Tocilizumab shortens time on mechanical ventilation and length of hospital stay in patients with severe COVID‐19: a retrospective cohort study

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

Download Full-text

A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

Disease Markers ◽

10.1155/2021/5598824 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Kang Li ◽

Chi Zhang ◽

Ling Qin ◽

Chaoran Zang ◽

Ang Li ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Characteristic Curve ◽

Length Of Hospital Stay ◽

Cox Proportional Hazards ◽

Brier Score ◽

Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence interval CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

Download Full-text

P-OGC74 Effect of pre-operative anaemia on short-term outcomes following oesophagectomy: a 10-year retrospective cohort study

British Journal of Surgery ◽

10.1093/bjs/znab430.202 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Siobhan Chien ◽

Khurram Khan ◽

Lewis Gall ◽

Liam Deboys ◽

Carol Craig ◽

...

Keyword(s):

Cohort Study ◽

Blood Transfusion ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

Short Term ◽

Operative Complications ◽

The Impact ◽

Post Operative Complications

Abstract Background Pre-operative anaemia is associated with increased length of hospital stay, requirement for allogenic blood transfusion, post-operative complications and mortality. Oesophagectomy is a complex procedure associated with significant physiological insult, thus pre-operative patient optimisation is imperative to improve clinical outcomes. This study aimed to determine the impact of pre-operative anaemia on short-term outcomes following oesophagectomy for benign and malignant disease. Methods A retrospective cohort study of all oesophagectomies performed in a single tertiary referral centre between 1 January 2010 and 31 December 2019 was performed. Patients were identified from a prospectively collected database and individual patient electronic records were interrogated. Patients were dichotomised into two groups, based on the most recent pre-operative haemoglobin. Patients with pre-operative anaemia (haemoglobin <130mg/L in males and <120mg/L in females) were compared to those without pre-operative anaemia. Patients with missing data were excluded from the study. Patients were followed up for a median of 32 months (IQR 18-66). Results Of 352 patients eligible for inclusion, 173 (49.1%) patients were anaemic immediately pre-operatively. Patients with pre-operative anaemia were older (66 vs. 64 years, p = 0.031), with a lower anaerobic threshold (11.7 vs. 12.3ml/min/kg, p = 0.011), and were significantly more likely to have undergone neoadjuvant chemotherapy (91.3% vs. 78.8%, p < 0.001). Patient comorbidities and disease-related characteristics were similar between the two groups. Patients with pre-operative anaemia were significantly more likely to require post-operative blood transfusion (34.7% vs. 16.8%; p < 0.001). However, pre-operative anaemia was not associated with increased post-operative complications, intensive care admission, length of hospital stay, or 30- and 90-day mortality rates following oesophagectomy. Conclusions Patients with anaemia immediately prior to undergoing an oesophagectomy were significantly more likely to require post-operative blood transfusion. However, pre-operative anaemia was not associated with an increased rate of post-operative morbidity or mortality. In addition, pre-operative iron transfusion is becoming increasingly utilised to minimise the incidence of pre-operative anaemia: this was not analysed in this study.

Download Full-text

Phase Angle is associated with Length of Hospital Stay, Readmissions, Mortality, and Falls in Patients Hospitalized in Internal Medicine: a Retrospective Cohort Study

Nutrition ◽

10.1016/j.nut.2020.111068 ◽

2020 ◽

pp. 111068

Author(s):

Rosaria Del Giorno ◽

Massimo Quarenghi ◽

Kevyn Stefanelli ◽

Alice Rigamonti ◽

Carlotta Stanglini ◽

...

Keyword(s):

Internal Medicine ◽

Cohort Study ◽

Hospital Stay ◽

Phase Angle ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay

Download Full-text

Intravenous Immunoglobulin-based Adjuvant Therapy for Severe COVID-19: a Single-center Retrospective Cohort Study

10.21203/rs.3.rs-258587/v1 ◽

2021 ◽

Author(s):

Xiao Hou ◽

Li Tian ◽

Lei Zhou ◽

Xinhua Jia ◽

Li Kong ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Adjuvant Therapy ◽

Hospital Stay ◽

Retrospective Cohort ◽

Primary Outcome ◽

Length Of Hospital Stay ◽

Confounding Factors ◽

Single Center ◽

Significant Difference

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG.Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay.Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared with the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P=0.008]. However, there was no statistically significant difference in the primary outcome between the two groups (P=0.167) after adjusting for confounding factors. Patients in the IVIG group had a longer hospital stay [23.0 (19.0-31.0) vs 16.0 (13.8-22.0), P<0.001]. After adjusting for confounding factors, there was still a statistically significant difference between the two groups (P=0.041).Conclusion Adjuvant therapy with IVIG did not improve the in-hospital mortality rate or the need for mechanical ventilation in patients with severe COVID-19. In contrast, the application of IVIG was related to a longer hospital stay.

