scholarly journals TROPONIN IS INDEPENDENTLY ASSOCIATED WITH DEATH IN PATIENTS WITH COVID: A RETROSPECTIVE STUDY

2021 ◽  
Author(s):  
Vijay Shyam-Sundar ◽  
Dan F Stein ◽  
Martina Spazzapan ◽  
Andrew Sullivan ◽  
Cathy Qin ◽  
...  
Keyword(s):  
District General Hospital ◽  
University Hospital ◽  
Electronic Patient Records ◽  
Short Term ◽  
Chi Squared ◽  
Short Term Mortality ◽  
Logistical Regression ◽  
Independent Association ◽  
Local Laboratory ◽  
Laboratory Assay

Objective: We performed a single-centre retrospective observational study investigating the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term. Methods: All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital (HUH) from 04.02.20 to 30.04.20 were eligible for inclusion. We retrospectively analysed demographic and biochemical data collected from the physical and electronic patient records according to the primary outcome of death at 28 days during hospital admission. Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5ng/l for females, >34 ng/l for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death. Results: Mean length of stay for all 402 hospitalised COVID-19 patients at HUH was 9.1 days (SD 12.0). Mean age was 65.3 years for men compared to 63.8 years for women. A chi-squared test showed that survival of COVID-19 patients was significantly higher in those with a negative troponin (p = 3.23 x10-10) compared to those with a positive troponin. In the multivariate logistical regression, lung disease, age, troponin positivity and CPAP were all significantly associated with death, with an AUC of 0.8872, sensitivity of 0.9004 and specificity of 0.6292 for the model. Within this model, troponin positivity was independently associated with short term mortality (OR 3.23, 95% CI 1.53-7.16, p=0.00278). Conclusions: We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital.

scholarly journals Investigation of the Role of the Cytomegalovirus as a Respiratory Pathogen in HIV-Infected Patients

1996 ◽  
Vol 3 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Rafael E de la Hoz ◽  
Shizu Hayashi ◽  
Darrel Cook ◽  
Christopher Sherlock ◽  
James C Hogg
Keyword(s):  
Relative Risk ◽  
Hiv Infection ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Pneumocystis Carinii ◽  
Clinical Severity ◽  
University Hospital ◽  
Respiratory Pathogen ◽  
Short Term ◽  
Short Term Mortality

OBJECTIVE:To investigate the occurrence of cytomegalovirus (CMV) pneumonitis in the setting of human immunodeficiency virus (HIV) infection and whether the presence of CMV as copathogen is associated with increased clinical severity or short term mortality in patients withPneumocystis cariniipneumonia.DESIGN:Retrospective cohort study.SETTING:Tertiary care university hospital.PATIENTS:One-hundred and fourteen HIV-infected homosexual men with pneumonia, followed for a minimum of four weeks.MEASUREMENTS:Clinical indicators of severity of pneumonia, microbiology of bronchoalveolar fluid and relative risk of short term mortality.RESULTS:Only two cases of CMV pneumonitis were found, one together withP carinii. However, 45 of the 86 patients withP cariniipneumonia were co-infected with CMV. No difference in clinical severity was detected between patients co-infected withP cariniiand CMV and those withP cariniialone. The relative risk of short term mortality was 3.64 (95% CI 0.82 to 16.18), in patients with co-infection compared with those withP cariniialone. The risk reached statistical significance for patients with earlier stages of HIV infection.CONCLUSIONS:CMV pneumonitis occurs rarely in HIV-infected patients, while CMV co-infection occurs in at least 50% of the cases ofP cariniipneumonia. Although no difference in clinical severity was detected, this study suggests that short term mortality fromP cariniipneumonia may be increased by CMV co-infection, particularly in patients with earlier stages of the disease.

scholarly journals The association between length of stay in the emergency department and short term mortality

2019 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carlsson ◽  
Ulf Ekelund ◽  
Olle Melander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Care ◽  
Mortality Rates ◽  
University Hospital ◽  
Short Term ◽  
Opposite Pattern ◽  
Prolonged Length ◽  
Short Term Mortality ◽  
Clinical Urgency

