scholarly journals Risk Factors in Patients with Diabetes Hospitalized for COVID-19: Findings from a Multicenter Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yili Zhang ◽  
Juan Wang ◽  
Nannan Tan ◽  
KangJia Du ◽  
Kuo Gao ◽  
...  

Background and Purpose. Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and identify the risk factors for COVID-19 patients complicated with diabetes. Methods. In this multicenter retrospective study, patients with COVID-19 in China were included and classified into two groups according to whether they were complicated with diabetes or not. Demographic symptoms and laboratory data were extracted from medical records. Univariable and multivariable logistic regression methods were used to explore the risk factors. Results. 538 COVID-19 patients were finally included in this study, of whom 492 were nondiabetes and 46 were diabetes. The median age was 47 years (IQR 35.0-56.0). And the elderly patients with diabetes were more likely to have dry cough, and the alanine aminotransferase, lactate dehydrogenase, Ca, and mean hemoglobin recovery rate were higher than the other groups. Furthermore, we also found the liver and kidney function of male patients was worse than that of female patients, while female cases should be paid more attention to the occurrence of bleeding and electrolyte disorders. Moreover, advance age, blood glucose, gender, prothrombin time, and total cholesterol could be considered as risk factors for COVID-19 patients with diabetes through the multivariable logistic regression model in our study. Conclusion. The potential risk factors found in our study showed a major piece of the complex puzzle linking diabetes and COVID-19 infection. Meanwhile, focusing on gender and age factors in COVID-19 patients with or without diabetes, specific clinical characteristics, and risk factors should be paid more attention by clinicians to figure out a targeted intervention to improve clinical efficacy worldwide.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S448-S448
Author(s):  
Alison L Blackman ◽  
Sabeen Ali ◽  
Xin Gao ◽  
Rosina Mesumbe ◽  
Carly Cheng ◽  
...  

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.


Author(s):  
Qiao Shi ◽  
Xiaoyi Zhang ◽  
Fang Jiang ◽  
Xuanzhe Zhang ◽  
Chibu Bimu ◽  
...  

<div><b>OBJECTIVE: </b>Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics, outcomes and analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes.</div><div><b><br></b></div><div><b>RESEARCH DESIGN AND METHODS: </b>This two-center, retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N=153) who were discharged or died from January 1, 2020, to March 8, 2020, were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients.</div><div><br></div><div><b>RESULTS:</b> Of 1561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (IQR, 56.0-72.0) years. A higher proportion of ICU admission (17.6% vs 7.8%, P=0.01) and more fatal cases (20.3% vs 10.5%, P=0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazards ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23) and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs 63.0 years), most were male (71.0% vs 29.0%), and were more likely to have underlying hypertension (83.9% vs 50.0%) and cardiovascular disease (45.2% vs 14.8%) (all P-values<0.05). Age ≥70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes.</div><div><br></div><div><b>CONCLUSIONS: </b>COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.</div>


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lori-Ann Fisher ◽  
Sunil Stephenson ◽  
Marshall Tulloch-Reid ◽  
Simon Anderson

