scholarly journals Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047121
Author(s):  
Devin Incerti ◽  
Shemra Rizzo ◽  
Xiao Li ◽  
Lisa Lindsay ◽  
Vincent Yau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Model ◽  
Vital Signs ◽  
Saturation Temperature ◽  
Full Model ◽  
Good Discrimination ◽  
Hospitalised Patients ◽  
Laboratory Results ◽  
All Cause Mortality ◽  
The Usa

ObjectivesTo develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.DesignRetrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.SettingOptum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.Participants17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.Main outcome measureAll-cause mortality while hospitalised.ResultsThe full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.ConclusionAge was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

scholarly journals Risk factors for mortality among hospitalized patients with COVID-19

2020 ◽  
Author(s):  
Devin Incerti ◽  
Shemra Rizzo ◽  
Xiao Li ◽  
Lisa Lindsay ◽  
Vince Yau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vital Signs ◽  
Model Performance ◽  
Saturation Temperature ◽  
Prognostic Information ◽  
Good Discrimination ◽  
Improve Model ◽  
Laboratory Results ◽  
All Cause Mortality ◽  
Risk Patients

AbstractObjectivesTo develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.DesignRetrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores, and calibration plots in the test set.SettingOptum® de-identified COVID-19 Electronic Health Record dataset.Participants17,086 patients hospitalized with COVID-19 between February 20, 2020 and June 5, 2020.Main outcome measureAll-cause mortality during hospital stay.ResultsThe full model that included information on demographics, comorbidities, laboratory results and vital signs had good discrimination (C-index = 0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were generally similar on the training and test sets, suggesting that there was little overfitting.Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index = 0.79) was only slightly better than a model that only included age (C-index = 0.76). Across the study period, predicted mortality was 1.2% for 18-year olds, 8.4% for 55-year olds, and 28.6% for 85-year olds. Predicted mortality across all ages declined over the study period from 21.7% by March to 13.3% by May.ConclusionAge was the most important predictor of all-cause mortality although vital signs and laboratory results added considerable prognostic information with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase, and white blood cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

MO543ASSESSMENT OF RISK FACTORS FOR CARDIOVASCULAR EVENTS AND MORTALITY IN DIALYSIS PATIENTS IN THE AURORA STUDY, A RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Bengt Fellström ◽  
Niclas Eriksson ◽  
Antonia Morga ◽  
Wim Wilpshaar ◽  
James Young ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Population ◽  
Cox Regression ◽  
Coronary Revascularisation ◽  
Study Patient ◽  
Full Model ◽  
Risk Equation ◽  
Fatal Stroke ◽  
C Statistic ◽  
All Cause Mortality