Abstract Background: Prolonged length of stay at the emergency department (ED-LOS) has been associated with increased mortality and hospital stay. The aim of this study was to investigate the association between ED-LOS and 7- and 30-days mortality in patients triaged according to Rapid Emergency Triage and Treatment System – Adult (RETTS-A), the most common used triage tool in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were included. Logistic regression analysis was used to determine association between prolonged ED-LOS and 7 and 30-days mortality rates. All patients were triaged according to the RETTS-A and subsequently separated into five quintiles of ED-LOS. Results : In patients triaged with the highest medical urgency, longer ED-LOS was associated with a lower risk for 7-days mortality, for triage priority 1: OR 0.94 (CI 95% 0.92-0.96) compared to OR 1.03 (CI 95% 0.99-1.07) for triage priority 4, and for 30-days mortality: OR 0.97 (CI 95% 0.96-0.99) OR for triage priority 1 compared to 1.03 (CI 95% 1.01-1.05) for triage priority 4. In contrast, the opposite pattern appeared evident in the 3 other triage groups, where a longer ED-LOS was generally associated with an increased mortality risk. Pro-longed ED-LOS in patients admitted to in-hospital care was associated with lower 30- and 7-days mortality independently of triage priority whereas the opposite was observed for patients not admitted to in-hospital care. Conclusion: Prolonged ED-LOS was associated with increased short term mortality in patients with lower clinical urgency and in patients not admitted to in-hospital care.

scholarly journals The association between length of stay in the emergency department and short term mortality

2020 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carlsson ◽  
Ulf Ekelund ◽  
Olle Melander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Care ◽  
University Hospital ◽  
University Hospitals ◽  
Short Term ◽  
Priority Group ◽  
Group 4 ◽  
Short Term Mortality ◽  
Clinical Urgency

Abstract Background: The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short term mortality in patients admitted to the EDs of two large University hospitals in Sweden. Methods: All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n=639 385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7 and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Results: We observed that prolonged ED-LOS was associated with increased mortality for patients with lowest triage priority (risk estimates for 30-day mortality were OR 1.49 (CI 95% 1.20-1.85) for patients with triage priority group 4 and the highest quintile of ED-LOS. No such association was observed in patients with the highest triage priority group and in patients admitted to in-hospital care. Conclusion : Our data suggest that increased ED-LOS could be associated with slightly increased short term mortality in patients with lower clinical urgency and dismissed from the ED but that this does not include patients admitted to in-hospital care.

scholarly journals Short-term mortality and prognostic factors related to status epilepticus

2015 ◽  
Vol 73 (8) ◽  
pp. 670-675 ◽  
Author(s):  
Fernando Gustavo Stelzer ◽  
Guilherme de Oliveira Bustamante ◽  
Heidi Sander ◽  
Americo Ceiki Sakamoto ◽  
Regina Maria França Fernandes
Keyword(s):  
Multivariate Analysis ◽  
Status Epilepticus ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Fatality ◽  
Epileptic Seizures ◽  
University Hospital ◽  
Short Term ◽  
Clinical Complications ◽  
Short Term Mortality

Objective Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications.

scholarly journals A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department

2018 ◽  
pp. emermed-2016-206382 ◽  
Author(s):  
Anne Kristine Servais Iversen ◽  
Michael Kristensen ◽  
Rebecca Monett Østervig ◽  
Lars Køber ◽  
György Sölétormos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Assessment ◽  
University Hospital ◽  
Short Term ◽  
Primary Analysis ◽  
Prediction Of Mortality ◽  
Short Term Mortality ◽  
Yellow Orange ◽  
Minor Injuries ◽  
Triage Level

ObjectiveTo compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).MethodsThe investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.ResultsA total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).ConclusionAgreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.

scholarly journals Sasang Constitution as a Risk Factor for Diabetes Mellitus: A Cross-Sectional Study

2009 ◽  
Vol 6 (s1) ◽  
pp. 99-103 ◽  
Author(s):  
Tae-Gyu Lee ◽  
Byunghee Koh ◽  
Sookyung Lee
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Multiple Logistic Regression ◽  
Cross Sectional ◽  
Exact Test ◽  
Chi Squared ◽  
Independent Association

