scholarly journals Pregnancy and risk of COVID-19

2021 ◽  
Author(s):  
Maria C. Magnus ◽  
Laura Oakley ◽  
Håkon K. Gjessing ◽  
Olof Stephansson ◽  
Hilde M. Engjom ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Regression Models ◽  
Cox Regression ◽  
Severe Disease ◽  
Positive Test ◽  
Specialist Care ◽  
Hazard Ratios ◽  
Increased Risk ◽  
To Receive ◽  
Similar Risk

AbstractBackgroundStudies report that pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, intensive-care and death. Whether pregnant women in general are more susceptible of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear.MethodsLinked registry-data on all women ages 15 to 45 living in Norway on March 1st, 2020 (N=1,033,699) were used in Cox regression models to estimate hazard ratios (HR) comparing pregnant to non-pregnant women, of having a positive test for SARS-CoV-2, a diagnosis of COVID-19 in specialist healthcare, or hospitalization with COVID-19, adjusting for age, marital status, education, income, country of birth and underlying medical conditions.ResultsCompared to non-pregnant women, pregnant women had a similar risk of a positive SARS-CoV-2 test (adjusted HR, 0.99; 95% confidence interval [CI], 0.92 to 1.07), a higher risk of a COVID-19 diagnosis in specialist care (HR, 3.46; 95% CI, 2.89 to 4.14), and to be hospitalized (HR, 4.70; 95% CI, 3.51 to 6.30). Pregnant women were in general not more likely to be tested for SARS-CoV-2. Pregnant women born outside Scandinavia were less likely to be tested, but at higher risk of a positive test (HR, 2.37; 95% CI, 2.51 to 8.87) and of hospitalization with COVID-19 (HR, 4.72; 95% CI, 2.51 to 8.87) than pregnant Scandinavian born women.ConclusionPregnant women were not more likely to be infected with SARS-CoV-2. However, pregnant women with COVID-19, especially those born outside of Scandinavia, were more likely to receive specialist care and to be hospitalized.

scholarly journals Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

2020 ◽  
Author(s):  
Fangfei Xiang ◽  
Jing Sun ◽  
Po-Hung Chen ◽  
Peijin Han ◽  
Haipeng Zheng ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Early Stage ◽  
Severe Disease ◽  
High Flow ◽  
Adverse Outcomes ◽  
Prolonged Hospitalization ◽  
Severe Stage ◽  
Increased Risk ◽  
High Flow Oxygen

Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

scholarly journals Influenza Hospitalizations during Childhood in Children born Preterm

2021 ◽  
Author(s):  
Siri Hauge ◽  
Birgitte De Blasio ◽  
Siri E Håberg ◽  
Laura Oakley
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
National Registry ◽  
Elevated Risk ◽  
Early Term ◽  
Very Preterm ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Influenza Vaccinations ◽  
National Registry Data

Objective: To determine if children born preterm were at increased risk of influenza hospitalization up to age five. Methods: National registry data on all children born in Norway between 2008 and 2011 was used in Cox regression models to estimate adjusted hazard ratios (aHR) for influenza hospitalizations up to age five in children born preterm (<37 pregnancy weeks). HRs were also estimated separately for very preterm (<32 weeks), early term (37-38 weeks), and post-term (≥42 weeks) children. Results: Among 238 628 children born in Norway from January 2008 to December 2011, 15 086 (6.3%) were born preterm. There were 754 (0.3%) children hospitalized with influenza before age five. The rate of hospitalizations in children born preterm was 1.4 per 10 000 person-years (95% confidence interval [CI]: 1.1-1.7), and 0.6 per 10 000 person-years (95% CI: 0.5-0.6) in children born at term (≥37 weeks). Children born preterm had a higher risk of influenza hospitalization before age 5: aHR 2.33 (95% CI: 1.85-2.93). The risk increased with decreasing gestational age and was highest among those born very preterm; aHR 4.07 (95% CI: 2.63-6.31). Compared to children born at 40-41 weeks, children born early term also had an elevated risk of influenza hospitalization; aHR (37 weeks) 1.89 (95% CI: 1.43-2.40), aHR (38 weeks) 1.43 (95% CI: 1.15-1.78). Conclusion: Children born preterm had a higher risk of influenza hospitalizations before age five. An elevated risk was also present among children born at an early term. Children born preterm would benefit from influenza vaccinations.

scholarly journals Association of Maternal Hypothyroidism With Cardiovascular Diseases in the Offspring

2021 ◽  
Vol 12 ◽  
Author(s):  
Maohua Miao ◽  
Hui Liu ◽  
Wei Yuan ◽  
Nicolas Madsen ◽  
Yongfu Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Genetic Background ◽  
Regression Models ◽  
Cox Regression ◽  
Population Based ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Familial Environment ◽  
Shared Genetic

