Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan

ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

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Risk factors for severity on admission and the disease progression during hospitalization in a large cohort of COVID-19 patients in Japan

10.1101/2021.04.02.21254809 ◽

2021 ◽

Author(s):

Mari Terada ◽

Hiroshi Ohtsu ◽

Sho Saito ◽

Kayoko Hayakawa ◽

Shinya Tsuzuki ◽

...

Keyword(s):

Risk Factors ◽

Disease Progression ◽

Chronic Respiratory Disease ◽

Major Effect ◽

Secondary Outcome ◽

List Type ◽

Public Health Perspective ◽

Healthcare Facilities ◽

Treatment Type ◽

Wide Range

AbstractObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors on worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity, and fatality.DesignA observational cohort study utilizing data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of August 31, 2020, 7,546 cases from 780 facilities have been registered. Participating facilities cover a wide range of hospitals where COVID-19 patients are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests, and were admitted to participating healthcare facilities. A total of 3,829 cases were identified from January 16 to May 31, 2020, of which 3,376 cases were included in this study.Primary and secondary outcoe measuresPrimary outcome was severe or non-severe on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2, or respiratory rate. Secondary outcome was the worst severity during hospitalization, judged by the requirement of oxygen and/or IMV/ECMO.ResultsRisk factors for severity on admission were older age, male, cardiovascular disease, chronic respiratory disease, diabetes, obesity, and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumor, and hyperlipidemia did not influence severity on admission; however it influenced worst severity. Fatality rates for obesity, hypertension, and hyperlipidemia were relatively lower.ConclusionsThis study segregated the comorbidities driving severity and death. It is possible that risk factors for severity on admission, worst severity, and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidemia, and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registrationUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453Strengths and limitations of this studyIn this article, we studied the disease progression of COVID-19, by comparing the risk factors on three points: early severity, worst severity, and fatality.Our results are useful from a public health perspective, as we provide risk factors for predicting the severity on admission and disease progression from patients’ background factors.This study pointed out the possibility that risk factors of the severity on admission, worst severity, and fatality are not consistent and may be propelled by different factors.Our data were collected from hundreds of healthcare facilities; thus data accuracy may be questionable.Also, treatment type, dosage, duration, and combination varied immensely across the facilities and we did not consider treatments prior to and during hospitalization in the analysis.

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Evaluation of Usefulness of Mannheim Peritonitis Index and APACHE II Score in Predicting Mortality and Morbidity in Patients with Peritonitis- A Prospective Diagnostic Test Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45556.14110 ◽

2020 ◽

Author(s):

D Paul Trinity Stephen ◽

Vijay Abraham ◽

Reka Karuppusami

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Sensitivity And Specificity ◽

Apache Ii ◽

Secondary Outcome ◽

Apache Ii Score ◽

Mannheim Peritonitis Index ◽

Mortality And Morbidity ◽

Icu Stay ◽

Prolonged Icu Stay

Introduction: Peritonitis, defined as inflammation of the peritoneal cavity can be of various causes, and is one of the most common surgical emergencies. This continues to be a challenge to diagnose and treat. Early intervention is essential to select patients who will need intensive care which brings out better outcome for the patients. This also helps us use the resources optimally. Over years, many scoring systems have been developed and studied to predict outcomes in patients with peritonitis. Aim: To evaluate the ability of Mannheim Peritonitis Index (MPI) and APACHE II (Acute Physiology And Chronic Health Evaluation II) scores in predicting mortality and morbidity in patients with peritonitis. Materials and Methods: A prospective, observational study was conducted at Christian Medical College and Hospital, Vellore, Tamil Nadu, India, for a period of two years from September 2014 to August 2016. A total of 78 patients were recruited for this study. These patients were scored with MPI and APACHE II scores. The primary outcome studied was in hospital death or discharge. The secondary outcome studied was morbidity in terms of local and systemic complications. The risk factors associated with mortality in patients with peritonitis were also studied. The best cut-off value for MPI and APACHE II from the data was calculated using Yuden index. The sensitivity, specificity and likelihood ratios were calculated and presented with 95% Confidence Interval(CI). The sub-group analysis was done for risk factors and complications. Results: There were more males than females. Age ≥48 years (p=0.002) and serum creatinine ≥1.3 g/dL (p=0.012) were found to be significant risk factors for mortality. The sensitivity and specificity of MPI ≥27 in predicting mortality was found to be 90% and 57% respectively. The sensitivity and specificity of APACHE II score ≥10 in predicting mortality was found to be 40% and 78%, respectively. MPI scores ≥27 were strongly associated with morbidity like prolonged ICU stay (p=0.004), mechanical ventilation requirement (p=0.001) and need for dialysis (p=0.035). Conclusion: Present study showed MPI to be a better predictor of mortality than APACHE II, though APACHE II showed better specificity. MPI score also was helpful in predicting morbidity such as prolonged ICU stay, mechanical ventilation requirement postoperatively and need for dialysis postoperatively. MPI was easier to use as it contained lesser variables. MPI could be of use in rural areas with no facility for laboratory investigations and blood gas analysis.

