Relationship Between Enteropathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study

Abstract Background Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. While such knowledge can be used to optimize therapy it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy. Methods We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11–20 points) vs.. non-severe (0–10 points). Results The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease. Conclusion In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII. Disclosures All authors: No reported disclosures.

Download Full-text

Underlying Disease Severity as a Major Risk Factor for Nosocomial Clostridium difficile Diarrhea

Infection Control and Hospital Epidemiology ◽

10.1086/501989 ◽

2002 ◽

Vol 23 (11) ◽

pp. 653-659 ◽

Cited By ~ 176

Author(s):

Lorraine Kyne ◽

Stavros Sougioultzis ◽

Lynne V. McFarland ◽

Ciarán P. Kelly

Keyword(s):

Cohort Study ◽

Clostridium Difficile ◽

Disease Severity ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Severe Disease ◽

Underlying Disease ◽

Hospitalized Patients ◽

Antibiotic Prescribing ◽

Predictive Values

Objective:To determine the diagnostic accuracy of an index of underlying disease severity (Horn's index) in identifying patients with a high probability of having nosocomial Clostridium difficile diarrhea as a complication of antimicrobial therapy.Design:A prospective cohort study of 252 adult patients admitted to the hospital and receiving antibiotics. Risk factors for C. difficile diarrhea were first determined retrospectively in a different cohort of 300 hospitalized patients (primary cobort) and then prospectively in this cohort of 252 hospitalized patients receiving antibiotics (secondary cohort). At the time of hospital admission, disease was rated by clinicians as mild (1), moderate (2), severe (3), or extremely severe (4) using a modified Horn's index. Multivariable logistic regression analysis was used to determine the odds ratio (OR) for C. difficile diarrhea associated with increasing levels of disease severity.Setting:An urban teaching hospital affiliated with a medical school in Boston, Massachusetts.Results:The incidence of nosocomial C. difficile diarrhea was 8.7% in the primary cohort and 11% in the secondary cohort. In the prospective cohort study (secondary cohort), the OR for C. difficile diarrhea associated with extremely severe disease was 17.6 (95% confidence interval, 5.8 to 53.5). The sensitivity, specificity, and positive and negative predictive values of a Horn's index score of 3 or more (severe to extremely severe disease) as a predictor of nosocomial C. difficile diarrhea were 79%, 73%, 27%, and 96%, respectively.Conclusions:These findings provide a means of early stratification of hospitalized patients receiving antibiotics according to their risk for nosocomial C. difficile diarrhea. Patients with severe to extremely severe disease at the time of admission may benefit from careful monitoring of antibiotic prescribing and early attention to infection control issues. In the future, these “high-risk” patients may benefit from prophylaxis studies of novel agents being developed to prevent C. difficile diarrhea.

Download Full-text

Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2018.06.016 ◽

2019 ◽

Vol 25 (4) ◽

pp. 454-461 ◽

Cited By ~ 6

Author(s):

J. Xie ◽

A. Nettel-Aguirre ◽

B.E. Lee ◽

L. Chui ◽

X.L. Pang ◽

...

Keyword(s):

Cohort Study ◽

Disease Severity ◽

Prospective Cohort Study ◽

Acute Gastroenteritis ◽

Prospective Cohort ◽

Enteric Pathogens

Download Full-text

SARS-CoV-2 viral load as a predictor for disease severity in outpatients and hospitalised patients with COVID-19: A prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0258421 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258421

Author(s):

Fredrikke Christie Knudtzen ◽

Thøger Gorm Jensen ◽

Susan Olaf Lindvig ◽

Line Dahlerup Rasmussen ◽

Lone Wulff Madsen ◽

...

Keyword(s):

