Abstract 16107: Electrocardiographic Findings and Their Associations With Adverse Outcomes in Hospitalized Patients With COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mariya Fatakdawala ◽  
Jason Pang ◽  
Ritesh Patel ◽  
Tariq Thannoun ◽  
Cullen Grable ◽  
...  
Keyword(s):  
New York ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Respiratory Illness ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Qtc Interval ◽  
T Wave ◽  
Cardiac Dysrhythmias ◽  
Electrocardiographic Findings

Introduction: Although primarily a respiratory illness, COVID-19 frequently involves the cardiovascular system. Hypothesis: Accordingly, we assessed whether abnormal electrocardiographic findings, including cardiac dysrhythmias, ST/T wave changes, and QTc interval prolongation, predict adverse outcomes in patients with COVID-19. Methods: A multi-center retrospective study of hospitalized patients with COVID-19 was performed across 4 hospitals in Texas and 1 in New York. Initial and subsequent ECG findings among patients with uncomplicated disease course, patients with adverse clinical outcomes (need for vasopressors, mechanical ventilation or renal replacement therapy) and patients who died were analyzed. Univariable and multivariable Cox analyses were performed. Results: We identified 297 consecutive patients with COVID-19. Of these patients, 91% had available ECGs. Median heart rate on initial ECG was 92 bpm (IQR: 27), and median QTc interval was 442 msec (IQR: 40). Longer QTc interval on initial ECG was associated with adverse clinical outcomes (443 msec, IQR: 43) and death (457 msec, IQR: 52, vs 441.5 msec, IQR: 36; p=0.033). Cardiac dysrhythmias or ST/T wave changes were noted in subsequent ECGs of 46% of patients and were associated with adverse clinical outcomes (58%) or death (68% vs 33%; HR: 2.2, 95% CI: 1.3-3.6; p=0.002). Sixty-four patients (23%) developed a QTc interval >500msec during their hospitalization. In multivariable Cox analysis, history of coronary artery disease was independently associated with development of QTc>500msec (HR 2.1, 95% CI 1.0-4.4; p=0.047) while other baseline comorbidities were not. Patients with QTc>500msec were more commonly treated with azithromycin (91% vs 77%; p=0.048); no other differences in COVID-19 treatment were identified. In-hospital mortality among patients with QTc>500msec was 37% versus 13% among patients with shorter QTc intervals (HR: 2.6, 95% CI 1.5-4.5; p=0.001). Conclusions: Prolonged QTc interval on initial ECG of COVID-19 patients predicted adverse outcomes and death. Azithromycin was associated with development of QTc>500msec. Patients with a QTc interval >500msec had a 2.6 times higher risk for in-hospital mortality compared to patients with shorter QTc intervals.

Excess Mortality Among Hospitalized Patients With Hypopituitarism—A Population-Based, Matched-Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Fahim Ebrahimi ◽  
Alexander Kutz ◽  
Ulrich Wagner ◽  
Ben Illigens ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Excess Mortality ◽  
Population Based ◽  
Hospitalized Patients ◽  
Matched Cohort ◽  
Prolonged Length ◽  
Matched Cohort Study ◽  
Increased Risk

Abstract Context Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. Objective The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). Design, Setting, and Patients In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score–matched with a general medical inpatient cohort. Main Outcome Measures The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. Results After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P < .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P < .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94–2.95, P < .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P < .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P < .001) was higher among patients with hypopituitarism as compared with medical controls. Conclusions Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.

Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

2012 ◽  
Vol 33 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Eman Shaban ◽  
Cecile Letourneau ◽  
Angel Pechie
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prolonged Exposure ◽  
Adverse Outcomes ◽  
Concurrent Use ◽  
Independent Risk Factors ◽  
The Impact

Objective.To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.Design.Retrospective cohort study.Setting.University-affiliated community hospital.Methods.We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.Results.Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.Conclusions.Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

scholarly journals Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hidehiro Kaneko ◽  
Hidetaka Itoh ◽  
Haruki Yotsumoto ◽  
Hiroyuki Kiriyama ◽  
Tatsuya Kamon ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Hospital Volume ◽  
Heart Association ◽  
High Volume ◽  
Association Class ◽  
Volume Group ◽  
New York Heart Association

Abstract Background Hospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database. Methods and results We studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class. Conclusion Hospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.

scholarly journals Clinical and Economic Outcomes of Intravenous Brivaracetam Compared With Levetiracetam for the Treatment of Seizures in United States Hospitals

2021 ◽  
Vol 12 ◽  
Author(s):  
Silky Beaty ◽  
Ning A. Rosenthal ◽  
Julie Gayle ◽  
Prashant Dongre ◽  
Kristen Ricchetti-Masterson
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Statistical Power ◽  
Cohort Analysis ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Healthcare Database ◽  
Icu Admission ◽  
Hospitalization Costs