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at higher risk of cardiovascular disease (CVD), which can also lead to end-stage renal disease (ESRD).1 As anaemia is an independent risk factor for CVD,2 treating anaemia might reduce CV events in this patient population. This study aimed to evaluate the impact of anaemia and other risk factors on long-term CV risk in haemodialysis (HD) patients with CKD. A secondary aim was to establish a CV risk equation for this patient population. Method This retrospective study used data from the Phase 3 AURORA study (NCT04042350) of 2776 ESRD patients aged 50–80 years receiving regular HD/haemofiltration, for a mean 3.2 year follow up.3 The primary endpoint of our analysis was time to first major adverse cardiovascular event (CV MACE; non-fatal stroke, non-fatal myocardial infarction, and CV mortality; n=804). Secondary endpoints included time to non-fatal stroke (ischaemic or haemorrhagic; n=98), coronary revascularisation therapy (n=300) and all-cause mortality (n=1296), and development of a CV risk equation. Ferritin and transferrin baseline values were determined for this analysis using the original frozen AURORA study patient samples (>10 years old). Statistical analyses were performed using univariate and multiple Cox regression models. For each outcome a full model was estimated and then simplified by approximation with fewer factors. This was done using linear regression against the linear predictor of the full Cox regression model. In a stepwise manner, the least contributing variable was removed until the subset of variables approximated the full model to 95%. Model performance was measured using the C-statistic, and internally validated using bootstrap. Results Incidence rates for CV MACE, non-fatal stroke, coronary revascularisation, and all-cause mortality were 9.36, 1.11, 3.57, and 13.73 per 100 patient-years, respectively. Certain established risk factors among HD patients, such as age, gender, previous history of CVD, diabetes mellitus, smoking, blood pressure, high phosphate and C-reactive protein levels, and low albumin levels, were also findings for this study, although non-fatal stroke was underpowered to show significance (Table). Elevated haemoglobin levels (≥127 g/L) demonstrated a protective effect on the risk of all-cause mortality (hazard ratio [HR] 0.916, p=0.010 for 127 g/L [upper quartile] versus 107 g/L [lower quartile]), but were also associated with an increased risk of coronary revascularisations (HR 1.164, p=0.011 for 127 g/L versus 107 g/L). Haemoglobin levels ≤107 g/L were associated with an approximately 9% increased annual risk of mortality (HR 1/0.916=1.092). Elevated ferritin and transferrin levels were significant and independent risk factors for CV MACE (HR [95% CI] 1.130 [1.025, 1.246] and 1.202 [0.987, 1.464], respectively), and all-cause mortality (HR [95% CI] 1.088 [1.008, 1.174] and 1.402 [1.198,1.641], respectively), but further analyses of iron metabolism markers, such as hepcidin, are needed to draw meaningful conclusions. The age of the samples may have also impacted the results. Risk prediction models were developed, and the predictive ability was 0.66–0.68 (C-statistic). Conclusion This analysis confirmed that this cohort is representative of a HD population. Moreover, elevated haemoglobin levels were associated with increased survival, concomitantly with coronary revascularisation. Elevated ferritin and transferrin levels were identified as potential risk factors for CV MACE and all-cause mortality, but further studies are required to better understand their value in estimating CV risk. Risk predication models were developed and performed well but require validation against an independent patient cohort.

scholarly journals The All-Cause Mortality and a Screening Tool to Determine High-Risk Patients among Prevalent Type 2 Diabetes Mellitus Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Mohamad Adam Bujang ◽  
Pei Xuan Kuan ◽  
Xun Ting Tiong ◽  
Fatin Ellisya Saperi ◽  
Mastura Ismail ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Prognostic Model ◽  
Screening Tool ◽  
All Cause Mortality ◽  
Risk Patients

Aims. This study aims to determine the all-cause mortality and the associated risk factors for all-cause mortality among the prevalent type 2 diabetes mellitus (T2DM) patients within five years’ period and to develop a screening tool to determine high-risk patients. Methods. This is a cohort study of T2DM patients in the national diabetes registry, Malaysia. Patients’ particulars were derived from the database between 1st January 2009 and 31st December 2009. Their records were matched with the national death record at the end of year 2013 to determine the status after five years. The factors associated with mortality were investigated, and a prognostic model was developed based on logistic regression model. Results. There were 69,555 records analyzed. The mortality rate was 1.4 persons per 100 person-years. The major cause of death were diseases of the circulatory system (28.4%), infectious and parasitic diseases (19.7%), and respiratory system (16.0%). The risk factors of mortality within five years were age group (p<0.001), body mass index category (p<0.001), duration of diabetes (p<0.001), retinopathy (p=0.001), ischaemic heart disease (p<0.001), cerebrovascular (p=0.007), nephropathy (p=0.001), and foot problem (p=0.001). The sensitivity and specificity of the proposed model was fairly strong with 70.2% and 61.3%, respectively. Conclusions. The elderly and underweight T2DM patients with complications have higher risk for mortality within five years. The model has moderate accuracy; the prognostic model can be used as a screening tool to classify T2DM patients who are at higher risk for mortality within five years.

scholarly journals Difference in the clinical outcome of bloodstream infections caused by Klebsiella aerogenes and Enterobacter cloacae complex

