scholarly journals Predicting the need for escalation of care or death from repeated daily clinical observations and laboratory results in patients with SARS-CoV-2 during 2020: a retrospective population-based cohort study from the United Kingdom

2020 ◽  
Author(s):  
Colin J Crooks ◽  
Joe West ◽  
Andrew Fogarty ◽  
Joanne R Morling ◽  
Matthew J Grainge ◽  
...  
Keyword(s):  
Cohort Study ◽  
Dynamic Change ◽  
Cox Proportional Hazards Model ◽  
Early Warning Score ◽  
Good Discrimination ◽  
Laboratory Parameters ◽  
Icu Admission ◽  
Clinical Observations ◽  
C Statistic ◽  
Better Than

Objectives: Currently used prognostic tools for patients with SARS-CoV-2 infection are based on clinical and laboratory parameters measured at a single point in time, usually on admission. We aimed to determine how dynamic changes in clinical and laboratory parameters relate to SARS-CoV-2 prognosis. Design: retrospective, observational cohort study using routinely collected clinical data to model the dynamic change in prognosis of SARS-CoV-2. Setting: a single, large hospital in England. Participants: all patients with confirmed SARS-CoV-2 admitted to Nottingham University Hospitals (NUH) NHS Trust, UK from 1st February 2020 until 30th November 2020. Main outcome measures: Intensive Care Unit (ICU) admission, death and discharge from hospital. Statistical Methods: We split patients into 1st (admissions until 30th June) and 2nd (admissions thereafter) waves. We incorporated all clinical observations, blood tests and other covariates from electronic patient records and follow up until death or 30 days from the point of hospital discharge. We modelled daily risk of admission to ICU or death with a time varying Cox proportional hazards model. Results: 2,964 patients with confirmed SARS-CoV-2 were included. Of 1,374 admitted during the 1st wave, 593 were eligible for ICU escalation, and 466 had near complete ascertainment of all covariates at admission. Our validation sample included 1,590 confirmed cases, of whom 958 were eligible for ICU admission. Our model had good discrimination of daily need for ICU admission or death (C statistic = 0.87 (IQR 0.85-0.90)) and predicted this daily prognosis better than previously published scores (NEWS2, ISCARIC 4C). In validation in the 2nd wave the score overestimated escalation (calibration slope 0.55), whilst retaining a linear relationship and good discrimination (C statistic = 0.88 (95% CI 0.81 -0.95)). Conclusions: A bespoke SARS-CoV-2 escalation risk prediction score can predict need for clinical escalation better than a generic early warning score or a single estimation of risk at admission.

scholarly journals Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Hyuk Kim ◽  
Hye Suk Choi ◽  
Eun Suk Jin ◽  
Hayoung Choi ◽  
Hyun Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Predictive Ability ◽  
Early Warning Score ◽  
Rapid Response System ◽  
Icu Mortality ◽  
Icu Admission ◽  
Response System ◽  
National Early Warning Score

AbstractThere are insufficient data in managing patients at high risk of deterioration. We aimed to investigate that national early warning score (NEWS) could predict severe outcomes in patients identified by a rapid response system (RRS), focusing on the patient’s age. We conducted a retrospective cohort study from June 2019 to December 2020. Outcomes were unplanned intensive care unit (ICU) admission, ICU mortality, and in-hospital mortality. We analyzed the predictive ability of NEWS using receiver operating characteristics (ROC) curve and the effect of NEWS parameters using multivariable logistic regression. A total of 2,814 RRS activations were obtained. The predictive ability of NEWS for unplanned ICU admission and in-hospital mortality was fair but was poor for ICU mortality. The predictive ability of NEWS showed no differences between patients aged 80 years or older and under 80 years. However, body temperature affected in-hospital mortality for patients aged 80 years or older, and the inverse effect on unplanned ICU admission was observed. The NEWS showed fair predictive ability for unplanned ICU admission and in-hospital mortality among patients identified by the RRS. The different presentations of patients 80 years or older should be considered in implementing the RRS.

scholarly journals Association between clinical frailty, illness severity and post-discharge survival: a prospective cohort study of older medical inpatients in Norway

2021 ◽  
Author(s):  
Andreas Engvig ◽  
Torgeir Bruun Wyller ◽  
Eva Skovlund ◽  
Marc Vali Ahmed ◽  
Trygve Sundby Hall ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Frailty Index ◽  
Illness Severity ◽  
Cox Proportional Hazards Model ◽  
Early Warning Score ◽  
Post Discharge ◽  
Medical Wards ◽  
The Impact