Abstract Background and Aims AKI is a common and resource intensive complication of cardiopulmonary bypass surgery (CPB) in high income-countries occurring in up to one third of surgeries performed. However, little is known of its incidence and impact in the small island developing states of the Caribbean. We describe the incidence, risk factors and outcomes of AKI following CPB at a referral cardiac centre in Jamaica. Method A review of the Medical Records of adult patients (aged ≥ 18 years) with no prior ESRD or dialysis requirement undergoing CPB at the University Hospital of the West Indies, Mona between January 1, 2016 to June 30, 2019 inclusive was undertaken. Demographics, pre-operative status, intraoperative and post-operative data were abstracted. The primary outcome was all-cause 30-day mortality. AKI was defined as meeting the KDIGO criteria based on the peak serum creatinine measurement obtained within 72 hours post-operatively. Multivariable logistic regression was used to examine the risk factors for and impact of AKI on all-cause mortality. Results Of the 259 persons who underwent CPB in the study period, 211 (58% men, mean age 58.1±12.9 years, median± IQR Euro-score II of 1.4 ± 1.4) met inclusion criteria. AKI occurred in 37.3 % (80) of patients with 43.8% (35) KDIGO I, 32.5% (26) KDIGO II and (19) 23.7% KDIGO III. Renal replacement therapy was required in 3.2% (7) of patients. In a multivariable logistic regression model, baseline CKD (eGFR&lt;60mL/min/1.732m2; odds ratio, 95%CI: 5.32,1.72-15.90), Prolonged bypass time (1.73,1.21-2.48; per hour), intraoperative PRBC transfusion (2.33,1.08-5.03) and elevated 24-hour post-operative Neutrophil/Lymphocyte ratio&gt;18 (3.00, 1.07-8.35) were associated with an increased risk of AKI. AKI after CPB resulted in greater hospital (23.6 versus 14.6 days, p&lt;0.001) and ICU stay (8.1 versus 3.3 days, p&lt;0.001) and a 6-fold increase in 30-day mortality after adjusting for age and sex (HR, 95 CI: 6.40, 2.38-17.25). (see Figure 1 Kaplan Meier survival estimates for AKI) Conclusion The occurrence of AKI following CPB is comparable to that reported in the literature and is associated with poor short-term outcomes. Larger multicentre prospective studies to predict risk, identify interventions to reduce mortality and assess long term complications of AKI following CPB in Caribbean countries are needed.


2020 ◽  
pp. neurintsurg-2020-016342 ◽  
Author(s):  
Moustafa Aly ◽  
Ramez N Abdalla ◽  
Ayush Batra ◽  
Ali Shaibani ◽  
Michael C Hurley ◽  
...  

BackgroundAdmission neutrophil-lymphocyte ratio (NLR) is significantly correlated to clinical outcomes in acute ischemic stroke (AIS). We investigated follow-up NLR and temporal changes in NLR after endovascular thrombectomy (EVT) with respect to successful revascularization, clinical outcomes, symptomatic intracranial hemorrhage (sICH) and mortality.MethodsRetrospective analysis of EVT for anterior circulation emergent LVO was performed with both admission (NLR1) and 3–7 day follow-up NLR (NLR2) laboratory data. Patient demographics, National Institutes of Health Stroke Scale (NIHSS) presentations, reperfusion efficacy (modified Thrombolysis in Cerebral Infarction (mTICI) score), sICH, and clinical outcomes (modified Rankin Scale (mRS)) at 90 days were studied. Univariate analyses correlated NLR1, NLR2, and temporal change in NLR (NLR2-NLR1) with successful reperfusion (mTICI ≥2b), favorable outcomes (mRS ≤2), sICH, and mortality. Multivariable logistic regression model evaluated the independent effects of NLR2 on favorable outcomes.Results142 AIS patients with median NIHSS 17 underwent EVT within 24 hours, and met NLR laboratory inclusion criteria. Lower follow-up NLR2 and less temporal change in NLR over 3–7 days, but not admission NLR1, inversely correlated with successful reperfusion (p<0.05) and favorable clinical outcomes (p<0.001). Higher follow-up NLR2 and greater temporal change in NLR was significantly associated with sICH and mortality (p≤0.05). In multivariable logistic regression, lower follow-up NLR2 remained a predictor of favorable outcomes (OR 0.785, p=0.001), independent of age or successful reperfusion.ConclusionsFollow-up NLR is a readily available and modifiable biomarker that correlates with the degree of reperfusion after mechanical stroke thrombectomy. Lower follow-up NLR2 at 3–7 days is associated with successful reperfusion and an independent predictor of favorable clinical outcomes, with reduced risk for sICH and mortality.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S525-S526
Author(s):  
Blake Hansen ◽  
Tao Liu ◽  
Lauri Bazerman ◽  
Mari-Lynn Drainoni ◽  
Fizza S Gillani ◽  
...  

