scholarly journals Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multi-center cohort study

2020 ◽  
Author(s):  
Huanyuan Luo ◽  
Songqiao Liu ◽  
Yuancheng Wang ◽  
Penelope A. Phillips-Howard ◽  
Yi Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Trend Test ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Chi Square Test

Objectives To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. Design and setting This is a retrospective, multi-center cohort study performed at twenty-four hospitals in Jiangsu, China. Participants From January 10 to March 15, 2020, 625 patients with COVID-19 were involved. Results Of the 625 patients (median age, 46 years; 329 [52.6%] males), 37 (5.9%) were children (18 years or less), 261 (40%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years), and 79 (12.6%) elderly (65 years or more). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease, and diabetes comorbidities increased with age (trend test, P < .0001, P = 0.0003, P < .0001, and P < .0001 respectively). Fever, cough, and shortness of breath occurred more commonly among older patients, especially the elderly, compared to children (Chi-square test, P = 0.0008, 0.0146, and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both P < .0001). Older patients had significantly more abnormal values in many laboratory parameters than younger patients. Elderly patients contributed the highest proportion of severe or critically-ill cases (33.0%, Chi-square test P < 0.001), intensive care unit (ICU) (35.4%, Chi-square test P < 0.001), and respiratory failure (31.6%, Chi-square test P = 0.0266), and longest hospital stay (21 days, ANOVA-test P < 0.001). Conclusions Elderly (≥65) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure, and the longest hospital stay, which may be due partly to that they had higher incidence of comorbidities and poor immune responses to COVID-19.

scholarly journals Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039887 ◽  
Author(s):  
Huanyuan Luo ◽  
Songqiao Liu ◽  
Yuancheng Wang ◽  
Penelope A Phillips-Howard ◽  
Shenghong Ju ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Trend Test ◽  
Chronic Obstructive ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

ObjectivesTo determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China.Design and settingRetrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China.Participants625 patients with COVID-19 enrolled between 10 January and 15 March 2020.ResultsOf the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19–44 years), 248 (39.7%) middle-aged adults (45–64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ2 test, p=0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ2 test p<0.0001), intensive care unit use (35.4%, χ2 test p<0.0001), respiratory failure (31.6%, χ2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal–Wallis test p<0.0001).ConclusionsElderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.

scholarly journals Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241849
Author(s):  
Fernanda Raphael Escobar Gimenes ◽  
Flávia Fernanda Luchetti Rodrigues Baracioli ◽  
Adriane Pinto de Medeiros ◽  
Patricia Rezende do Prado ◽  
Janine Koepp ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Adverse Events ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mechanical Device ◽  
Chi Square ◽  
Factors Associated ◽  
Level Of Consciousness ◽  
Chi Square Test

Aims To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. Materials and methods A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization’s International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher’s exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. Results 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. Conclusion Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.

scholarly journals Factors associated with readmissions to an adult intensive care unit at a university hospital

Rev Rene ◽  
2020 ◽  
Vol 21 ◽  
pp. e43724
Author(s):  
Daniele Lopes ◽  
Luciana Magnani Fernandes ◽  
Débora Cristina Ignácio Alves ◽  
Nelsi Salete Tonini ◽  
João Lucas Campos de Oliveira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Medical Records ◽  
University Hospital ◽  
Chi Square ◽  
Adult Intensive Care Unit ◽  
Factors Associated ◽  
Extubation Time ◽  
Chi Square Test

Objective: to verify the rate and factors associated with readmissions in the Intensive Care Unit. Methods: a documentary study, carried out with a sample (n=441) of medical records of adult patients admitted to the Intensive Care Unit of a university hospital. The descriptive and inferential statistical analysis was applied, using Pearson’s correlation, the chi-square test, and the t-student test, at a 5% confidence level. Results: most were men (66.2%), with 52.8±18.5 years of age and hospital stay of 10.2±10.8 days. Of these, 29 (6.5%) were readmitted. Death was similar (p=0.893) between readmitted (31.0%) and not readmitted (29.8%). There was no significant correlation between the readmission outcome and age, Nursing Activities Score and time on mechanical ventilation. By comparison, the hospital stay, and extubation were significantly longer (p<0.05) among those readmitted. Conclusion: the rate of readmission was slightly low. Only extubation time was negatively and significantly correlated with the readmission outcome.

scholarly journals The pattern of admission and outcome of neonates managed in the neonatal intensive care unit in a Sudanese hospital

2021 ◽  
Vol 8 (4) ◽  
pp. 616
Author(s):  
Safaa A. M. Ahmed ◽  
Mohammed A. O. Ali ◽  
Esraa A. A. Mahgoub ◽  
Mohammed Nimir ◽  
Elfatih M. Malik
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Medical Records ◽  
Neonatal Intensive Care ◽  
Binary Logistic Regression ◽  
Neonatal Morbidity ◽  
Chi Square ◽  
Chi Square Test

Background: This study aimed to assess the admission pattern and outcome of neonates managed in the neonatal intensive care unit (NICU) in a Sudanese hospital.Methods: This hospital-based retrospective study was conducted in the NICU of Saad Abu Elella Teaching Hospital in Khartoum, Sudan. Data was collected from medical records of 207 neonates using an extraction form. Chi-square test and binary logistic regression were used in analysis.Results: Most of the neonates were term, and 43% of them had a birth weight less than 2.5 kg. Moreover, the most common morbidities among them were sepsis, respiratory distress syndrome, neonatal jaundice and asphyxia, and the mortality rate was 15%. Additionally, the birth weight, gestational age, the need for resuscitations, direct breast feeding and being beside mother were found to be significantly associated with the studied outcome.Conclusions: Majority of causes of neonatal morbidity and mortality in our study were preventable diseases. Therefore, interventions to improve services in the NICU are highly needed to improve the outcomes.

