scholarly journals Survival of hospitalized COVID-19 patients in Northern Italy: a population-based cohort study by the ITA-COVID19 Network

2020 ◽  
Author(s):  
P. Giorgi Rossi ◽  
E. Ferroni ◽  
S. Spila Alegiani ◽  
G. Pitter ◽  
O. Leoni ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Population Based ◽  
Northern Italy ◽  
Charlson Index ◽  
Fatality Rate ◽  
Survival Curves ◽  
Younger Patients ◽  
High Fatality Rate

AbstractBackgroundCOVID-19 case fatality rate in hospitalized patients varies across countries and studies, but reliable estimates specific for age, sex, and comorbidities are needed to design trials for COVID-19 interventions. Aim of this study is to provide population-based survival curves of hospitalized COVID-19 patients.MethodsA cohort study was conducted in Lombardy, Veneto, and Reggio Emilia using COVID-19 registries linked to hospital discharge databases containing patient clinical histories. All patients with positive SARS-CoV-2 RT-PCR test on oral/nasopharyngeal swabs hospitalized from 21st February to 21st April 2020 were identified. Kaplan Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex and Charlson Index.FindingsOverall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57-79), 62·6% were males, 69·4% had a Charlson Index of 0. In total, 11,205 (26·1%) patients died over a median follow-up of 24 days (IQR: 10-35). Survival curves showed that 22·0% of patients died within 14 days and 27·6% within 30 days of hospitalization. Survival was higher in younger patients and in females. Younger patients with comorbidities had a lower survival than older ones with comorbidities.InterpretationOver 27% of hospitalized COVID-19 patients died within one month in three areas of Northern Italy that were heavily affected by SARS-CoV-2 infection. Such a high fatality rate suggests that trials should focus on survival and have follow-up of at least one month.FundingThe study did not receive any external funding.Research in contextEvidence before this studyTwo recent systematic reviews with meta-analyses report case fatality rates of three to four percent in COVID-19 patients. Most studies on hospitalized cohorts report only slightly higher figures. These figures do not correspond to those derived from routinely collected clinical data in most European countries, reporting a 10% case fatality rate which has been increasing over time since the epidemic started.Robust and precise survival estimates of hospitalized COVID-19 patients which take into account prognostic factors such as age, sex and burden of comorbidities are needed to design appropriate phase II and phase III clinical studies of drugs targeting COVID-19.Added value of this studyIn this study we present the first survival estimates by age, sex and Charlson index for a large population-based cohort of Italian hospitalized COVID-19 patients.Implications of all the available evidenceOver 27% of COVID-19 patients died within one month from hospital admission. Such a high fatality rate suggests that studies should prioritize mortality as primary outcome. Furthermore, we found that the fatality rate reaches a plateau 30 days after hospitalization, suggesting that studies should have at least one month of follow up to observe deaths; shorter follow-up could lead to overestimation of treatment benefits.

scholarly journals Managing Recurrent Clozapine-Induced Constipation in a Patient with Resistant Schizophrenia

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Silviu Tomulescu ◽  
Kim Uittenhove ◽  
Reda Boukakiou
Keyword(s):  
Side Effects ◽  
Case Fatality Rate ◽  
Surgical Intervention ◽  
Case Fatality ◽  
Fatality Rate ◽  
Augmentation Strategy

Clozapine is an effective antipsychotic for the treatment of resistant schizophrenia. However, clozapine can lead to serious side effects. One of the most common side effects is constipation and in rare cases ileus, which is associated with a considerable case fatality rate. Our patient exhibited repeated episodes of ileus while being treated with clozapine. We adapted the treatment of the patient in several ways to manage these severe side effects. First, we reduced clozapine dosage by opting for an augmentation strategy of clozapine through paliperidone. Then, we added linaclotide as a nonconventional laxative. We further adapted treatment after the occurrence of a volvulus prompting surgical intervention which revealed a malformation of the intestines’ peritoneal attachment. A gastrostomy to facilitate the treatment of any further episode was performed and bethanechol was introduced alongside linaclotide. Follow-up revealed the efficacy of our strategy involving the use of linaclotide in managing the side effects of clozapine in this patient.

scholarly journals Pediatric Stroke Rates Over 17 Years: Report From a Population-Based Study

2018 ◽  
Vol 33 (7) ◽  
pp. 463-467 ◽  
Author(s):  
Laura L. Lehman ◽  
Jane C. Khoury ◽  
J. Michael Taylor ◽  
Samrat Yeramaneni ◽  
Heidi Sucharew ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Population Based ◽  
Pediatric Stroke ◽  
Stroke Rate ◽  
Fatality Rate ◽  
Population Based Study ◽  
Study Region ◽  
Stroke Study ◽  
Stroke Type

