scholarly journals Clinical Characteristics and Short-Term Outcomes of Severe Patients with COVID-19 in Wuhan, China

2020 ◽  
Author(s):  
Xiaobo Feng ◽  
Peiyun Li ◽  
Liang Ma ◽  
Hang Liang ◽  
Jie Lei ◽  
...  
Keyword(s):  
Observational Study ◽  
Troponin I ◽  
Lactate Concentration ◽  
Interleukin 10 ◽  
Short Term ◽  
Term Outcome ◽  
Poor Outcome ◽  
Increased Risk ◽  
Creatine Kinase Mb ◽  
Union Hospital

AbstractObjectiveA novel pneumonia (COVID-19) which is sweeping the globe was started in December, 2019, in Wuhan, China. Most deaths occurred in severe and critically cases, but information on prognostic risk factors for severe ill patients is incomplete. Further research is urgently needed to guide clinicians, so we prospectively evaluate the clinical outcomes of 114 severe ill patients with COVID-19 for short-term in the Union Hospital in Wuhan, China.MethodsIn this single-centered, prospective and observational study, we enrolled 114 severe ill patients with confirmed COVID-19 from Jan 23, 2020 to February 22, 2020. Epidemiological, demographic and laboratory information were collected at baseline, data on treatment and outcome were collected until the day of death or discharge or for the first 28 days after severe ill diagnosis, whichever was shorter. Univariate and multivariate Cox proportional hazard models were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs) of poor outcome.ResultsAmong enrolled 114 patients, 94 (82.5%) had good outcome while 20 (17.5%) had poor outcome. No significant differences were showed in age, gender and the prevalence of coexisting disorders between outcome groups. Results of multivariate Cox analyses indicated that higher levels of oxygen saturation (HR, 0.123; 95% CI, 0.041-0.369), albumin (HR, 0.060; 95% CI, 0.008-0.460) and arterial partial pressure of oxygen (HR, 0.321; 95% CI, 0.106-0.973) were associated with decreased risk of developing poor outcome within 28 days. In the other hand, higher levels of leucocytes (HR, 5.575; 95% CI, 2.080-14.943), neutrophils (HR, 2.566; 95% CI, 1.022-6.443), total bilirubin (HR, 6.171; 95% CI, 2.458- 15.496), globulin (HR, 2.526; 95% CI, 1.027-6.211), blood urea nitrogen (HR, 5.640; 95% CI, 2.193-14.509), creatine kinase-MB (HR, 3.032; 95% CI, 1.203-7.644), lactate dehydrogenase (HR, 4.607; 95% CI, 1.057-20.090), hypersensitive cardiac troponin I (HR, 5.023; 95% CI, 1.921-13.136), lactate concentration (HR,15.721; 95% CI, 2.099-117.777), Interleukin-10 (HR, 3.551; 95% CI, 1.280-9.857) and C-reactive protein (HR, 5.275; 95% CI, 1.517-18.344) were associated with increased risk of poor outcome development. We also found that traditional Chinese medicine can significantly improve the patient’s condition, which is conducive to the transformation from severe to mild.ConclusionIn summary, we firstly reported this single-centered, prospective and observational study for short-term outcome in severe patients with COVID-19. We found that cytokine storm and uncontrolled inflammation responses, liver, kidney, cardiac dysfunction may play important roles in final outcome of severe ill patients with COVID-19. Our study will provide clinicians to be benefit to rapidly estimate the likelihood risk of short-term poor outcome for severe patients.

scholarly journals Troponin-I elevation predicts outcome after thrombolysis in ischemic stroke patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Rania S. Nageeb ◽  
Alaa A. Omran ◽  
Wafaa S. Mohamed
Keyword(s):  
Ischemic Stroke ◽  
Troponin I ◽  
Elevated Serum ◽  
Stroke Patients ◽  
Short Term ◽  
Term Outcome ◽  
Nihss Score ◽  
Poor Outcome ◽  
Short Term Outcome ◽  
Group 1