Preventable hospitalizations among older patients with cognitive impairments and dementia

2018 ◽  
Vol 31 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Dominik Wolf ◽  
Carolin Rhein ◽  
Katharina Geschke ◽  
Andreas Fellgiebel
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Ambulatory Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Hospital Admissions ◽  
Cognitive Impairments ◽  
Length Of Hospital Stay ◽  
Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

Maternal and Perinatal Outcomes in Women with Eclampsia by Mode of delivery at Riley Mother Baby Hospital: A longitudinal case-series study

2020 ◽  
Author(s):  
Philippe Amubuomombe Poli ◽  
Koech MMED Irene ◽  
Richard Mogeni ◽  
Ann Mwangi ◽  
Andrew Cheruiyot ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Categorical Variables ◽  
Chi Square ◽  
Case Series Study ◽  
Chi Square Test ◽  
Series Study

Abstract Background Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0-40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1-2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. Instead, it increases the risk of perinatal adverse outcomes, including the risk of admission to the newborn unit and perinatal death.

Peri-operative Adverse Outcomes in Patients with Atrial Fibrillation Taking Warfarin or Edoxaban: Analysis of the ENGAGE AF-TIMI 48 Trial

2018 ◽  
Vol 118 (06) ◽  
pp. 1001-1008 ◽  
Author(s):  
James Douketis ◽  
Sabina Murphy ◽  
Elliott Antman ◽  
Laura Grip ◽  
Michele Mercuri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Invasive Procedure ◽  
Operative Management ◽  
Adverse Outcomes ◽  
Systemic Embolism ◽  
Chi Square ◽  
Treatment Groups ◽  
Post Procedure ◽  
Chi Square Test ◽  
Anticoagulated Patients

Background Peri-operative management of anticoagulated patients with atrial fibrillation (AF) is challenging. To gain information on the peri-operative management of edoxaban, we compared outcomes in patients on warfarin or edoxaban enrolled in ENGAGE AF-TIMI 48 who underwent a surgery or invasive procedure. Methods Data from patients undergoing their first surgery/procedure were analysed and results compared by anticoagulant (warfarin vs. higher- or lower-dose edoxaban regimen [HDER and LDER, respectively]). Patients were classified by procedural management: anticoagulant interrupted (last dose 4–10 days pre-procedure) or anticoagulant continued (last dose ≤ 3 days pre-procedure). Stroke/systemic embolism (SSE), major bleeding (MB), MB or clinically relevant non-MB (CRNMB) and death were assessed from 7 days pre- until 30 days post-procedure. The chi-square test was used to compare outcomes across treatment groups. Results A total of 7,193 patients (34%) underwent surgery/procedure: 3,116 had anticoagulant interrupted, 4,077 had anticoagulant continued. Among patients on warfarin, HDER and LDER who had anticoagulant interrupted, rates of SSE were 0.6, 0.5 and 0.9% (p = 0.53), rates of MB were 1.0, 1.2 and 1.1% (p = 0.94) and rates of MB or CRNMB were 3.9, 4.2 and 3.6% (p = 0.78); among patients on warfarin, HDER and LDER who had anticoagulant continued, rates of SSE were 1.1, 0.7 and 0.9% (p = 0.51), rates of MB were 3.6, 2.6 and 2.4% (p = 0.13) and rates of MB or CRNMB were 8.5, 7.9 and 6.6% (p = 0.17). Conclusion In patients requiring surgery/procedure in ENGAGE AF-TIMI 48, peri-operative rates of SSE, MB and death were not significantly different in patients who received edoxaban or warfarin.

scholarly journals Effectiveness of early rehabilitation on patients with chronic obstructive lung disease and acute respiratory failure in intensive care units: A case–control study

2019 ◽  
Vol 16 ◽  
pp. 147997311882031
Author(s):  
Willy Chou ◽  
Chih-Cheng Lai ◽  
Kuo-Chen Cheng ◽  
Kuo-Shu Yuan ◽  
Chin-Ming Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Intensive Care Units ◽  
Case Control Study ◽  
Case Control ◽  
Early Rehabilitation ◽  
Chronic Obstructive ◽  
Copd Patients ◽  
Control Study

The effect of early rehabilitation on the outcome of patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) in intensive care units (ICUs) remains unclear. We examined the effect of early rehabilitation on the outcomes of COPD patients requiring mechanical ventilation (MV) in the ICU. This retrospective, observational, case–control study was conducted in a medical center with a 19-bed ICU. The records of all 105 ICU patients with COPD and ARF who required MV from January to December 2011 were examined. The outcomes (MV duration, rates of successful weaning and survival, lengths of ICU and hospital stays, and medical costs) were recorded and analyzed. During the study period, 35 patients with COPD underwent early rehabilitation in the ICU and 70 demographically and clinically matched patients with similar COPD stage, cause of intubation, type of respiratory failure, and levels of disease severity who had not undergone early rehabilitation in the ICU were selected as comparative controls. Multiple regression analysis showed that early rehabilitation was significantly negatively associated with MV duration. Early rehabilitation for COPD patients in the ICU with ARF shortened the duration of their MV.

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