2021 ◽  
Author(s):  
Minji Jeon ◽  
Kyungmin Huh ◽  
Jae-Hoon Ko ◽  
Sun Young Cho ◽  
Hee Jae Huh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Bloodstream Infections ◽  
Enterobacter Cloacae ◽  
Klebsiella Aerogenes ◽  
Retrospective Case ◽  
Hospitalised Patients ◽  
All Cause Mortality ◽  
Independent Risk Factors ◽  
Enterobacter Cloacae Complex

Abstract Background The difference in clinical outcomes between Klebsiella aerogenes (formerly Enterobacter aerogenes) bacteremia (KAB) and Enterobacter cloacae complex bacteremia (ECB) is controversial. Objectives We compared the clinical outcomes of patients with KAB and ECB and examined the risk factors associated with mortality. Methods We conducted a retrospective case-control study of hospitalised patients with monobacterial KAB and ECB between January 2011 and June 2020. The primary outcome measure was 30-day all-cause mortality. Multiple logistic regression and propensity-score (PS) matching were used to identify independent risk factors for mortality. The models included demographic characteristics, comorbidities, recent healthcare contact, patient status at the onset of bacteremia, and severity of infection as covariates. Results A total of 282 patients with KAB or ECB were included, among whom 194 patients were selected after PS matching. The 30-day all-cause mortality rate was higher in the ECB group than in the KAB group (24.1% vs. 10.6%, p=0.003). In a multivariable model, ECB was an independent risk factor for 30-day mortality in both overall and PS-matched cohorts (adjusted odds ratio, 3.528; 95% confidence interval, 1.614–7.714; P=0.002). Stay in the intensive care unit at the onset of bacteremia and higher Pitt bacteremia score were found to be independent risk factors for 30-day mortality. Conclusion In our study, mortality was significantly higher in patients with ECB than in those with KAB. Further studies are warranted to clarify the virulence mechanisms of E. cloacae complex.

scholarly journals Do specific delirium aetiologies have different associations with death? A longitudinal cohort of hospitalised patients

2021 ◽  
Author(s):  
Louis A. Chalmers ◽  
Samuel D. Searle ◽  
Jon Whitby ◽  
Alex Tsui ◽  
Daniel Davis
Keyword(s):  
Hospital Admissions ◽  
Total Mortality ◽  
Acute Hospital ◽  
Important Predictor ◽  
Longitudinal Cohort ◽  
Hospitalised Patients ◽  
Laboratory Results ◽  
All Cause Mortality ◽  
Hospital Patients ◽  
Time Of Admission

Abstract Purpose To describe aetiology-specific associations with mortality among older hospital patients with delirium. Methods Over 21 months, a cohort of 1702 patients with 2471 acute hospital admissions (median age 85, IQR 80–90, 56% women) were assessed for delirium, categorised with inflammatory and metabolic aetiologies based on available laboratory results, and followed up for all-cause mortality. Interactions between aetiology and delirium were tested. Results The total mortality for the cohort was 35.2%. While inflammation, metabolic disturbance, and delirium at time of admission all demonstrated independent associations with mortality, there was no evidence for any interactions between delirium and these laboratory-measured aetiologies. Conclusions Delirium remains an important predictor of death in older hospital patients, irrespective of underlying aetiology.

scholarly journals Hospital admission with non-alcoholic fatty liver disease is associated with increased all-cause mortality independent of cardiovascular risk factors

2019 ◽  
Author(s):  
Jake P. Mann ◽  
Paul Carter ◽  
Matthew J. Armstrong ◽  
Hesham K Abdelaziz ◽  
Hardeep Uppal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Hospitalised Patients ◽  
All Cause Mortality ◽  
Alcoholic Fatty Liver Disease

