignA retrospective cohort study.SettingFuwai Hospital, National Center for Cardiovascular Disease, Beijing, ChinaParticipantsConsecutive patients with successfully recanalised CTO were included from January 2010 to December 2013.Primary and secondary outcome measuresThe primary endpoint of the present study was a composite event of all-cause death and myocardial infarction (MI). The secondary endpoints included target lesion revascularisation (TLR) and target vessel revascularisation (TVR).ResultsA total of 1987 patients were included and 1801 (90.6%) subjects completed 5-year follow-up in this study. Based on occlusion length, the patients were divided equally into two groups: short (length <15 mm, n=957) and long (length ≥15 mm, n=1030) CTO group. Kaplan-Meier survival curve showed no significant difference in the risk of the composite primary endpoint between short and long CTO groups (p=0.242). Receiver operating characteristic curve analysis also established occlusion length ≥15 mm as a cut-off value for predicting TLR and TVR, with an area under the curve of 0.604 (95% CI: 0.569 to 0.638, p<0.001) and 0.605 (95% CI: 0.572 to 0.638; p<0.001). Kaplan-Meier analysis revealed that the risks for TLR (p=0.002) and TVR (p=0.002) were higher in a patient with long CTO lesion. Multivariate Cox analysis also identified long CTO lesion as an independent predictor of TLR (HR: 1.539, 95% CI: 1.033 to 2.293; p=0.034) and TVR (HR: 1.476, 95% CI: 1.012 to 2.151; p=0.043).ConclusionPatients with long CTO lesion did not show a higher risk of death and MI after recanalisation, but had higher risks of TLR and TVR. Lesion with occlusion length ≥15 mm should be under close surveillance for restenosis after recanalisation.

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Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes

American Journal of Perinatology Reports ◽

10.1055/s-0038-1649486 ◽

2018 ◽

Vol 08 (02) ◽

pp. e89-e94 ◽

Cited By ~ 1

Author(s):

Tetsuya Kawakita ◽

Chun-Chih Huang ◽

Helain Landy

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

Cervical Dilation ◽

Cord Prolapse ◽

Umbilical Cord Prolapse ◽

Singleton Pregnancies

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

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Prolonged Colonization with the Methicillin-Resistant Staphylococcus aureus Strain USA300 among Residents of Extended Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/655015 ◽

2010 ◽

Vol 31 (8) ◽

pp. 838-841 ◽

Cited By ~ 2

Author(s):

Simone M. Shurland ◽

O. Colin Stine ◽

Richard A. Venezia ◽

Jennifer K. Johnson ◽

Min Zhan ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

Methicillin Resistant Staphylococcus Aureus ◽

Aureus Strain ◽

Methicillin Resistant ◽

Extended Care ◽

Care Facilities ◽

Mrsa Strains

We performed a retrospective cohort study (n = 129) to assess whether residents of extended care facilities who were initially colonized or infected with the methicillin-resistant Staphylococcus aureus (MRSA) strain USA300 were less likely to have prolonged colonization than were residents colonized or infected with other MRSA strains. We found no difference in prolonged colonization (adjusted odds ratio, 1.1 [95% confidence interval, 0.5–2.4]).

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The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

10.21203/rs.3.rs-15794/v1 ◽

2020 ◽

Author(s):

Magali Bisbal ◽

Michael Darmon ◽

Colombe Saillard ◽

Vincent Mallet ◽

Charlotte Mouliade ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Cancer Progression ◽

Critically Ill Patients ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hematological Malignancies ◽

Severity Of Illness ◽

Rank Test ◽

Total Serum

Abstract BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

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Clinical Relevance of Impaired Consciousness in Accidental Hypothermia: A Japanese Multicenter Retrospective Study

10.21203/rs.3.rs-102317/v1 ◽

2020 ◽

Author(s):

Masahiro Fukuda ◽

Masahiro NOZAWA ◽

Yohei OKADA ◽

Sachiko MORITA ◽

Naoki EHARA ◽

...

Keyword(s):

Hospital Mortality ◽

Likelihood Ratio ◽

Clinical Relevance ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Accidental Hypothermia ◽

Impaired Consciousness ◽

Severe Hypothermia ◽

Level Of Consciousness ◽

The Relationship

Abstract Background: Severe accidental hypothermia (AH) is a life-threatening condition, and early identification can enable transport to an appropriate medical facility. The Swiss staging model has been used to classify patients with AH, but little is known regarding the relationship between the degree of impaired consciousness and core body temperature (BT) in AH. This study aimed to clarify the relationship between the level of consciousness and core BT and determine whether the level of consciousness could be used to predict severe hypothermia and in-hospital mortality among patients with AH.Methods: We retrospectively investigated the clinical relevance of impaired consciousness in AH. We included adult patients with AH and excluded patients with out-of-hospital cardiac arrest. The patients were identified from the J-point registry, which contains information regarding patients treated for AH between April 1, 2011 and March 31, 2016 in any of the 12 participating institutions in Japan. The primary exposure of interest was the level of consciousness at hospital arrival. Odds ratios were calculated for severe hypothermia and in-hospital mortality.Results: Overall, 505 of the 572 patients in the registry were included. Compared to mildly impaired consciousness, the adjusted odds ratio for severe hypothermia was 3.3 (95% confidence interval [CI]: 1.7–6.3) for moderately impaired consciousness and 4.7 (95% CI: 2.4–9.1) for severely impaired consciousness. Severely impaired consciousness as a predictor severe hypothermia had a sensitivity of 0.44 (95% CI: 0.34–0.54), specificity of 0.78 (95% CI: 0.74–0.82), positive likelihood ratio of 2.04, and negative likelihood ratio of 0.71. Compared to mildly impaired consciousness, the adjusted odds ratio for in-hospital mortality was 1.7 (95% CI: 0.95–2.9) for moderately impaired consciousness and 2.1 (95% CI: 1.2–3.8) for severely impaired consciousness.Conclusions: Severely impaired consciousness was a reliable predictor of severe hypothermia and in-hospital mortality in patients with AH. Thus, in an urban out-of-hospital emergency setting, the level of impaired consciousness may be helpful for triaging patients to the appropriate hospital.

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