Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

SummaryA prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to describe the determinants of mortality among hospitalized COVID-19 patients. 186 adult patients were enrolled and all-cause mortality was found to be 36% (67/186). Those who died were older and more likely to be males (p<0.05). Temperature and respiratory rate were higher among non-survivors while Oxygen saturation was lower (p<0.05). Serum CRP, D-dimer and IL-6 were higher while SpO2 was lower on admission among non-survivors (p<0.05). Non-survivors had higher SOFA and CURB-65 scores while thrombocytopenia, lymphopenia and severe ARDS was more prevalent among them (p<0.05). Use of non-invasive ventilation in emergency room, ICU admission and invasive ventilation were associated with mortality in our cohort (p<0.05). Length of hospital stay and days of intubation were longer in non-survivors (p<0.05). Use of azithromycin, hydroxychloroquine, steroids, tocilizumab, antibiotics, IVIG or anticoagulation showed no mortality benefit (p>0.05). Multivariable logistic regression showed that age > 60 years, oxygen saturation <93% on admission, pro-calcitonin > 2 ng/ml, unit rise in temperature and SOFA score, ICU admission and sepsis during hospital stay were associated with higher odds of mortality. Larger prospective studies are needed to further strengthen these findings.Key FindingsAge greater than 60 years is associated with in-hospital mortality among COVID-19 patientsOxygen saturation less than 93% and ICU admission are associated with higher odds of mortalityInflammatory markers including CRP, Ferritin and IL-6 were significantly higher among non-survivorsSerum pro-calcitonin greater than 2 ng/ml and sepsis during hospital stay are associated with higher odds of mortality among COVID-19 patients

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Preventable hospitalizations among older patients with cognitive impairments and dementia

International Psychogeriatrics ◽

10.1017/s1041610218000960 ◽

2018 ◽

Vol 31 (3) ◽

pp. 383-391 ◽

Cited By ~ 7

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.

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Length of Hospital Stay Is Associated with a Decline in Activities of Daily Living in Hemodialysis Patients: A Prospective Cohort Study

10.21203/rs.2.10346/v2 ◽

2019 ◽

Author(s):

Tsukasa Kamitani ◽

Shingo Fukuma ◽

Sayaka Shimizu ◽

Tadao Akizawa ◽

Shunichi Fukuhara

Keyword(s):

Cohort Study ◽

Activities Of Daily Living ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Length Of Hospital Stay ◽

Hemodialysis Patients ◽

Cumulative Length ◽

The Impact

Abstract Background The impact of length of hospital stay on activities of daily living (ADLs) has not specifically been investigated among dialysis patients. Therefore, we attempt to verify the association between the length of hospital stay and the decline in ADLs among hemodialysis patients. Methods This prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). We included 2,442 hemodialysis patients aged ³ 40 years from the J-DOPPS phase V (2012–2015) and subsequently excluded those who had already lost basic activities of daily living (BADLs) as demonstrated by dependency in at least three of the five BADLs at baseline and for whom changes in ADLs had been evaluated for less than 90 days. The main exposure was the cumulative length of hospital stay during the follow-up period. The primary outcomes were a decline in at least one of the five BADLs and eight instrumental activities of daily living (IADLs). We compared risk ratios (RRs) for 30-day increments for hospital stays with 10-year increments for age and having diabetes. Results A total of 849 patients were included in the statistical analysis. The cumulative length of hospital stay was significantly associated with a risk of decline in ADLs (adjusted RRs [95% confidence intervals] per 30-day increments: 1.42 [1.15 to 1.75] for BADLs, 1.38 [1.13 to 1.68] for IADLs). The adjusted RRs [95% CI] for 10-year increments in age were 1.20 [0.96 to 1.50] and 1.21 [1.00 to 1.47]. The adjusted RRs [95% CI] for having diabetes were 1.36 [0.97 to 1.91] for BADLs and 1.38 [1.04 to 1.84] for IADLs. Conclusion The impact of a 30-day increment in the cumulative length of hospital stay on the decline in ADLs was comparable to that of a 10-year increase in age and having diabetes.

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Length of Hospital Stay Is Associated with a Decline in Activities of Daily Living in Hemodialysis Patients: A Prospective Cohort Study

10.21203/rs.2.10346/v3 ◽

2020 ◽

Author(s):

Tsukasa Kamitani ◽

Shingo Fukuma ◽

Sayaka Shimizu ◽

Tadao Akizawa ◽

Shunichi Fukuhara

Keyword(s):

Cohort Study ◽

Activities Of Daily Living ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Length Of Hospital Stay ◽

Hemodialysis Patients ◽

Cumulative Length ◽

The Impact

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Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China

BMJ Open ◽

10.1136/bmjopen-2018-021979 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021979 ◽

Cited By ~ 1

Author(s):

Qingtao Zhou ◽

Meng Wang ◽

Shuo Li ◽

Jing Zhang ◽

Qingbian Ma ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Hospital Mortality ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

University Hospital ◽

Medical Patients ◽

Chinese Cohort ◽

Length Of Icu Stay

ObjectiveTo evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis.DesignA single-centre prospective cohort study conducted from May 2015 to April 2017.SettingA tertiary care university hospital in China.ParticipantsA total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included.Main outcome measuresThe primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay.ResultsThe median age (IQR) was 78 (66–84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5–22) and 15 (9–28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate.ConclusionsBMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.