AbstractBackgroundNon-alcoholic fatty liver disease (NAFLD) is common and strongly associated with the metabolic syndrome. Though NAFLD may progress to end-stage liver disease, the top cause of mortality in NAFLD is cardiovascular disease (CVD). Most of the data on liver-related mortality in NAFLD derives from specialist liver centres. We aimed to assess mortality in NAFLD when adjusting for CVD in a ‘real world’ cohort of inpatients.MethodsRetrospective study of hospitalised patients with 14-years follow-up. NAFL (non-alcoholi c fatty liver), non-alcoholic steatohepatitis (NASH), and NAFLD-cirrhosis groups were defined by ICD-10 codes using ACALM methodology. Cases were age-/sex-matched 1:10 with non-NAFLD hospitalised patients from the ACALM registry. All-cause mortality was compared between groups using cox regression adjusted for CVD and metabolic syndrome risk factors.ResultsWe identified 1238 patients with NAFL, 105 with NASH and 1235 with NAFLD-cirrhosis. There was an increasing burden of cardiovascular disease with progression from NAFL to NASH to cirrhosis. After adjustment for demographics, metabolic syndrome components and cardiovascular disease, patients with NAFL, NASH, and cirrhosis all had increased all-cause mortality (HR 1.3 (CI 1.1-1.5), HR 1.5 (CI 1.0-2.3) and HR 3.5 (CI 3.3-3.9), respectively). Hepatic decompensation (NAFL HR 8.0 (CI 6.1-10.4), NASH HR 6.5 (2.7-15.4) and cirrhosis HR 85.8 (CI 72-104)), and hepatocellular carcinoma were increased in all NAFLD groups.ConclusionThere is a high burden of cardiovascular disease in NAFLD-cirrhosis patients. From a large “real-life” non-specialist registry of hospitalized patients, NAFLD patients have increased overall mortality and rate of liver-related complications compared to controls after adjusting for cardiovascular disease.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

scholarly journals Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study

2021 ◽  
Vol 36 (3) ◽  
pp. 287-298
Author(s):  
Jonathan Bergman ◽  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Long Term Care ◽  
Care Facility ◽  
Prescription Medication ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
All Cause Mortality

AbstractWe conducted a nationwide, registry-based study to investigate the importance of 34 potential risk factors for coronavirus disease 2019 (COVID-19) diagnosis, hospitalization (with or without intensive care unit [ICU] admission), and subsequent all-cause mortality. The study population comprised all COVID-19 cases confirmed in Sweden by mid-September 2020 (68,575 non-hospitalized, 2494 ICU hospitalized, and 13,589 non-ICU hospitalized) and 434,081 randomly sampled general-population controls. Older age was the strongest risk factor for hospitalization, although the odds of ICU hospitalization decreased after 60–69 years and, after controlling for other risk factors, the odds of non-ICU hospitalization showed no trend after 40–49 years. Residence in a long-term care facility was associated with non-ICU hospitalization. Male sex and the presence of at least one investigated comorbidity or prescription medication were associated with both ICU and non-ICU hospitalization. Three comorbidities associated with both ICU and non-ICU hospitalization were asthma, hypertension, and Down syndrome. History of cancer was not associated with COVID-19 hospitalization, but cancer in the past year was associated with non-ICU hospitalization, after controlling for other risk factors. Cardiovascular disease was weakly associated with non-ICU hospitalization for COVID-19, but not with ICU hospitalization, after adjustment for other risk factors. Excess mortality was observed in both hospitalized and non-hospitalized COVID-19 cases. These results confirm that severe COVID-19 is related to age, sex, and comorbidity in general. The study provides new evidence that hypertension, asthma, Down syndrome, and residence in a long-term care facility are associated with severe COVID-19.

scholarly journals Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Victor Garcia-Bustos ◽  
Ana Isabel Renau Escrig ◽  
Cristina Campo López ◽  
Rosario Alonso Estellés ◽  
Koen Jerusalem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Incontinence ◽  
Multidrug Resistance ◽  
Urinary Tract ◽  
Prospective Cohort ◽  
Bacterial Infections ◽  
Cohort Analysis ◽  
Term Care ◽  
Hospitalised Patients ◽  
Tract Infections

AbstractUrinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

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