Abstract Background Prognostic significance of troponin-I (T-I) elevation for poor short-term outcome in thrombolyzed ischemic stroke patients remains uncertain. Objectives To evaluate its role as a predictive biomarker of short-term outcome in thrombolyzed ischemic stroke patients. Methods This study included 72 acute ischemic stroke patients who were treated with intravenous thrombolytic therapy. All patients were subjected to clinical assessment and measurement of serum T-I level on admission. Outcome was assessed 3 months after stroke onset using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale. Results Thirteen patients had elevated serum T-I level (group 1) and the remaining 59 were classified as group 2. Group 1 had a higher statistically significant older age, history of diabetes mellitus (DM), previous stroke, atrial fibrillation (AF), and admission NIHSS score, with significant decrease in high-density lipoprotein cholesterol (P < 0.05). Regarding the outcome of both groups, good outcome was significantly less common among group 1. Also, death was significantly more common among group I. Poor outcome in group 1 were significantly associated with older age, DM, AF, elevated serum T-I level at admission, and higher admission NIHSS score (P = 0.03, 0.04, 0.02, 0.05, and 0.001 respectively). The predictors of poor outcome in group 1 were elevated serum T-I level at admission, higher admission NIHSS score, and DM (P = 0.001, 0.02, and 0.05 respectively). Conclusion Elevated serum T-I levels on admission is a reliable prognostic predictor of poor outcome in thrombolyzed ischemic stroke patients. Trial registration ClinicalTrials.govNCT03925298 (19 April 2019) “retrospectively registered,”

scholarly journals Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

2015 ◽  
Vol 122 (5) ◽  
pp. 1087-1095 ◽  
Author(s):  
Raman Mohan Sharma ◽  
Nupur Pruthi ◽  
Arivazhagan Arimappamagan ◽  
Sampath Somanna ◽  
Bhagavathula Indira Devi ◽  
...  
Keyword(s):  
Hiv Positive ◽  
Short Term ◽  
Tubercular Meningitis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shunt Placement ◽  
Poor Outcome ◽  
Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

Two-Center Observational Study of the Accuracy of a Bayes Network for Short-Term Outcome Prediction in Cholecystectomy Patients

2013 ◽  
Vol 30 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Andrej Udelnow ◽  
Agnes Schmidt ◽  
Rainer Muche ◽  
Doris Henne-Bruns ◽  
Peter Würl ◽  
...  
Keyword(s):  
Observational Study ◽  
Outcome Prediction ◽  
Short Term ◽  
Term Outcome ◽  
Bayes Network ◽  
Short Term Outcome

scholarly journals Prognostic value of somatosensory evoked potentials, neuron-specific enolase, and S100 for short-term outcome in ischemic stroke

2016 ◽  
Vol 115 (3) ◽  
pp. 1273-1278 ◽  
Author(s):  
Walter F. Haupt ◽  
Ghesal Chopan ◽  
Jan Sobesky ◽  
Wei-Chi Liu ◽  
Christian Dohmen
Keyword(s):  
Ischemic Stroke ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Biochemical Markers ◽  
S100 Protein ◽  
Neuron Specific Enolase ◽  
Short Term ◽  
Term Outcome ◽  
Poor Outcome ◽  
Short Term Outcome