Sasang Constitutional Medicine, which is a branch of traditional Korean medicine, states that medications for diabetes should be individualized according to the patient's individual constitution. However, the effect of constitution on diabetes has not been evaluated to date. Therefore, this study was conducted to determine if constitution is an independent risk factor for diabetes by comparing the prevalence and odds ratios (ORs) of the disease according to constitution. The medical records of 1443 adults who had been examined and classified based on their constitution at Kyung Hee University Hospital in Seoul, Korea were reviewed. A chi-squared test and Fisher's exact test were used to compare the prevalence of diabetes according to constitution, and multiple logistic regression was used to calculate the ORs for diabetes. The prevalence of diabetes differed significantly according to constitution (Χ2= 36.20, df = 2,P< 0.001). Specifically, the prevalence of the disease was higher in Tae-eumin (11.4%) individuals than in Soyangin (5.0%) or Soeumin (1.7%) individuals. In addition, multiple logistic regression revealed that Tae-eumin individuals had a greater risk for diabetes than Soeumin individuals. When compared to Soeumin individuals, the adjusted ORs were 2.01 (95% CI 0.77–5.26) for Soyangin individuals and 3.96 (95% CI 1.48–10.60) for Tae-eumin individuals. These results show that constitution has a significant and independent association with diabetes, which suggests that constitution is an independent risk factor for diabetes that should be considered when attempting to detect and prevent the disease.

scholarly journals The association between length of stay in the emergency department and short-term mortality

2021 ◽  
Author(s):  
Torgny Wessman ◽  
Johan Ärnlöv ◽  
Axel Carl Carlsson ◽  
Ulf Ekelund ◽  
Per Wändell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
University Hospital ◽  
University Hospitals ◽  
Short Term ◽  
Priority Level ◽  
Higher Ed ◽  
Short Term Mortality ◽  
Priority Levels ◽  
Clinical Urgency

AbstractThe detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2–4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20–1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.

scholarly journals Assessment of Metabolic Dysfunction in Sepsis in a Retrospective Single-Centre Cohort

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Julien Goutay ◽  
Juliette Perche ◽  
Aurelia Toussaint ◽  
Elodie Drumez ◽  
Michael Howsam ◽  
...  
Keyword(s):  
Sofa Score ◽  
Poor Prognosis ◽  
University Hospital ◽  
Metabolic Dysfunction ◽  
Day Hospital ◽  
Single Centre ◽  
Short Term ◽  
Comorbidity Score ◽  
Short Term Mortality ◽  
Severe Infections

Objective. Our primary aim was to assess selected metabolic dysfunction parameters, both independently and as a complement to the SOFA score, as predictors of short-term mortality in patients with infection admitted to the intensive care unit (ICU). Methods. We retrospectively enrolled all consecutive adult patients admitted to the eight ICUs of Lille University Hospital, between January 2015 and September 2016, with suspected or confirmed infection. We selected seven routinely measured biological and clinical parameters of metabolic dysfunction (maximal arterial lactatemia, minimal and maximal temperature, minimal and maximal glycaemia, cholesterolemia, and triglyceridemia), in addition to age and the Charlson’s comorbidity score. All parameters and SOFA scores were recorded within 24 h of admission. Results. We included 956 patients with infection, among which 295 (30.9%) died within 90 days. Among the seven metabolic parameters investigated, only maximal lactatemia was associated with higher risk of 90-day hospital mortality in SOFA-adjusted analyses (SOFA-adjusted OR, 1.17; 95%CI, 1.10 to 1.25; p < 0.001 ). Age and the Charlson’s comorbidity score were also statistically associated with a poor prognosis in SOFA-adjusted analyses. We were thus able to develop a metabolic failure, age, and comorbidity assessment (MACA) score based on scales of lactatemia, age, and the Charlson’s score, intended for use in combination with the SOFA score. Conclusions. The maximal lactatemia level within 24 h of ICU admission is the best predictor of short-term mortality among seven measures of metabolic dysfunction. Our combined “SOFA + MACA” score could facilitate early detection of patients likely to develop severe infections. Its accuracy requires further evaluation.

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