Abstract Background The “Undetectable equals Untransmittable (U=U)” HIV prevention campaign is a cornerstone of HIV prevention. However, there are few recommendations to guide patients and providers in U=U implementation and limited data on risk factors for viral rebound among persons eligible for U=U. Methods We conducted a retrospective multi-center study using data from the CNICS HIV research network to identify risk factors for viral rebound among persons with established viral suppression [two viral loads (VL) and all VLs of &lt; 200 copies/ul within a one-year period (U=U eligible)]. Demographics, patient-reported outcomes, and longitudinal clinical data from 21,359 persons with HIV were analyzed. To include missing data in the analysis, they were treated as a separate category. The primary outcome of viral rebound was defined as any VL &gt; 200 copies/ul within two years after U=U eligibility. A univariable logistic regression model was conducted to identify predictors of viral rebound. Significant variables (p&lt; 0.05) were included in a multivariable logistic regression model. Predictive values of individual variables were captured by adjusted odds ratios (aORs). Results From 2011-2019, 12,150 patients met criteria for U=U eligibility and had two years of follow up data. The median age was 46 (IQR: 38-53); 68% male; 51% were white, 39% black. 1544 (13%) experienced viral rebound during follow-up. Forest plot summaries of univariable and multivariable logistic regression models are in Figures 1&2. In multivariable analysis, Black race (aOR=1.56, p&lt; 0.001); MSM-IDU risk (aOR=1.38, p=0.006); lower QoL score (aOR=1.49, p=0.005); poorer ART adherence (aOR=1.84, p&lt; 0.001); duration of lifetime ART [aOR=1.47 (10+yrs), = 1.37 (5-10 yrs); and = 1.28 (2-5 yrs), p&lt; 0.001]; use of InSTIs after eligibility (aOR=1.60, p&lt; 0.001); current smoker (aOR=1.49, p&lt; 0.001), current amphetamine (aOR=1.83, p&lt; 0.001) or cocaine use (aOR=1.46, p=0.012), were associated with viral rebound. In both analyses, older age was protective against viral rebound. Figure 1. Summary of Univariate Logistic Regression Model Figure 2. Summary of Multivariable Logistic Regression Model Conclusion We identified multiple risk factors for viral rebound among PWH with viral suppression. Further research is needed to identify synergistic risk factors that increase probability of viral rebound to inform optimal implementation of U=U. Disclosures Edward Cachay, MD, MAS, Gilead (Consultant, Grant/Research Support)Merck Sciences (Grant/Research Support) Heidi Crane, MD, MPH, ViiV (Grant/Research Support) Benigno Rodriguez, MD, Gilead (Speaker’s Bureau)ViiV (Speaker’s Bureau)


2014 ◽  
Vol 143 (3) ◽  
pp. 608-617 ◽  
Author(s):  
E. Z. GEBREMEDHIN ◽  
G. TESFAMARYAM ◽  
H. A. YUNUS ◽  
R. DUGUMA ◽  
G. TILAHUN ◽  
...  