To predict short-term outcome in acute ischemic stroke, we analyzed somatosensory evoked potentials (SEP) and biochemical parameters [neuron-specific enolase (NSE) and S100 protein] in a prospective study with serial measurement. In 31 patients with 1st middle cerebral artery infarction, serum NSE and S100 protein were measured daily between days 1 and 6 poststroke. The N20 and N70 components of the SEP (SEP20 and SEP70) were determined on days 1 and 6. SEP and biochemical markers in stroke patients were compared with a control group. Short-term outcome was assessed by the modified Rankin Scale (mRS) at days 7-10 and was dichotomized between good (mRS 0–2) and poor (mRS ≥3) outcome. Specificity and positive predictive value (PPV) were high at day 1 for SEP (SEP20: 100% for both; SEP70: 93 and 88%, respectively) compared with lower values for NSE (67 and 50%) and S100 (23 and 57%). In contrast, S100 showed the highest sensitivity at day 1 with 77% compared with a relatively low sensitivity of NSE (31%) and SEP (SEP20: 35%, SEP70: 47%). The biochemical markers showed an improving sensitivity over time with best values (>90%) between days 3 and 4 at the expense of a lower specificity. Specificity and PPV of SEP on day 6 was still 100% with sensitivity increasing up to 53% (SEP20) and 60% (SEP70). SEP could early differentiate between good and poor outcome and reliably predict poor outcome. Since biochemical markers and SEP complement each other in the prognosis of stroke, a combined application of these markers seems promising.

scholarly journals EP.FRI.552 Evaluating short term and long term outcome for patients undergoing emergency laparotomy in comparison to NELA mortality risk calculator

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nourelhuda Darwish ◽  
Elsammoual Mohammed ◽  
Ibrahim Warrag ◽  
AdeelAbbas Dhahri ◽  
Bogdan Ivanov
Keyword(s):  
Mortality Risk ◽  
Emergency Laparotomy ◽  
Risk Calculator ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Uk

Abstract Aim NELA is a project that was introduced in the UK since 2013, aiming to improve quality of care for patients undergoing emergency laparotomy.  NELA mortality risk calculator”was launched in 2017, which estimates the risk of death within 30 days of emergency laparotomy.  Our aim is to determine the short-term (30-day) and long-term (12 months) outcome in patients undergoing emergency laparotomy surgery and compare this with the estimated scores that were documented in the NELA website. Methods This is retrospective study involving patients who underwent emergency laparotomy surgery in the year of 2019. The primary outcome is to determine short-term (30-day) mortality. Results A total of 135 patients were included. The overall 30-day mortality was 8.8% (12/135). 55.77% (78/135) had NELA mortality score of &lt; 5%. Only 1 out of these (1.28%) died within 30 days. (4/78,5.12%) died in 6 to 12 months period of this group. 9 patients (11.53%) had NELA score &gt; 30%, of which 6 (66.66%) died within 30 days and 1 died within 6 months. 26.96% (48/135) had NELA scores 55 to 30%, 5 of them (10.41%) died within 30 days while 7 (14.58%) died within 6-12 months.  Patients with NELA scores more than 5% who survived the operation had higher chance of 30-day complications (25.58%, 11/43), when compared to those with scores less than 5% (11.68%, 9/77). Conclusion NELA mortality score has high accuracy especially if it was &gt;30%. In addition, high NELA scores are associated with increased risk of post operative complications.

scholarly journals Cardio embolic stroke and blood biomarkers: diagnosis and predictors of short-term outcome

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Wafaa S. Mohamed ◽  
Elhady A. Abd ElGawad ◽  
Amal SE. ElMotayam ◽  
Sabah E. Fathy
Keyword(s):  
Ischemic Stroke ◽  
Serum Levels ◽  
Embolic Stroke ◽  
Short Term ◽  
Stroke Subtype ◽  
Term Outcome ◽  
Simple Method ◽  
Albumin Ratio ◽  
Short Term Outcome ◽  
Creatine Kinase Mb

Abstract Background The brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), d-dimer, creatine–kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome. Methods This study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, d-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS. Results The mean levels of BNP, d-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome. Conclusion Elevated plasma levels of BNP, d-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.

scholarly journals Predicting Early Mortality in Multiple Myeloma Patients Treated with Novel Agents