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A National Analysis of Inpatient Pediatric Adenoidectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211067615 ◽

2022 ◽

pp. 000348942110676

Author(s):

Flora Yan ◽

Victoria Huang ◽

Shaun A. Nguyen ◽

William W. Carroll ◽

Clarice S. Clemmens ◽

...

Keyword(s):

Risk Factors ◽

Neuromuscular Disorders ◽

Multivariate Logistic Regression Analysis ◽

Chronic Respiratory Disease ◽

Bleeding Complications ◽

Complication Rates ◽

Healthy Children ◽

Cross Sectional ◽

Using Data ◽

National Analysis

Objective: Hospital admission following pediatric adenoidectomy without tonsillectomy is not well characterized. The objective of our study is to better characterize risk factors for post-operative complications in younger children undergoing inpatient adenoidectomy. Methods: A cross-sectional analysis using data derived from the Kid’s Inpatient Database (KID) was performed. Study participants included children <3 years of age who underwent an adenoidectomy and were admitted to hospitals participating in the KID for years 1997, 2000, 2003, 2006, 2009, and 2012. Descriptive statistical analysis and a multivariate logistic regression analysis were performed to identify risk factors for post-operative complication. Results: A total of 3406 children (mean age 1.1 ± 0.7 years) were included. The overall post-operative bleeding and respiratory complication rates were 0.6% and 5.4%, respectively. Children less than 18 months of age demonstrated increased rates of post-operative respiratory complications ( P = .009), but not bleeding complications ( P = .857). Presence of cardiopulmonary congenital malformations (OR 1.54, 95% CI 1.07-2.20), chronic respiratory disease of the newborn (OR 5.03, 95% CI 2.86-8.85), and neuromuscular disorders (OR 1.97, 95% CI 1.09-3.57) were associated with post-operative respiratory distress. Conclusions: This analysis of a national dataset suggests that otherwise healthy children less than 18 months of age and children 18 months to 3 years of age with certain comorbidities may benefit from overnight observation following adenoidectomy.

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398. Risk Factors Associated with Requiring Invasive Mechanical Ventilation in Patients with SARS-CoV-2 Infection: Experience in a Tertiary Care Hospital in Mexico City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.593 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S268-S268

Author(s):

Brian Ricardo Garibay-Vega ◽

Paulo F Castañeda-Mendez ◽

José Luis Castillo-Álvarez ◽

Armando Barragán-Reyes ◽

Daniela Bay-Sansores ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Mechanical Ventilation ◽

High Blood Pressure ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Care Hospital ◽

Laboratory Studies ◽

Obesity Hypertension ◽

D Dimer

Abstract Background The clinical presentation of SARS-CoV-2 disease ranges from asymptomatic respiratory infection to acute respiratory distress syndrome. Risk factors upon hospital admission associated with the need for invasive mechanical ventilation are not well documented. Methods 185 hospitalized patients with confirmed COVID-19 were enrolled in this study, and they were classified as patients who required invasive mechanical ventilation and patients who did not require it. Comorbidities such as diabetes, high blood pressure, obesity, chronic lung disease and immunodeficiency were recorded. Laboratory studies were requested upon admission such as C-reactive protein, leukocyte and lymphocyte levels, D-dimer, troponin, serum ferritin and procalcitonin. Results Of the patients who entered the study, 65 patients (35%) required invasive mechanical ventilation (IMV), while 120 (65%) did not require advanced airway management. Of the patients with invasive mechanical ventilation, age > 65 years, male sex, obesity (BMI > 30) and high blood pressure were the most frequent characteristics, presenting the latter two in 26% and 27% respectively. Regarding laboratory studies, the parameters most associated with the requirement for mechanical ventilation were a D-dimer (> 1000) and troponin (> 1), with 26% and 18%, respectively. Conclusion This study showed the high proportion of obesity, hypertension and advanced age among patients who required invasive mechanical ventilation associated with SARS-CoV2 infection. The presence of elevated D-dimer and troponin on admission are associated with more severe presentations and a requirement for invasive mechanical ventilation. Disclosures All Authors: No reported disclosures

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Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic: a systematic review

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00993-w ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Alexandra Peters ◽

Nasim Lotfinejad ◽

Rafael Palomo ◽

Walter Zingg ◽

Pierre Parneix ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Ethylene Oxide ◽