We previously published rates of pediatric stroke using our population-based Greater Cincinnati Northern Kentucky Stroke Study (GCNK) for periods July 1993–June 1994 and 1999. We report population-based rates from 2 additional study periods: 2005 and 2010. We identified all pediatric strokes for residents of the GCNK region that occurred in July 1, 1993–June 30, 1994, and calendar years 1999, 2005, and 2010. Stroke cases were ascertained by screening discharge ICD-9 codes, and verified by a physician. Pediatric stroke was defined as stroke in those <20 years of age. Stroke rates by study period, overall, by age and by race, were calculated. Eleven children died within 30 days, yielding an all-cause case fatality rate of 15.7% (95% confidence interval 1.1%, 26.4%) with 3 (27.3%) ischemic, 6 (54.5%) hemorrhagic, and 2 (18.2%) unknown stroke type. The pediatric stroke rate of 4.4 per 100 000 in the GCNK study region has not changed over 17 years.

scholarly journals Regional Differences in Epidemiological and Clinical Characteristics, Treatment, and Clinical Outcomes of COVID-19 in Wuhan and Remote Areas of Hubei Province

2021 ◽  
Vol 8 ◽  
Author(s):  
Honggang Ren ◽  
Xingyi Guo ◽  
Antonio Palazón-Bru ◽  
Pengcheng Yang ◽  
Nan Huo ◽  
...  
Keyword(s):  
Regional Differences ◽  
Case Fatality Rate ◽  
Clinical Characteristics ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Hubei Province ◽  
Fatality Rate ◽  
Cross Sectional ◽  
Suburban Areas

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a major threat to global health. Regional differences in epidemiological and clinical characteristics, treatment and outcomes of patients have not yet been investigated. This study was conducted to investigate these differences amongCOVID-19 patients in Hubei Province, China.Methods: This retrospective cross-sectional study analyzed data on 289 COVID-19 patients from designated hospitals in three regions:Urban (Wuhan Union West Hospital), Suburban areas of Wuhan (Hannan Hospital) and Enshi city, between February 8 and 20, 2020. The final date of follow-up was December 14th, 2020. The outcomes were case fatality rate and epidemiological and clinical data.Results: Urban Wuhan experienced a significantly higher case fatality rate (21.5%) than suburban Wuhan (5.23%) and rural area of Enshi (3.51%). Urban Wuhan had a higher proportion of patients on mechanical ventilation (24.05%) than suburban Wuhan (0%) and rural Enshi (3.57%). Treatment with glucocorticoids was equivalent in urban and suburban Wuhan (46.84 and 45.75%, respectively) and higher than Enshi (25.00%). Urban Wuhan had a higher proportion of patients with abnormal tests including liver function and serum electrolytes and a higher rate of pneumonia (p &lt; 0.01 for all). Urban Wuhan also had a higher incidence of respiratory failure, heart disease, liver disease and shock, compared with the other two regions (all p &lt; 0.05).Conclusions: Our findings revealed that there are regional differences in COVID-19. These findings provide novel insights into the distribution of appropriate resources for the prevention, control and treatment of COVID-19 for the global community.

scholarly journals Correlation of population mortality of COVID-19 and testing coverage: a comparison among 36 OECD countries and Taiwan

2020 ◽  
Author(s):  
Chen Wei ◽  
Chien-Chang Lee ◽  
Tzu-Chun Hsu ◽  
Wan-Ting Hsu ◽  
Chang-Chuan Chan ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Disease Burden ◽  
Case Fatality ◽  
Correlation Coefficients ◽  
Oecd Countries ◽  
Population Based ◽  
Fatality Rate ◽  
Successful Infection ◽  
Population Mortality ◽  
Testing Coverage

ABSTRACTAlthough testing is widely regarded as critical to fighting the Covid-19 pandemic, what measure and level of testing best reflects successful infection control remains unresolved. Our aim was to compare the sensitivity of two testing metrics-population testing number and testing coverage-to population mortality outcomes and identify a benchmark for testing adequacy with respect to population mortality and capture of potential disease burden. This ecological study aggregated publicly available data through April 12 on testing and outcomes related to COVID-19 across 36 OECD (Organization for Economic Development) countries and Taiwan. All OECD countries and Taiwan were included in this population-based study as a proxy for countries with highly developed economic and healthcare infrastructure. Spearman correlation coefficients were calculated between the aforementioned metrics and following outcome measures: deaths per 1 million people, case fatality rate, and case proportion of critical illness. Fractional polynomials were used to generate scatter plots to model the relationship between the testing metrics and outcomes. Testing coverage, but not population testing number, was highly correlated with population mortality (rs= −0.79, P=5.975e-09 vs rs = − 0.3, P=0.05) and case fatality rate (rs= −0.67, P=9.067e-06 vs rs= −0.21, P=0.20). A testing coverage threshold of 15-45 signified adequate testing: below 15, testing coverage was associated with exponentially increasing population mortality, whereas above 45, increased testing did not yield significant incremental mortality benefit. Testing coverage was better than population testing number in explaining country performance and can be used as an early and sensitive indicator of testing adequacy and disease burden. This may be particularly useful as countries consider re-opening their economies.