BackgroundNo previous study has examined the effect of maternal hypothyroidism on a broad spectrum of cardiovascular disease (CVD) endpoints in the offspring.MethodsA nationwide population-based cohort study based on the linkage of several Danish nationwide registries was conducted to explore whether maternal hypothyroidism is associated with offspring’s CVD. Altogether 1,041,448 singletons born between the 1st of January 1978 and the 31st of December 1998 were investigated from the age of 8 years to the 31st of December 2016. Exposure was maternal diagnosis of hypothyroidism across lifespan and the outcome of interest was a CVD diagnosis in the offspring. Cox regression models were performed to estimate the hazard ratios (HRs) of CVD.ResultsOffspring born to mothers with hypothyroidism had an increased risk of CVD (hazard ratios (HR)=1.23, 95% confidence interval (CI): 1.12-1.35), and of several subcategories of CVD including hypertension, arrhythmia, and acute myocardial infarction in offspring. The magnitude of association was the most pronounced in an exposure occur during pregnancy (HR=1.71, 95% CI: 1.10-2.67), which is consistent across all the subgroup analysis, including sibling analysis.ConclusionsMaternal hypothyroidism is associated with an increased risk of CVD in offspring. Thyroid hormone insufficiency during pregnancy may predominantly contribute to the observed associations; however, the effects of a shared genetic background and a time-stable familial environment/lifestyle factors cannot be excluded.

scholarly journals Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

2020 ◽  
Author(s):  
Fangfei Xiang ◽  
Jing Sun ◽  
Po-Hung Chen ◽  
Peijin Han ◽  
Haipeng Zheng ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Early Stage ◽  
Severe Disease ◽  
High Flow ◽  
Adverse Outcomes ◽  
Prolonged Hospitalization ◽  
Severe Stage ◽  
Increased Risk ◽  
High Flow Oxygen

Abstract Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. We sought to evaluate the association between FIB-4 at an early stage of infection and COVID-19 outcomes. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (&gt;30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (&gt;3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4&gt;3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

scholarly journals In-Hospital Glycemic Dysregulation Associated With Worse Outcomes in COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A346-A346
Author(s):  
Lisette Patricia Rodriguez ◽  
Vida Farhangi ◽  
Julaine Braham ◽  
Robert A Smith ◽  
Wilhelmine Wiese-Rometsch
Keyword(s):  
Coefficient Of Variation ◽  
Regression Models ◽  
Operating Characteristic ◽  
Cox Regression ◽  
Severe Disease ◽  
Composite Outcome ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Test ◽  
Significant Covariates

Abstract Introduction: Evidence establishes that COVID-19 patients with DM2 are at increased risk for severe disease and worse outcomes. Peer reviewed data is sparse comparing glycemic control and clinical outcomes among COVID-19 patients with vs. without DM2, and thus we sought to address this gap. Methods: We selected patients at least 18 years old who expired or were discharged between March 16, 2020 through September 15, 2020. Principal analysis compared glycemic patterns among patients with DM2 vs. non-DM2. Median, coefficient of variation (CV), maximum and minimum glucose parameters were computed to characterize longitudinal glycemic patterns. Logistic regression modeling identified significant (p&lt;.05) associations between composite outcome vs. glycemic parameters and putative risks for progression to severe COVID-19. Receiver operating characteristic (ROC) curve identified cut points for glycemic parameters. Cox regression models were employed to control for significant confounders. Continuous data summarized as median was compared using Kruskal-Wallis test. Discrete data were compared with Pearson’s chi-square test. Two-tailed p&lt;.05 was significant. Results: Among 494 patients, 157 (32%) had DM2 with no intergroup differences in age (68 [56–79]), sex (52% male, 48% female), or race (68% Caucasian, 19% Other, 13% African American). Insulin was administered to DM2 (93%) and non-DM2 (54%) patients (p&lt;.0001). Comorbidities were more prevalent in DM2, including cardiovascular (68% vs. 54%, p=.003), renal (72% vs. 52%, p&lt;.0001) and obesity (51% vs. 38%, p&lt;.0001). Markers including D-dimer (0.98 [0.61–1.95] mg/L), lactate dehydrogenase (308 [230–392] U/L), ferritin (436 [174–856] ng/mL), and triglycerides (172 [109–239] mg/dL), were not different in DM2 vs. non-DM2 (p&gt;.05). CRP was greater in patients with (8.6 [3.6–14.6]) vs. without (6.1 [2.0–12.6]) DM2 (p=.005). Baseline glucose in DM2 (163 [121–253] mg/dL) vs. non-DM2 (107 [96–124] mg/dL) was significantly greater, with former an independent predictor of composite outcome (p=.0005). Cox modeling of other glucose parameters in DM2 vs. non-DM2 demonstrated various impact regarding risk for composite outcome including median (155 [128–209], p=.46) vs. (103 [94–118], p=.09); coefficient of variation (28 [19–38], p=.08) vs. (15 [9–20], p=.002); maximum (252 [187–362], p=.0005) vs. (129 [110–156], p=.002); and minimum (99 [79–128], p=.95) vs. (89 [81–98], p=.02). The unified baseline glucose cut point for composite outcome risk controlled for significant covariates was 138 gm/dL (p&lt;.0001), which included respectively 20% and 10% of patients with and without DM2. Conclusion: Glycemic dysregulation in COVID-19 patients is independently associated with ICU admission and/or hospital mortality. Presence of DM2 amplifies glycemic dysregulation, but risk stratification appears warranted in all COVID-19 patients.