Download Full-text

LACK OF ASSOCIATION BETWEEN CONVALESCENT PLASMA ADMINISTRATION AND LENGTH OF HOSPITAL STAY: A HOSPITAL-DAY STRATIFIED MULTI-CENTER RETROSPECTIVE COHORT STUDY

10.1101/2021.05.04.21256627 ◽

2021 ◽

Author(s):

Joy Alamgir ◽

Ruhul Abid ◽

Brian T Garibaldi ◽

Naved Munir ◽

Soko Setoguchi ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

The United States ◽

Competing Risk ◽

Survival Models ◽

Hospital Death ◽

Cox's Regression

Background: Effects of timing of Convalescent plasma (CP) administration on hospitalized COVID-19 patients are not established. Methods: We used the National COVID Cohort Collaborative data to perform a retrospective cohort study of hospitalized COVID-19 patients in the United States between 07-01-2020 and 12-19-2020. We stratified patients based on day of CP administration (Day 0, 1, 2, 3 and 4) from COVID-19 diagnosis. We used 35 predictors to frame matched cohorts accounting for clinical and sociodemographic characteristics. We used competing risk survival models to examine the association between CP administration and length of hospital stay with in-hospital death as a competing risk performing Gray's test on the cumulative incidence function and Cox's regression on cause specific hazard ratios. Results: In a cohort of 4,003 hospitalized COVID-19 patients, 197 (4.9%) received CP within the first 5 days following COVID-19 diagnosis. After adjusting for potential confounding variables, there were no statistically significant associations between day of CP administration and length of hospital stay. Day 0 CP administration signallled lower mortality but was not statistically significant (HR 0.45 [0.19-1.03]). Conclusions: We found no association between the timing of CP administration and length of stay among hospitalized COVID-19 patients.

Download Full-text

Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

10.21203/rs.3.rs-754089/v1 ◽

2021 ◽

Author(s):

Chenwei Lv ◽

Jing Hu ◽

Xingxing Hu ◽

Jiangyun Liu

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Drug Use ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Serum Magnesium ◽

Vasoactive Drug ◽

Magnesium Supplementation ◽

Length Of Icu Stay

Abstract Objective Existing studies have shown that the incidence of hypomagnesemia may be as high as 60%. However, the correlation between hypomagnesia and sepsis mortality remains elusive. The current study evaluated the effect of hypomagnesemia on the prognosis of patients with sepsis in ICU. Methods It was a retrospective cohort study based on an online database named MIMIC III. A total of 1448 sepsis patients with serum magnesium were admitted to the database, among which 645 patients were screened out. Results At 28 days, 99 patients (30.84%) in the hypomagnesemia group and 123 patients (38.0%) (P = 0.06) in the non-hypomagnesemia group died. There was no correlation between hypomagnesemia and 28-day mortality in patients with sepsis (HR = 1.07; P = 0.87, 95% CI). However, the duration of mechanical ventilation (P < 0.01), the duration of vasoactive drug use (P < 0.01), the length of ICU stay (P < 0.01), and the length of hospital stay (P < 0.01) of patients in the hypomagnesemia group were higher than those in the non-hypomagnesemia group. In the subgroup analysis, the time of no vasopressor (P < 0.01) and the time of no mechanical ventilation (P < 0.01) in the magnesium supplementation group were significantly longer than those in the non-magnesium supplementation group. More importantly, the 14-day mortality (30.8% vs 48.9%, P < 0.01) and 28-day mortality (33.8% vs 48.9%, P = 0.03) in patients with magnesium supplementation were lower than patients without magnesium supplementation. Conclusions For sepsis patients in ICU, although hypomagnesemia had no significant correlation with 28-day mortality, it still prolonged the duration of mechanical ventilation and vasoactive drug use, and increased the length of ICU stay and hospital stay. Even for patients with normal serum magnesium levels, optimizing serum magnesium levels may improve the prognosis of patients with sepsis.

Download Full-text