Abstract Purpose Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Methods Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after discharge. Ward physicians screened for frailty and quantified its degree from one to eight using Clinical Frailty Scale (CFS), while clinical illness severity was estimated by New Early Warning Score 2 (NEWS2) and laboratory illness severity was calculated by a frailty index (FI-lab) using routine blood tests. Results CFS, NEWS2 and FI-lab scores were independently associated with post-discharge survival in an adjusted Cox proportional hazards model with age, ward category (acute geriatric and general medical) and comorbidity as covariates. Adjusted hazard ratios and 95% confidence intervals were 1.54 (1.24–1.91) for CFS, 1.12 (1.03–1.23) for NEWS2, and 1.02 (1.00–1.05) for FI-lab. A frailty × illness severity category interaction effect (p = 0.003), suggested that the impact of frailty on survival was greater in those experiencing higher levels of illness severity. Among patients with at least moderate frailty (CFS six to eight) and high illness severity according to both NEWS2 and FI-lab, two (13%) were alive at follow-up. Conclusion Frailty screening aided prognostication of survival following discharge in older acutely ill persons admitted to medical wards. The prognostic value of frailty increased when combined with readily available illness severity markers acquired during admission.

Prognostic and discriminative accuracy of the quick Sepsis-related Organ Failure Assessment compared with an early warning score: a Danish cohort study

2021 ◽  
pp. emermed-2020-209746
Author(s):  
Lise Skovgaard Svingel ◽  
Merete Storgaard ◽  
Buket Öztürk Esen ◽  
Lotte Ebdrup ◽  
Jette Ahrensberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Organ Failure ◽  
Early Warning ◽  
Predictive Value ◽  
Primary Outcome ◽  
Characteristic Curve ◽  
Early Warning Score ◽  
Icu Admission ◽  
Hospitalised Patients ◽  
Failure Assessment

BackgroundThe clinical benefit of implementing the quick Sepsis-related Organ Failure Assessment (qSOFA) instead of early warning scores (EWS) to screen all hospitalised patients for critical illness has yet to be investigated in a large, multicentre study.MethodsWe conducted a cohort study including all hospitalised patients ≥18 years with EWS recorded at hospitals in the Central Denmark Region during the year 2016. The primary outcome was intensive care unit (ICU) admission and/or death within 2 days following an initial EWS. Prognostic accuracy was examined using sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). Discriminative accuracy was examined by the area under the receiver operating characteristic curve (AUROC).ResultsAmong 97 332 evaluated patients, 1714 (1.8%) experienced the primary outcome. The qSOFA ≥2 was less sensitive (11.7% (95% CI: 10.2% to 13.3%) vs 25.1% (95% CI: 23.1% to 27.3%)) and more specific (99.3% (95% CI: 99.2% to 99.3%) vs 97.5% (95% CI: 97.4% to 97.6%)) than EWS ≥5. The NPV was similar for the two scores (EWS ≥5, 98.6% (95% CI: 98.6% to 98.7%) and qSOFA ≥2, 98.4% (95% CI: 98.3% to 98.5%)), while the PPV was 15.1% (95% CI: 13.8% to 16.5%) for EWS ≥5 and 22.4% (95% CI: 19.7% to 25.3%) for qSOFA ≥2. The AUROC was 0.72 (95% CI: 0.70 to 0.73) for EWS and 0.66 (95% CI: 0.65 to 0.67) for qSOFA.ConclusionThe qSOFA was less sensitive (qSOFA ≥2 vs EWS ≥5) and discriminatively accurate than the EWS for predicting ICU admission and/or death within 2 days after an initial EWS. This study did not support replacing EWS with qSOFA in all hospitalised patients.

scholarly journals Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Juhyun Song ◽  
Dae Won Park ◽  
Jae-hyung Cha ◽  
Hyeri Seok ◽  
Joo Yeong Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Icu Admission ◽  
Hazards Model

AbstractWe investigated association between epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients and clinical outcomes in Korea. This nationwide retrospective cohort study included 5621 discharged patients with COVID-19, extracted from the Korea Disease Control and Prevention Agency (KDCA) database. We compared clinical data between survivors (n = 5387) and non-survivors (n = 234). We used logistic regression analysis and Cox proportional hazards model to explore risk factors of death and fatal adverse outcomes. Increased odds ratio (OR) of mortality occurred with age (≥ 60 years) [OR 11.685, 95% confidence interval (CI) 4.655–34.150, p < 0.001], isolation period, dyspnoea, altered mentality, diabetes, malignancy, dementia, and intensive care unit (ICU) admission. The multivariable regression equation including all potential variables predicted mortality (AUC = 0.979, 95% CI 0.964–0.993). Cox proportional hazards model showed increasing hazard ratio (HR) of mortality with dementia (HR 6.376, 95% CI 3.736–10.802, p < 0.001), ICU admission (HR 4.233, 95% CI 2.661–6.734, p < 0.001), age ≥ 60 years (HR 3.530, 95% CI 1.664–7.485, p = 0.001), malignancy (HR 3.054, 95% CI 1.494–6.245, p = 0.002), and dyspnoea (HR 1.823, 95% CI 1.125–2.954, p = 0.015). Presence of dementia, ICU admission, age ≥ 60 years, malignancy, and dyspnoea could help clinicians identify COVID-19 patients with poor prognosis.