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5641-5641
Author(s):  
Catarina Geraldes ◽  
Adriana Roque ◽  
Ana Bela Sarmento-Ribeiro ◽  
Maria Leticia Ribeiro ◽  
Rui Bergantim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Multivariate Analysis ◽  
Response Rate ◽  
Early Mortality ◽  
Novel Agents ◽  
Short Term ◽  
Term Outcome ◽  
Risk Of Death ◽  
Short Term Outcome ◽  
Increased Risk

Abstract BACKGROUND: Despite remarkable therapeutic advances in the last 2 decades and a major improvement in survival, a number of multiple myeloma (MM) patients (pts) present a short-term outcome. AIMS: Our aim was to identify the main factors (baseline characteristics, response to therapy, relapse features) determining early mortality (EM) among a cohort of newly diagnosed symptomatic MM pts treated with novel agents. METHODS: We conducted a national multicenter retrospective study, including a cohort of symptomatic MM pts diagnosed between January/2010 and June/2017, treated with novel agents (bortezomib, thalidomide or lenalidomide) with the maximum age of 75 years-old and living <3 years (y) after diagnosis. We considered EM as pts living <12 months (m). All pts were dead at the time of the analysis. Data were collected from medical registries and databases. Response to treatment was evaluated according to the International Myeloma Working Group (IMWG) consensus criteria (2016). Statistical analysis was performed using STATA v.14.2 and significant levels were set at p<0.05. All risk factors with p<0.15 in the univariate model were further entered into the multivariate analysis. RESULTS: A total of 142 pts were included in the study, 58% male and the median age at diagnosis was 65 y (27-75). IgG was the most frequent subtype (41%), followed by IgA (32%) and light-chain κ (14%) and λ (9%). At diagnosis, renal impairment (RI) was present in 32%, extramedullary disease (EMD) in 18% and bone disease in 69% of the pts; 58.3% were in stage III and 30.6% in stage II (ISS). Fluorescent in situ hybridization analysis was performed in 76 pts, 45% presenting high-risk cytogenetic abnormalities (HRC) [del(17p) and/or t(4;14) and/or t(14;16)]. Hypertension was present at diagnosis in 32% and diabetes in 18% pts. First-line therapy (1stL) included novel agents in 97% of the pts (64% bortezomib-based (Bor), 23% thalidomide-based (Thal) and 10% bortezomib plus IMID-based (BorIM). Response evaluation showed an overall response rate (ORR) of 73% (12% CR; 25% VGPR; 36% PR); 27% were refractory. Median time to response was 3.2m. Median number of therapy lines was 2 (1-3); 65% of the pts were refractory or progressed after 1stL therapy, 18% developed extramedullary disease (EMD) and 5 pts progressed to plasma cell leukemia. In pts receiving a 2ndL therapy, treatment-free interval was 9.2m and the most used regimens were lenalidomide (33%), Thal (25%), Bor (14%) and BorIM (11%) -based. ORR to 2ndL was 19.5% (3.4% VGPR and 16.1% PR). Six-month, 1-year and 2-years mortality was 7%, 27% and 65%, respectively. Median time until death was 18.2m; 55% of the pts died directly from disease progression (DP) and 45% from other causes [infection in 68% (only 17% of whom in DP), and cardiovascular complications in 13%]. In our study, prior hypertension (HR 1.53; 95% CI 1.01-2.32; p=0.046) and relapse with EMD (HR 2.0; 95% CI 1.23-3.26; p=0.005) were associated with increased risk of death. Pts≥70y also showed an increased risk of death, although not statistically significant (HR 1.42; 95% CI 0.96-2.12; p=0.081). In our cohort, refractoriness to 1stL treatment was not related to a significant increased risk of death (HR 1.48; 95% CI 0.91-2.40; p=0.11). Moreover, age, HRC, ISS stage, RI, bone disease and lactate dehydrogenase levels didn´t show a mortality predictive value. When comparing pts living <1y (EM) with pts living 1-3y, we identified the lack of at least PR (42.1% vs 21.2%, respectively; p=0.013) and a shorter time to 2ndL treatment (1.2 vs 10.0m; p=0.033) as predictors of death within the first 12m. Finally, in a multivariate analysis only the age at diagnosis >70y (HR 2.11; 95% CI 1.22-3.65; p=0.008) and EMD at relapse/progression (HR 2.55; 95% CI 1.45-4.50; p=0.001) predicted higher risk of mortality. CONCLUSIONS: ORR to 1stL therapy was similar to the generally expected response rate, showing that IMWG response criteria are not adequate to predict short-term outcome in the era of novel agents. The same was observed with classical baseline risk stratification features, raising the importance of defining a more accurate strategy to predict survival in MM pts. Refractory disease after 2ndL (higher than generally reported) and infections were the leading contributors to early death in our pts cohort. These data may provide new opportunities to define patient-adapted treatment strategies in order to decrease EM and improve overall survival in MM. Disclosures No relevant conflicts of interest to declare.