SUMMARYWe performed a seroepidemiological study ofToxoplasma gondiiinfection in free-range chickens from October 2012 to May 2013. We used cross-sectional two-stage cluster sampling to collect blood samples from wing veins of 601 chickens from central Ethiopia.T. gondii-specific antibodies were assayed by modified agglutination test (MAT). We collected information about risk factors by questionnaire and used univariable and multivariable logistic regression to assess risk factors. An overall seroprevalence of 30·5% [95% confidence interval (CI) 26·27–34·14] and 54·2% (95% CI 47·06–61·36) was found at animal- and flock-level, respectively. The MAT end titre of seropositive chickens (n = 183) were 1 : 60 in 46, 1 : 180 in 28, 1 : 540 in 29, ⩾1 : 1620 in 48, 1 : 6000 in 22, 1 : 18 000 in five, 1 : 54 000 in one, and ⩾1 : 162 000 in four. Animal-level risk factors identified using multivariable logistic regression model were: midland altitude [odds ratio (OR) 2·53, 95% CI 1·12–5·72], cross and exotic breeds (OR 3·17, 95% CI 1·39–7·23), increased age of chickens (OR 2·32, 95% CI 1·19–4·49), extensive management (OR 6·92, 95% CI 1·34–35·86) and the presence of cats (OR 2·08, 95% CI 1·20–3·61). Similarly, flock-level risk factors were midland altitude (OR 3·62, 95% CI 1·31–9·99) and the presence of cats (OR 1·19–4·94). The knowledge of the local people about the health risk of cats to humans and animals is poor. Housing and management of cats and chickens are also poor. The widespread presence ofT. gondiiinfection in free-range chickens of Central Ethiopia provides suggestive evidence for the high level of contamination of the living environment of people withT. gondiioocysts. Meat from free-range chickens might be an important source of infection for humans. Altitude, breed, age, management and presence of cats are independent predictors of seropositivity. Education of farmers about toxoplasmosis and further studies to elucidate the burden of toxoplasmosis in animals and humans warrants consideration.


Author(s):  
Qiao Shi ◽  
Xiaoyi Zhang ◽  
Fang Jiang ◽  
Xuanzhe Zhang ◽  
Chibu Bimu ◽  
...  

<div><b>OBJECTIVE: </b>Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics, outcomes and analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes.</div><div><b><br></b></div><div><b>RESEARCH DESIGN AND METHODS: </b>This two-center, retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N=153) who were discharged or died from January 1, 2020, to March 8, 2020, were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients.</div><div><br></div><div><b>RESULTS:</b> Of 1561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (IQR, 56.0-72.0) years. A higher proportion of ICU admission (17.6% vs 7.8%, P=0.01) and more fatal cases (20.3% vs 10.5%, P=0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazards ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23) and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs 63.0 years), most were male (71.0% vs 29.0%), and were more likely to have underlying hypertension (83.9% vs 50.0%) and cardiovascular disease (45.2% vs 14.8%) (all P-values<0.05). Age ≥70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes.</div><div><br></div><div><b>CONCLUSIONS: </b>COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.</div>


2021 ◽  
Vol 39 ◽  
Author(s):  
Rifat Latifi ◽  
◽  
Lior Levy ◽  
Medha Reddy ◽  
Kenji Okumura ◽  
...  

Background: Elderly patients admitted emergently for ventral hernia may have high rates of complications, including morbidity and mortality. The goal of this study was to retrospectively assess risk factors for in-hospital mortality for elderly patients admitted emergently with a primary diagnosis of ventral hernia. Methods: Elderly patients with ventral hernia that required emergency admission were analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and the predictors was assessed using a stratified analysis, multivariable logistic regression model, and multivariable generalized additive model. Results: A total of 33,700 elderly patients were analyzed. The mean (SD) age for males and females was 75 (7.25) and 76.25 (7.75) years, respectively (p<0.001). Approximately 70% of the patients were females. The mean (SD) hospital length of stay (HLOS) was 6.3 (6.5) and 11.6 (13.7) days in survived vs. deceased patients (p<0.001), respectively. Gangrene was present in 1.5% of survivors vs. 5.6% of deceased (p<0.001) patients. Intestinal obstruction was observed in 78% of survivors vs. 88% of deceased patients (p<0.001). Of the 8,554 cases managed non-operatively, 2.1% died. In contrast, in the 25,163 patients who were operated upon, the mortality rate was 2.9%. The mean (SD) HLOS was 7.39 (7.41) days in patients who had an operation vs. 3.82 (3.48) days in those who did not (p<0.0001). Time to operation was 1.12 (1.97) days in survivors vs. 1.81 (3.02) days in deceased patients (p<0.001). In the final multivariable logistic regression model for patients who underwent an operation, delayed operation, elderly male, frailty, invasive diagnostic procedures and presence of gangrene or obstruction were the main risk factors for mortality. In the final model for patients who did not have an operation, age, frailty, presence of gangrene or obstruction and HLOS were the main risk factors for mortality. Conclusion: A delayed operation in elderly males and frail patients with intestinal obstruction or gangrene admitted emergently due to ventral hernia significantly increases mortality in this setting.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S23-S23
Author(s):  
Jessica Gillon ◽  
Elizabeth Townsley ◽  
Natalia Jimenez-Truque ◽  
Kathryn Garguilo ◽  
Ritu Banerjee ◽  
...  