Cohort Study ◽

Viral Load ◽

Hospital Admission ◽

Disease Severity ◽

Prospective Cohort Study ◽

Symptom Onset ◽

Prospective Cohort ◽

Severe Disease ◽

Adult Patients ◽

Hospitalised Patients

Introduction We aimed to examine if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) cycle quantification (Cq) value, as a surrogate for SARS-CoV-2 viral load, could predict hospitalisation and disease severity in adult patients with coronavirus disease 2019 (COVID-19). Methods We performed a prospective cohort study of adult patients with PCR positive SARS-CoV-2 airway samples including all out-patients registered at the Department of Infectious Diseases, Odense University Hospital (OUH) March 9-March 17 2020, and all hospitalised patients at OUH March 10-April 21 2020. To identify associations between Cq-values and a) hospital admission and b) a severe outcome, logistic regression analyses were used to compute odds ratios (OR) and 95% Confidence Intervals (CI), adjusting for confounding factors (aOR). Results We included 87 non-hospitalised and 82 hospitalised patients. The median baseline Cq-value was 25.5 (interquartile range 22.3–29.0). We found a significant association between increasing Cq-value and hospital-admission in univariate analysis (OR 1.11, 95% CI 1.04–1.19). However, this was due to an association between time from symptom onset to testing and Cq-values, and no association was found in the adjusted analysis (aOR 1.08, 95% CI 0.94–1.23). In hospitalised patients, a significant association between lower Cq-values and higher risk of severe disease was found (aOR 0.89, 95% CI 0.81–0.98), independent of timing of testing. Conclusions SARS-CoV-2 PCR Cq-values in outpatients correlated with time after symptom onset, but was not a predictor of hospitalisation. However, in hospitalised patients lower Cq-values were associated with higher risk of severe disease.

Download Full-text

Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (The Secondary Prevention and Compliance following Acute Myocardial Infarction-study)

BMC Cardiovascular Disorders ◽

10.1186/1471-2261-11-45 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 4

Author(s):

Lena André-Petersson ◽

Mona Schlyter ◽

Gunnar Engström ◽

Patrik Tydén ◽

Bo Hedblad

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cohort Study ◽

Secondary Prevention ◽

Disease Severity ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Personality Factors ◽

Stressful Situation

Download Full-text

Cost of Living with Parkinson’s Disease over 12 Months in Australia: A Prospective Cohort Study

Parkinson s Disease ◽

10.1155/2017/5932675 ◽

2017 ◽

Vol 2017 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Shalika Bohingamu Mudiyanselage ◽

Jennifer J. Watts ◽

Julie Abimanyi-Ochom ◽

Lisa Lane ◽

Anna T. Murphy ◽

...

Keyword(s):

Cohort Study ◽

Health System ◽

Prospective Cohort Study ◽

Resource Use ◽

Prospective Cohort ◽

Annual Cost ◽

Severe Disease ◽

Medicare Data ◽

The Mean

Background. Parkinson disease (PD) is a costly chronic condition in terms of managing both motor and nonmotor symptoms. The burden of disease is high for individuals, caregivers, and the health system. The aim of this study is to estimate the annual cost of PD from the household, health system, and societal perspectives. Methods. A prospective cohort study of newly referred people with PD to a specialist PD clinic in Melbourne, Australia. Participants completed baseline and monthly health resource use questionnaires and Medicare data were collected over 12 months. Results. 87 patients completed the 12-month follow-up assessments. The mean annual cost per person to the health care system was $32,556 AUD. The burden to society was an additional $45,000 per annum per person with PD. The largest component of health system costs were for hospitalisation (69% of total costs). The costs for people with moderate to severe disease were almost 4 times those with mild PD ($63,569 versus $17,537 p<0.001). Conclusion. PD is associated with significant costs to individuals and to society. Costs escalated with disease severity suggesting that the burden to society is likely to grow with the increasing disease prevalence that is associated with population ageing.

Download Full-text

Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal Tract

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.49.2.798-800.2005 ◽

2005 ◽

Vol 49 (2) ◽

pp. 798-800 ◽

Cited By ~ 51

Author(s):

Ebbing Lautenbach ◽

Anthony D. Harris ◽

Eli N. Perencevich ◽

Irving Nachamkin ◽

Pam Tolomeo ◽

...

Keyword(s):

Escherichia Coli ◽

Cohort Study ◽

Gastrointestinal Tract ◽

Confidence Interval ◽

Stool Sample ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rectal Swab ◽

Test Characteristics ◽

Gut Colonization

ABSTRACT Among 63 patients enrolled in a prospective cohort study of gut colonization with fluoroquinolone-resistant Escherichia coli, the sensitivity of perirectal swab compared to stool sample was 90% (95% confidence interval [CI], 70 to 99%) and the specificity was 100% (95% CI, 91 to 100%). For rectal swab, the sensitivity was 90% (95% CI, 68 to 99%) and the specificity was 100% (95% CI, 91 to 100%).