Peracetic Acid ◽

Grey Literature ◽

Ultra Violet ◽

Secondary Outcome ◽

Healthcare Facilities ◽

Physical Integrity ◽

Ultra Violet Radiation ◽

Registration Number

Abstract Background With the current COVID-19 pandemic, many healthcare facilities have been lacking a steady supply of filtering facepiece respirators. To better address this challenge, the decontamination and reuse of these respirators is a strategy that has been studied by an increasing number of institutions during the COVID-19 pandemic. Methods We conducted a systematic literature review in PubMed, PubMed Central, Embase, and Google Scholar. Studies were eligible when (electronically or in print) up to 17 June 2020, and published in English, French, German, or Spanish. The primary outcome was reduction of test viruses or test bacteria by log3 for disinfection and log6 for sterilization. Secondary outcome was physical integrity (fit/filtration/degradation) of the respirators after reprocessing. Materials from the grey literature, including an unpublished study were added to the findings. Findings Of 938 retrieved studies, 35 studies were included in the analysis with 70 individual tests conducted. 17 methods of decontamination were found, included the use of liquids (detergent, benzalkonium chloride, hypochlorite, or ethanol), gases (hydrogen peroxide, ozone, peracetic acid or ethylene oxide), heat (either moist with or without pressure or dry heat), or ultra violet radiation (UVA and UVGI); either alone or in combination. Ethylene oxide, gaseous hydrogen peroxide (with or without peracetic acid), peracetic acid dry fogging system, microwave-generated moist heat, and steam seem to be the most promising methods on decontamination efficacy, physical integrity and filtration capacity. Interpretation A number of methods can be used for N95/FFP2 mask reprocessing in case of shortage, helping to keep healthcare workers and patients safe. However, the selection of disinfection or sterilization methods must take into account local availability and turnover capacity as well as the manufacturer; meaning that some methods work better on specific models from specific manufacturers. Systematic registration number CRD42020193309.

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Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

10.31234/osf.io/je3ch ◽

2021 ◽

Author(s):

Ekaterina Mosolova ◽

Dmitry Sosin ◽

Sergey Mosolov

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Female Gender ◽

Assessment Tools ◽

Care Workers ◽

Younger Age ◽

Wide Range ◽

Associated Risk Factors ◽

Anxiety Depression ◽

The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

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The development of information interaction as a key element of state risk management and health protection

Sanitarnyj vrač (Sanitary Inspector) ◽

10.33920/med-08-2003-08 ◽

2020 ◽

pp. 68-76

Author(s):

S. Voronkova

Keyword(s):

Risk Factors ◽

Health Promotion ◽

Information System ◽

Information Interaction ◽

New Information ◽

Wide Range ◽

Working Age ◽

The Russian Federation ◽

Working Age Population ◽

Types Of Information

The article discusses ways to obtain information about risk factors and the health status of the population. The article describes a new information system «labor Medicine», which allows to organize the collection of a wide range of data for further analysis and application in the activities of various Executive authorities, public organizations, foundations, legal entities and citizens. It is proposed to improve this system by expanding the types of information collected, creating a passport for health promotion organizations, as well as integration with systems that are being implemented in the Russian Federation for managing the health of the working-age population in the context of state policy in the field of Informatization.

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Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

Current Vascular Pharmacology ◽

10.2174/1570161117666190619143842 ◽

2020 ◽

Vol 18 (5) ◽

pp. 431-446 ◽

Cited By ~ 3

Author(s):

George E. Fragoulis ◽

Ismini Panayotidis ◽

Elena Nikiphorou

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Current Evidence ◽

Pharmacological Intervention ◽

Cvd Risk ◽

The Past ◽

Increased Risk ◽

Cv Disease ◽

Obesity Hypertension ◽

Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

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A Phase II Safety and Efficacy Study on Prognosis of Moderate Pneumonia in COVID-19 patients with Regular Intravenous Immunoglobulin Therapy

The Journal of Infectious Diseases ◽

10.1093/infdis/jiab098 ◽

2021 ◽

Author(s):

Raman R S ◽

Vijaykumar Bhagwan Barge ◽

Anil Kumar Darivenula ◽

Himanshu Dandu ◽

Rakesh R Kartha ◽

...

Keyword(s):

Mechanical Ventilation ◽

Randomized Study ◽

Standard Of Care ◽

Immunoglobulin Therapy ◽

Clinical Trial Registry ◽

Open Label ◽

Intravenous Immunoglobulin Therapy ◽

Safety And Efficacy ◽

Therapeutic Benefits ◽

Wide Range

Abstract Background Currently, there is no specific drug for the treatment of COVID-19. Therapeutic benefits of intravenous immunoglobin (IVIG) have been demonstrated in wide range of diseases. The present study is conducted to evaluate the safety and efficacy of IVIG in the treatment of COVID-19 patients with moderate pneumonia. Methods An open-label, multicenter, comparative, randomized study was conducted on COVID-19 patients with moderate pneumonia. 100 eligible patients were randomized in 1:1 ratio either to receive IVIG + standard of care (SOC) or SOC. Results Duration of hospital stay was significantly shorter in IVIG group to that of SOC alone (7.7 Vs. 17.5 days). Duration for normalization of body temperature, oxygen saturation and mechanical ventilation were significantly shorter in IVIG compared to SOC. Percentages of patients on mechanical ventilation in two groups were not significantly different (24% Vs. 38%). Median time to RT-PCR negativity was significantly shorter with IVIG than SOC (7 Vs.18 days). There were only mild to moderate adverse events in both groups except for one patient (2%), who died in SOC. Conclusions IVIG was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19. The trial was registered under Clinical Trial Registry, India (CTRI/2020/06/026222).

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

BMJ Open ◽

10.1136/bmjopen-2021-049089 ◽

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.

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