Abstract Background Outpatient parenteral antibiotic therapy (OPAT) can decrease the length of hospital stay but is associated with adverse events (AEs). The purpose of this study was to quantify and identify risk factors for OPAT-associated AEs in children. Methods This is a retrospective, single-center study of patients aged ≤21 years discharged on OPAT from January 2016 to April 2019. Only patients with OPAT overseen by the infectious disease service were included. Medication AE’s included: rash, neutropenia, hepatitis, diarrhea, C. difficile infection, increased serum creatinine, or others. Central line AEs included: central line dysfunction, infection, rash around line site, or other. Wilcoxon rank-sum test, Pearson’s χ2 test, Fisher’s exact test, and multivariable logistic regression models were used for analyses. Results Demographic information can be found in Table 1. Among 176 patients included in the study, an AE occurred in 69 (39%). In a multivariable logistic regression model adjusting for age, county of residence, duration of OPAT, and duration line was in place, each additional day of antibiotics increased the odds of having a medication or line-related AE by 3% (OR 1.03; 95% CI 1.01–1.06; P = 0.005; Table 2). Medication AEs occurred in 30 patients (17%). The most frequent medication AEs were neutropenia (24%), rash (15%), and increased liver function tests (15%). Patients residing in a Large Fringe Metro area (suburb) had 33% lower odds of having a drug-related AE compared with those in a Large Central Metro area (OR 0.67; 95% CI 0.50 to 0.90; P = 0.008). Line AEs occurred in 46 patients (26%), with 10 patients (21%) experiencing >1 line AE. The most common line AEs were line malfunction (56.5%) and line infection (13%). Seven patients experienced both a medication AE and a central line AE. Of the 176 patients, 20 (11%) were readmitted to the hospital due to medication or line AE and an additional 25 (14%) had a healthcare visit for an AE although did not require admission. Conclusion In our region, nearly 40% of children experienced an OPAT-associated AE and line AEs were more common than medication AEs. Longer durations of IV therapy was an independent risk factor for AEs. Converting to oral antibiotic therapy as soon as feasible may reduce OPAT-associated AEs. Disclosures Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.


2010 ◽  
Vol 30 (11) ◽  
pp. 903-908 ◽  
Author(s):  
Ana C Coelho ◽  
Maria L Pinto ◽  
Adosinda M Coelho ◽  
Alfredo Aires ◽  
Jorge Rodrigues

The aim of this study was evaluate the risk factors for Mycobacterium avium subsp. paratuberculosis (Map) seroprevalence in sheep in the North of Portugal. The effects on seroprevalence of several variables such as individual characteristics, management practices, farm characteristics, animal health, and available veterinary services were evaluated. This information was then used in a multivariable logistic regression model in order to identify risk factors for Map seropositivity. Univariable analysis was used to screen the variables used in the logistic regression model. Variables that showed p values of <0.15 were retained for the multivariable analysis. Fifteen variables were associated with paratuberculosis in univariable analysis. The multivariable logistic regression model identified a number of variables as risk factors for seropositivity like sheep pure local and/or a cross of a local breed (OR=2.02), herd size with 31-60 head (OR=2.14), culling during the Spring-Summer season (OR=1.69) and the use of an anti-parasitic treatment such as Ivermectin as the only anti-parasitic medication (OR=5.60). Potential risk factors identified in this study support current recommendations for the control of paratuberculosis.


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