scholarly journals Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

2021 ◽  
Vol 38 (5) ◽  
pp. 366-370
Author(s):  
Marcus J Lyall ◽  
Nazir I Lone
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Hospital Death ◽  
Hospital Inpatient ◽  
Day Hospital ◽  
Inpatient Mortality ◽  
Increased Risk ◽  
The Uk

ObjectivesTo understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.DesignA prospective observational study.Setting3 large acute medical receiving units in NHS Lothian, Scotland.ParticipantsNon-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).Main outcome measuresPatient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.ResultsNon-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).ConclusionsThese data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

scholarly journals Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

2020 ◽  
Author(s):  
Marcus J Lyall ◽  
Nazir I Lone
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Severity Of Illness ◽  
Medical Attention ◽  
Hospital Death ◽  
Hospital Inpatient ◽  
Day Hospital ◽  
Risk Of Death ◽  
Ambulance Transport ◽  
Emergency Ambulance

AbstractObjectivesTo understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.DesignA prospective observational studySetting3 large acute medical receiving units in NHS Lothian, Scotland. Participants: Non-covid-19 acute admissions (n = 1756) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the United Kingdom on 23rd March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n = 14961).Main outcome measuresPatient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.ResultsNon-covid-19 acute medical admissions reduced by a mean 43.8% (95% CI 27.3, 59.4) across all 3 sites in comparison to the mean of the preceding 5 years P < 0.001. The reduction in admissions predominated in the over 75 age category and a greater proportion arrived by emergency ambulance transport. Non-covid-19 admissions during lockdown had a greater incidence of severe renal injury, hyperlactataemia and over twice the risk of hospital death within 7 days 5.01% vs 2.49% which persisted after adjustment for confounders (OR 2.17, 95% CI 1.70,2.73, P < 0.0001)ConclusionsThese data support current fears that patients are delaying seeking medical attention for acute illness which is associated with worsening clinical parameters and a higher risk of death following admission.

scholarly journals Hyperuricemia: An Early Marker for Severity of Illness in Sepsis

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Sana R. Akbar ◽  
Dustin M. Long ◽  
Kashif Hussain ◽  
Ahmad Alhajhusain ◽  
Umair S. Ahmed ◽  
...  
Keyword(s):  
Uric Acid ◽  
Poor Prognosis ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Acid Value ◽  
Morbidity Rate ◽  
End Point ◽  
Increased Risk ◽  
Medical Intensive Care

Background.Uric acid can acutely activate various inflammatory transcription factors. Since high levels of oxyradicals and lower antioxidant levels in septic patients are believed to result in multiorgan failure, uric acid levels could be used as a marker of oxidative stress and poor prognosis in patients with sepsis.Design.We conducted a prospective cohort study on Medical Intensive Care Unit (MICU) patients and hypothesized that elevated uric acid in patients with sepsis is predictive of greater morbidity. The primary end point was the correlation between hyperuricemia and the morbidity rate. Secondary end points were Acute Kidney Injury (AKI), mortality, Acute Respiratory Distress Syndrome (ARDS), and duration of stay.Results.We enrolled 144 patients. 54 (37.5%) had the primary end point of hyperuricemia. The overall morbidity rate was 85.2%. The probability of having hyperuricemia along with AKI was 68.5% and without AKI was 31.5%. Meanwhile the probability of having a uric acid value <7 mg/dL along with AKI was 18.9% and without AKI was 81.1% (pvalue < 0.0001).Conclusion.We report that elevated uric acid levels on arrival to the MICU in patients with sepsis are associated with poor prognosis. These patients are at an increased risk for AKI and ARDS.

scholarly journals Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study

2020 ◽  
Author(s):  
VS Gaurav Narayan ◽  
SG Ramya ◽  
Sonal Rajesh Kumar ◽  
SK Nellaiappa Ganesan
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Rapid Decline ◽  
Care Hospital ◽  
Medical Intensive Care

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome.

Associations of ophthalmic and systemic conditions with incident dementia in the UK Biobank

2021 ◽  
pp. bjophthalmol-2021-319508
Author(s):  
Xianwen Shang ◽  
Zhuoting Zhu ◽  
Yu Huang ◽  
Xueli Zhang ◽  
Wei Wang ◽  
...  
Keyword(s):  
Heart Disease ◽  
Age Related Macular Degeneration ◽  
Hospital Inpatient ◽  
Uk Biobank ◽  
Age Related ◽  
Incident Dementia ◽  
Increased Risk ◽  
The Uk ◽  
Systemic Condition

AimsTo examine independent and interactive associations of ophthalmic and systemic conditions with incident dementia.MethodsOur analysis included 12 364 adults aged 55–73 years from the UK Biobank cohort. Participants were assessed between 2006 and 2010 at baseline and were followed up until the early of 2021. Incident dementia was ascertained using hospital inpatient, death records and self-reported data.ResultsOver 1 263 513 person-years of follow-up, 2304 cases of incident dementia were documented. The multivariable-adjusted HRs (95% CI) for dementia associated with age-related macular degeneration (AMD), cataract, diabetes-related eye disease (DRED) and glaucoma at baseline were 1.26 (1.05 to 1.52), 1.11 (1.00 to 1.24), 1.61 (1.30 to 2.00) and (1.07 (0.92 to 1.25), respectively. Diabetes, heart disease, stroke and depression at baseline were all associated with an increased risk of dementia. Of the combination of AMD and a systemic condition, AMD-diabetes was associated with the highest risk for incident dementia (HR (95% CI): 2.73 (1.79 to 4.17)). Individuals with cataract and a systemic condition were 1.19–2.29 times more likely to develop dementia compared with those without cataract and systemic conditions. The corresponding number for DRED and a systemic condition was 1.50–3.24. Diabetes, hypertension, heart disease, depression and stroke newly identified during follow-up mediated the association between cataract and incident dementia as well as the association between DRED and incident dementia.ConclusionsAMD, cataract and DRED but not glaucoma are associated with an increased risk of dementia. Individuals with both ophthalmic and systemic conditions are at higher risk of dementia compared with those with an ophthalmic or systemic condition only.

scholarly journals P0559AKI SEASONALITY IN ENGLAND

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esther Wong ◽  
Dorothea Nitsch
Keyword(s):  
Cox Regression ◽  
Winter Season ◽  
Kidney Injury ◽  
Seasonal Effect ◽  
Winter Mortality ◽  
Age Group ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Abstract Background and Aims Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations. Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases. Method Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage Results Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p&lt;0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p&lt;0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group &gt;75, there were 23.7% in summer and 27.1% in winter. Conclusion Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

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