Abstract 29: Initial NIHSS Predicts Poor Short-term Outcome After Minor Stroke Even at Very Low Scores

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jonathan M Raser ◽  
Arthur Z Washington ◽  
Koto Ishida ◽  
Christina A Wilson ◽  
Swaroop A Pawar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Substantial Proportion ◽  
Minor Stroke ◽  
Hospital Death ◽  
Short Term ◽  
Term Outcome ◽  
Poor Outcome ◽  
Short Term Outcome ◽  
Minor Ischemic Stroke ◽  
Iv Tpa

Background: Minor ischemic stroke patients often do not receive IV tPA due to mild or rapidly resolving symptoms as it is assumed that they will have excellent outcomes without treatment. Nevertheless, a substantial proportion of these patients have a poor outcome. It is unclear if this is due to factors such as preexisting disability, medical comorbidities, or recurrent stroke, or due to the deficits associated with the minor stroke, We hypothesized that initial stroke severity would predict poor short-term outcome even when the deficits are mild. Methods: We conducted a retrospective cohort study based on chart review of all patients with minor ischemic stroke, as defined by NIHSS≤6 at presentation, who were admitted to our hospital over a 30-month time period. Poor short-term outcome was defined by in-hospital death or discharge to any destination other than home. Results: Data were complete for 461 of 471 patients with minor stroke. A substantial proportion, 38% (95%CI 34-43%), had a poor short-term outcome, including 31% discharged to rehabilitation, 5% discharged to a nursing facility, and 2% dead or discharged to hospice. Impaired ambulation prior to admission was associated with a poor outcome (OR 3.4; 95%CI 1.1-10, p<0.03), but only present in 3% of patients. In multivariable analysis, poor outcome was strongly associated with initial NIHSS ( figure ; OR 1.5; 95%CI 1.3-1.7, p<0.001) and age (OR 1.04; 95%CI 1.03-1.06, p<0.001). Similarly, NIHSS predicted poor outcome when analysis was limited to initial NIHSS≤3 (OR 1.8; 95%CI 1.3-2.4, p<0.001). Of the 112 patients presenting within 4.5 hours of time last seen well, 15% received IV tPA and 45% were excluded solely due to mild or rapidly improving symptoms. NIHSS was lower in those patients excluded than in those who received tPA (median 2 vs. 5, p<0.001). After adjustment for age, NIHSS, and prior ambulatory status, there was no significant difference in poor outcome, which occurred in 42% of patients treated with tPA and 24% of those excluded due to mild or rapidly improving symptoms (OR 1.9 for poor outcome after tPA; 95%CI 0.4-9.5, p=0.43). Conclusions: More than one-third of patients with minor stroke had a poor short-term outcome, including nearly one-fourth of those who were excluded from IV tPA due to mild or rapidly improving symptoms. NIHSS was predictive of poor outcome at very low scores, consistent with the hypothesis that the deficits due to the initial stroke were responsible for poor outcome. However, the impact of tPA treatment in this population is uncertain.

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