scholarly journals Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Svendsen ◽  
H.W Krogh ◽  
J Igland ◽  
G.S Tell ◽  
L.J Mundal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Familial Hypercholesterolemia ◽  
Cox Regression ◽  
Public Institution ◽  
University Hospital ◽  
Funding Source ◽  
Hazard Ratios ◽  
Increased Risk ◽  
University Of Oslo

Abstract Background and aim We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls). Methods The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age. Results Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (&gt;28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95]. Conclusion This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital

scholarly journals Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood

2021 ◽  
pp. 108705472110256
Author(s):  
Lingjing Chen ◽  
Ellenor Mittendorfer-Rutz ◽  
Emma Björkenstam ◽  
Syed Rahman ◽  
Klas Gustafsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Disability Pension ◽  
Cox Regression ◽  
Related Factors ◽  
Adult Age ◽  
Work Related ◽  
Hyperactivity Disorder ◽  
Increased Risk ◽  
Similar Risk

Objective: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. Method: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19–29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. Results: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39–1.71); low educational level (HR = 1.97; 95%CI 1.60–2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35–2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17–2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66–2.80), autism (HR = 1.87; 95%CI 1.42–2.46), anxiety (HR = 1.34; 95%CI 1.22–1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. Conclusion: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.

Treatment Time or Convection Volume in HDF: What Drives the Reduced Mortality Risk?

2015 ◽  
Vol 40 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Camiel L.M. de Roij van Zuijdewijn ◽  
Menso J. Nubé ◽  
Piet M. ter Wee ◽  
Peter J. Blankestijn ◽  
Renée Lévesque ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Mortality Risk ◽  
Survival Benefit ◽  
Regression Models ◽  
Cox Regression ◽  
Treatment Time ◽  
High Volume ◽  
P Values ◽  
Hazard Ratios

Background/Aims: Treatment time is associated with survival in hemodialysis (HD) patients and with convection volume in hemodiafiltration (HDF) patients. High-volume HDF is associated with improved survival. Therefore, we investigated whether this survival benefit is explained by treatment time. Methods: Participants were subdivided into four groups: HD and tertiles of convection volume in HDF. Three Cox regression models were fitted to calculate hazard ratios (HRs) for mortality of HDF subgroups versus HD: (1) crude, (2) adjusted for confounders, (3) model 2 plus mean treatment time. As the only difference between the latter models is treatment time, any change in HRs is due to this variable. Results: 114/700 analyzed individuals were treated with high-volume HDF. HRs of high-volume HDF are 0.61, 0.62 and 0.64 in the three models, respectively (p values <0.05). Confidence intervals of models 2 and 3 overlap. Conclusion: The survival benefit of high-volume HDF over HD is independent of treatment time.

Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study

2021 ◽  
pp. oemed-2021-107764
Author(s):  
Kimmo Herttua ◽  
Linda Juel Ahrenfeldt ◽  
Tapio Paljarvi
Keyword(s):  
Oral Cancer ◽  
Chronic Diseases ◽  
Respiratory Disease ◽  
Regression Models ◽  
Cox Regression ◽  
Chronic Respiratory Disease ◽  
Police Force ◽  
Rescue Service ◽  
Active Population ◽  
Increased Risk

ObjectiveTo investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries.MethodsWe performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population.ResultsHR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases.ConclusionsWe observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

2018 ◽  
Vol 48 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Solène Guilloteau ◽  
Thierry Lobbedez ◽  
Sonia Guillouët ◽  
Christian Verger ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Regression Models ◽  
Cox Regression ◽  
French Language ◽  
Dialysis Modality ◽  
Technique Survival ◽  
Hazard Ratios ◽  
Effect Of Pd ◽  
Assisted Peritoneal Dialysis

Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

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