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Length of Hospital Stay Is Associated with a Decline in Activities of Daily Living in Hemodialysis Patients: A Prospective Cohort Study

10.21203/rs.2.10346/v1 ◽

2019 ◽

Author(s):

Tsukasa Kamitani ◽

Shingo Fukuma ◽

Sayaka Shimizu ◽

Tadao Akizawa ◽

Shunichi Fukuhara

Keyword(s):

Cohort Study ◽

Activities Of Daily Living ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Length Of Hospital Stay ◽

Hemodialysis Patients ◽

Cumulative Length ◽

The Impact

Abstract Background The impact of length of hospital stay on activities of daily living (ADLs) has not specifically been investigated among dialysis patients. Therefore, we attempt to verify the association between the length of hospital stay and decline in ADLs among hemodialysis patients. Methods This prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). We included 2,442 hemodialysis patients aged more than or equal to 40 years from the J-DOPPS phase V (2012–2015) and then excluded those who were not independent in more than three of the five basic activities of daily living (BADLs) and for whom changes in ADLs were evaluated for less than 90 days. The main exposure was the cumulative length of hospital stay during the follow-up period. The main outcomes were a decline in at least one of the five BADLs and eight instrumental activities of daily living (IADLs). We compared risk ratios (RRs) for 30-day increments in hospital stay with 10-year increments in age and having diabetes. Results A total of 960 patients were included in the statistical analysis. The cumulative length of hospital stay was significantly associated with a risk of decline in ADLs (adjusted RRs [95% confidence intervals] per 30-day increments: 1.42 [1.17 to 1.73] for BADLs, 1.30 [1.10 to 1.54] for IADLs). The adjusted RRs [95% CI] for 10-year increments in age were 1.20 [0.96 to 1.50] and 1.27 [1.05 to 1.54]. The adjusted RRs [95% CI] for having diabetes were 1.46 [1.06 to 2.02] for BADLs and 1.38 [1.05 to 1.81] for IADLs. Conclusion The impact of a 30-day increment in the cumulative length of hospital stay on the decline in ADLs was comparable to that of a 10-year increase in age and having diabetes.

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Comparison of QSOFA and SIRS Scores for the Prediction of Adverse Outcomes of Secondary Peritonitis in a Tertiary Teaching Hospital in Uganda: a Prospective Cohort Study

10.21203/rs.3.rs-537264/v1 ◽

2021 ◽

Author(s):

Emmanuel Nkonge ◽

Olivia Kituuka ◽

William Ocen

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Adverse Outcomes ◽

Secondary Peritonitis ◽

Mulago Hospital ◽

Prolonged Hospital Stay ◽

Prolonged Hospital

Abstract Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. Mulago hospital uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However it’s associated with delays in decision making given its partial reliance on laboratory parameters. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool, however its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in Mulago hospital, Uganda.Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis in Mulago hospital, Uganda.Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the A&E, Mulago hospital. QSOFA and SIRS scores were generated for each of the patient, with a score of ≥ 2 recorded as high risk, while a score of ≤ 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS.Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

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The effect of malnutrition at admission on length of hospital stay among adult patients in developing country: A prospective cohort study

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.12.013 ◽

2021 ◽

Vol 41 ◽

pp. 217-224

Author(s):

Yakob Desalegn Nigatu ◽

Seifu Hagos Gebreyesus ◽

Johane P. Allard ◽

Bilal Shikur Endris

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Developing Country ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Length Of Hospital Stay ◽

Adult Patients

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Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

PLoS ONE ◽

10.1371/journal.pone.0251754 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251754

Author(s):

Samreen Sarfaraz ◽

Quratulain Shaikh ◽

Syed Ghazanfar Saleem ◽

Anum Rahim ◽

Fivzia Farooq Herekar ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Oxygen Saturation ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Binary Logistic Regression ◽

Peripheral Oxygen Saturation ◽

Non Invasive Ventilation ◽

Unit Increase ◽

Lactate Levels

A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8–49.0) compared to survivors (21.8: IQR = 12.6–36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6–12) compared to survivors (5: IQR = 3–7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6–6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6–7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9–12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.

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