scholarly journals Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

2020 ◽  
pp. 1-6
Author(s):  
Enrico Giordan ◽  
Christopher S. Graffeo ◽  
Alejandro A. Rabinstein ◽  
Robert D. Brown ◽  
Walter A. Rocca ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Incidence Rate ◽  
Case Fatality Rate ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Fatality ◽  
Population Based ◽  
Fatality Rate ◽  
Olmsted County ◽  
Day Case ◽  
Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study

2021 ◽  
pp. 174749302199559
Author(s):  
Eleni Karantali ◽  
Konstantinos Vemmos ◽  
Evangelos Tsampalas ◽  
Konstantinos Xynos ◽  
Persefoni Karachalia ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Temporal Trends ◽  
Case Fatality ◽  
Population Based ◽  
Incidence Rates ◽  
European Population ◽  
Fatality Rate ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Southern Greece

Background Stroke incidence and case-fatality are reported to decline in high-income countries during the last decades. Epidemiological studies are important for health services to organize prevention and treatment strategies. Aims The aim of this population-based study was to determine temporal trends of stroke incidence and case-fatality rates of first-ever stroke in Arcadia, a prefecture in southern Greece. Methods All first-ever stroke cases in the Arcadia prefecture were ascertained using the same standard criteria and multiple overlapping sources in three study periods: from November 1993 to October 1995; 2004; and 2015–2016. Crude and age-adjusted to European population incidence rates were compared using Poisson regression. Twenty-eight days case fatality rates were estimated and compared using the same method. Results In total, 1315 patients with first-ever stroke were identified. The age-standardized incidence to the European population was 252 per 100,000 person-years (95% CI 231–239) in 1993/1995, 252 (95% CI 223–286) in 2004, and 211 (192–232) in 2015/2016. The overall age- and sex-adjusted incidence rates fell by 16% (incidence rates ratio 0.84, 95% CI: 0.72–0.97). Similarly, 28-day case-fatality rate decreased by 28% (case fatality rate ratio = 0.72, 95% CI: 0.58–0.90). Conclusions This population-based study reports a significant decline in stroke incidence and mortality rates in southern Greece between 1993 and 2016.

scholarly journals Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045414
Author(s):  
Aysha Almas ◽  
Zain Mushtaq ◽  
Jette Moller
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Level Of Care ◽  
Fatality Rate ◽  
Follow Up Study ◽  
High Acuity

ObjectivesTo determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.DesignA hospital-based observational follow-up study.SettingInternal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.ParticipantsAdult patients with confirmed COVID-19, aged ≥18 years.MethodsALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and length of stay.ResultsA total of 822 patients with COVID-19 were admitted during the study period and 699 met inclusion criteria. The mean age was 54.5 years and 67% were males; 50.4% were triaged to low, 42.5% to intermediate and 7.2% to high acuity care. The overall case-fatality rate was 11.6%, with the highest (52%) in high acuity level followed by 16.2% in intermediate and 2% in low acuity care. Acuity level was associated with case fatality, with an HR (95% CI) of 5.0 (2.0 to 12.1) for high versus low acuity care and an HR of 2.7 (1.2, 6.4) for intermediate versus low acuity care, after adjusting for age, sex and common comorbidities including diabetes, hypertension, ischaemic heart disease and chronic lung disease. Similarly, acuity level was also associated with length of hospital stay.ConclusionHigh and intermediate acuity level is associated with higher case fatality rate and prolonged length of hospital stay in patients admitted with COVID-19. In resource-limited settings where the provision of high acuity care is limited, the intermediate care acuity could serve as a useful strategy to treat relatively less critical patients with COVID-19.

scholarly journals Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †

Viruses ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1228
Author(s):  
Maria Conceição N. Costa ◽  
Luciana Lobato Cardim ◽  
Maria Gloria Teixeira ◽  
Mauricio L. Barreto ◽  
Rita de Cassia Oliveira de Carvalho-Sauer ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Very Low Birth Weight ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Preterm Births ◽  
Population Based ◽  
Fatality Rate ◽  
Maternal Characteristics ◽  
Logistic Regression Models ◽  
Congenital Zika Syndrome

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child’s health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child–maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015–2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2–10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63–2.83), and very low birth weight (OR = 3.77; 95% CI 2.20–6.46); late preterm births (OR = 1.65; 95% CI 1.21–2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46–8.02) and 5th minutes (OR = 4.13; 95% CI 2.78–6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

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