Download Full-text

Long-Term Survival After Venous Thromboembolism: A Prospective Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.749342 ◽

2021 ◽

Vol 8 ◽

Author(s):

Henning Nilius ◽

Tamara Mertins ◽

Robin Boss ◽

Matthias Knuchel ◽

Eva Blozik ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Venous Thromboembolism ◽

Disease Severity ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Anticoagulant Treatment ◽

Term Survival ◽

Cardiovascular Comorbidities

Background: Little is known about long-term survival after the initial treatment of venous thromboembolism (VTE). In a prospective cohort study, we aimed to assess the long-term mortality and key predictor variables relating to disease severity, treatment intensity, and comorbidities.Materials and Methods: Between 1988 and 2018, 6,243 consecutive patients with VTE from a University outpatient unit were prospectively included and followed until December 2019; clinical characteristics, measures of disease severity, and treatment details were recorded. Dates of death were retrieved from the Swiss Central Compensation Office.Results: Overall, 254 deaths occurred over an observation period of 57,212 patient-years. Compared to the Swiss population, the standardized mortality ratio was 1.30 (95% CI: 1.14, 1.47; overall mortality rate: 4.44 per 1,000 patient-years). The following predictors were associated with increased mortality: Unprovoked VTE (hazard ratio [HR]: 5.06; 95% CI: 3.29, 7.77), transient triggering risk factors (HR: 3.46; 95% CI: 2.18, 5.48), previous VTE (HR: 2.05; 95% CI: 1.60, 2.62), pulmonary embolism (HR: 1.45, 95% CI: 1.10, 1.89), permanent anticoagulant treatment (HR: 3.14; 95% CI: 2.40, 4.12), prolonged anticoagulant treatment (7–24 months; HR: 1.70; 95% CI: 1.16, 2.48), and cardiovascular comorbidities. Unprovoked VTE, previous VTE, permanent and prolonged anticoagulation remain independent risk factors after adjustment for age, sex, and comorbidities.Conclusion: Survival after VTE was significantly reduced compared to the Swiss general population, especially in patients with more severe disease, cardiovascular comorbidities, and longer anticoagulant treatment.

Download Full-text

Associations with covid-19 hospitalisation amongst 406,793 adults: the UK Biobank prospective cohort study

10.1101/2020.05.06.20092957 ◽

2020 ◽

Cited By ~ 8

Author(s):

Anthony P Khawaja ◽

Alasdair N Warwick ◽

Pirro G Hysi ◽

Alan Kastner ◽

Andrew Dick ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antihypertensive Medication ◽

Severe Disease ◽

Chronic Obstructive ◽

Uk Biobank ◽

Antihypertensive Medications ◽

Asian Ethnicity ◽

Increased Risk

ABSTRACTOBJECTIVESTo identify the sociodemographic, lifestyle, comorbidity and antihypertensive medication associations with the development of hospitalisation with covid-19 in an English population.DESIGNProspective cohort studySETTINGThe population-based UK Biobank study was linked to English covid-19 test results.PARTICIPANTSIndividuals resident in England and alive in 2020.MAIN OUTCOME MEASURESCases (n=605) were defined by a positive covid-19 test result conducted between 16th March and 16th April 2020, during a restricted testing policy for hospitalised individuals with severe disease.RESULTSA total of 406,793 participants were included. Mean age on 1st January 2020 was 68 years (range 48 to 85 years). 55% were women. In multivariable models, major independent risk factors for hospitalisation with covid-19 were male sex (odds ratio 1.52; 95% confidence interval 1.28 to 1.81; P<0.001), South Asian ethnicity (2.02; 1.28 to 3.17; P=0.002) or black ethnicity (3.09; 2.18 to 4.38; P<0.001) compared to white ethnicity, greater residential deprivation (1.92 for most deprived quartile compared to least deprived quartile; 1.50 to 2.47; P<0.001), higher BMI (2.04 for BMI >35 compared to <25 Kg/m2; 1.50 to 2.77; P<0.001), former smoking (1.39 compared to never smoked; 1.16 to 1.66; P<0.001), and comorbidities hypertension (1.28; 1.06 to 1.53; P=0.009) and chronic obstructive pulmonary disease (1.81; 1.34 to 2.44; P<0.001). Increased risk was observed with increasing number of antihypertensive medications used rather than any individual class.CONCLUSIONUnderstanding why these factors confer increased risk of severe covid-19 in the population may help elucidate the underlying mechanisms as well as inform strategy and policy to prevent this disease and its consequences. We found no evidence of increased risk with specific classes of antihypertensive medication.

Download Full-text