scholarly journals Patient trajectories among hospitalised COVID-19 patients vaccinated with an mRNA vaccine in Norway: a register-based cohort study

2021 ◽  
Author(s):  
Robert Whittaker ◽  
Anja Brathen Kristofferson ◽  
Beatriz Valcarcel Salamanca ◽  
Elina Seppala ◽  
Karan Golestani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Capacity Planning ◽  
Patient Management ◽  
Proportional Hazards Model ◽  
Vaccination Status ◽  
Cox Proportional Hazards Model ◽  
Hospital Death ◽  
Lower Odds ◽  
Icu Admission

Objectives With most of the Norwegian population vaccinated against COVID-19, an increasing number and proportion of COVID-19 related hospitalisations are occurring among vaccinated patients. To support patient management and capacity planning in hospitals, we estimated the length of stay (LoS) in hospital and odds of intensive care (ICU) admission and in-hospital mortality among COVID-19 patients ≥18 years who had been vaccinated with an mRNA vaccine, compared to unvaccinated patients. Methods Using national registry data, we conducted a cohort study on SARS-CoV-2 positive patients hospitalised in Norway between 1 February and 30 September 2021, with COVID-19 as the main cause of hospitalisation. We used a Cox proportional hazards model to examine the association between vaccination status and LoS. We used logistic regression to examine the association between vaccination status and ICU admission and in-hospital mortality. Results We included 2,361 patients, including 70 (3%) partially vaccinated and 183 (8%) fully vaccinated. Fully vaccinated patients 18-79 years had a shorter LoS in hospital overall (adjusted hazard ratio for discharge: 1.35, 95%CI: 1.07-1.72), and lower odds of ICU admission (adjusted odds ratio: 0.57, 95%CI: 0.33-0.96). Similar estimates were observed when collectively analysing partially and fully vaccinated patients. We observed no difference in the LoS for patients not admitted to ICU, nor odds of in-hospital death between vaccinated and unvaccinated patients. Conclusions Vaccinated patients hospitalised with COVID-19 in Norway have a shorter LoS and lower odds of ICU admission than unvaccinated patients. These findings can support patient management and ongoing capacity planning in hospitals.

A Cohort study to compare Admission criteria and Academic performance among preclinical students at The Copperbelt University School of Medicine: complete enumeration (Preprint)

2019 ◽  
Author(s):  
Andrew Mwila
Keyword(s):  
Academic Performance ◽  
Cohort Study ◽  
Clinical Medicine ◽  
Average Score ◽  
First Year ◽  
Admission Criteria ◽  
Biomedical Sciences ◽  
Dental Surgery ◽  
School Of Medicine ◽  
Better Than

BACKGROUND The Copperbelt University is the second public University in Zambia. The School of Medicine has four major programs namely; Bachelor of Medicine and Surgery, Bachelor of Dental Surgery, Bachelor of Clinical Medicine and Bachelor of Biomedical sciences. The Copperbelt University School of Medicine runs a five-year training program for both the BDS and the MBCHB programs. Students are admitted into the Medical school after successfully completing their first year at the Main campus in the School of Natural Sciences with an average of 4 B grades or higher (B grade is a mark of 65 to 74%). OBJECTIVE The study was done to determine the association between admission criteria and academic performance among preclinical students. Hence, the study compares the academic performance among preclinical students admitted into the Bachelor of Dental Surgery and Bachelor of Medicine and Surgery at the Copperbelt University School of Medicine. METHODS This is a retrospective cohort study conducted at Michael Chilufya Sata School of medicine Campus. A pilot study was conducted with 30 BDS and 30 MBCHB students and the obtained information helped determine the sample size. SPSS was used to analyze the data. The study period lasted approximately 7 weeks at a cost of K1621. RESULTS In 2014, there was an improvement in average performance between 2nd and 3rd year for each program. An average score of 15.4 (SD 4.2) was obtained in 3rd year compared to 12.8 (SD 4.9) in 2nd year (p<0.001). Meanwhile, 3rd MB ChB mean score was 12.6 (SD 3.7) compared to 10.7 (SD 3.6) in 2nd years (p<0.05). However, in 2016, both programs, 3rd year mean scores were lower than 2nd year (MB ChB 2nd year mean score was 12.0 (SD 4.3) compared to 3rd year with a mean score of 9.5 (SD 4.5), p<0.001; BDS 2nd year mean score was 10.6 (SD 4.0) compared to 3rd year mean score of 8.2 (SD 3.4), p<0.01. On average MB ChB students performed better than BDS students in all the years (p<0.05), except in 2016 when the results were comparable. CONCLUSIONS Results from the study shows that entry criteria has a correlation to academic performance as students admitted with higher grades perform much better than those with lower grades.

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

scholarly journals Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049089
Author(s):  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Eduardo Marques Macário ◽  
Giovanny Vinícius A França
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Factors Associated ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

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

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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