Background: Seizures are common among hospitalized patients. Levetiracetam (LEV), a synaptic vesicle protein 2A (SV2A) ligand, is a common intravenous (IV) anti-seizure medication option in hospitals. Brivaracetam (BRV), a selective SV2A ligand for treatment of focal seizures in patients ≥16 years, has greater binding affinity, higher lipophilicity, and faster brain entry than IV LEV. Differences in clinical outcomes and associated costs between IV BRV and IV LEV in treating hospitalized patients with seizure remain unknown.Objectives: To compare the clinical outcomes, costs, and healthcare resource utilization between patients with seizure treated with IV BRV and those with IV LEV within hospital setting.Design/Methods: A retrospective cohort analysis was performed using chargemaster data from 210 United States hospitals in Premier Healthcare Database. Adult patients (age ≥18 years) treated intravenously with LEV or BRV (with or without BZD) and a seizure discharge diagnosis between July 1, 2016 and December 31, 2019 were included. The cohorts were propensity score-matched 4:1 on baseline characteristics. Outcomes included intubation rates, intensive care unit (ICU) admission, length of stay (LOS), all-cause and seizure-related readmission, total hospitalization cost, and in-hospital mortality. A multivariable regression analysis was performed to determine the association between treatment and main outcomes adjusting for unbalanced confounders.Results: A total of 450 patients were analyzed (IV LEV, n = 360 vs. IV BRV, n = 90). Patients treated with IV BRV had lower crude prevalence of ICU admission (14.4 vs. 24.2%, P &lt; 0.05), 30-day all-cause readmission (1.1 vs. 6.4%, P = 0.06), seizure-related 30-day readmission (0 vs. 4.2%, P &lt; 0.05), similar mean total hospitalization costs ($13,715 vs. $13,419, P = 0.91), intubation (0 vs. 1.1%, P = 0.59), and in-hospital mortality (4.4 vs. 3.9%, P = 0.77). The adjusted odds for ICU admission (adjusted odds ratio [aOR] = 0.6; 95% confidence interval [CI]:0.31, 1.16; P = 0.13), 30-day all-cause readmission (aOR = 0.17; 95% CI:0.02, 1.24; P = 0.08), and in-hospital mortality (aOR = 1.15; 95% CI:0.37, 3.58, P = 0.81) were statistically similar between comparison groups.Conclusion: The use of IV BRV may provide an alternative to IV LEV for management of seizures in hospital setting due to lower or comparable prevalence of ICU admission, intubation, and 30-day seizure-related readmission. Additional studies with greater statistical power are needed to confirm these findings.

scholarly journals MO384ERYTHROCYTURIAAT ADMISSION IS A PREDICTOR OF ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Yulia Khruleva ◽  
Elena Troitskaya ◽  
Marina Efremovtseva ◽  
Tapiwa Mubayazvamba ◽  
Zhanna Kobalava
Keyword(s):  
Acute Kidney Injury ◽  
Lung Injury ◽  
Hospital Mortality ◽  
Oral Anticoagulants ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Common Finding ◽  
P Value

Abstract Background and Aims Acute kidney injury (AKI) is common among patients with coronavirus disease (COVID-19) and a major risk factor associated with mortality in hospitalized patients. Previously abnormal urine tests were reported to have a high incidence in COVID-19. We aimed to investigate the prevalence of urine tests changes and their impact on the outcomes in patients hospitalized with COVID-19. Method A retrospective analysis of the register of patients with COVID-19 was performed. COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture with typical clinical signs. We excluded patients with re-hospitalizations, urinary tract infection, and single serum creatinine (SCr) measurement during hospitalization. Urine tests were performed within the first 24 h after hospitalization. Erythrocyturia was defined as the presence of &gt;3 red blood cells (RBC) per high-power field. Definition of acute kidney injury (AKI) was based on KDIGO criteria. Patients were identified as having in-hospital AKI, if AKI developed during hospitalization. P value &lt;0.05 was considered statistically significant. Results In final analysis we included 495 patients. Mean age was 64 [53;74], 51% (244) were males, mean Charlson index 3 [1;3], 66% with hypertension, 48% with obesity, 24% with diabetes mellitus (DM) and 6% with chronic kidney disease (CKD). 25% of patients were hospitalized in the intensive care unit (ICU), 17.8% (88) were treated with mechanical ventilation at some point during hospitalization. Patients were hospitalized on the 6±4 day of illness at mean. The mean length of stay was 11 [9;14] days, in the ICU - 4 [2;7] days. 19.4% patients died in hospital. The incidence of AKI was 22%, 47% patients had the 1st stage of AKI, 41% - the 2nd and 20% - the 3rd. In-hospital AKI was observed in 8.3% (41) of patients. Among discharged patients AKI was registered in 13%, of those who died in 60% (p&lt;0.0001). 52% (256) of patients had erythrocyturia and/or proteinuria and/or leukocyturia in urine test and admission: 35% of patients had proteinuria, 17% - hematuria and 19% - leukocyturia. The most prognostically significant associations of urinalysis changes were identified for erythrocyturia, which was present in 82 patients at admission, their mean RBC count in urine was 18.5 [7;52]. The presence of еrythrocyturia at admission was independent of age, gender, presence of hypertension, DM, obesity, blood test changes, pre-admission drug intake, included oral anticoagulants. Patients with erythrocyturia at admission had higher level of SCr at admission (101[83;140] vs 88[74;109] µmol/l, p=0.003), were more likely to develop AKI compared to patients without AKI (31.2% vs 12.4%, p&lt;0.001, respectively), had higher prevalence of in-hospital AKI (17% vs 6.5%, p=0.002) and more severe course of AKI (the 1st stage – 31% vs 54%, the 2nd - 43% vs 32%, the 3rd – 26% vs 14%, p=0.02). They also more often had CKD (13,4% vs 4.4%, p=0.001), more severe lung injury by CT scan during hospitalization (15.6% vs 5.5% with 75-90% lung injury, p=0.005, for the trend), were more frequently hospitalized in ICU (39% vs 22%, p=0.001), and had higher level of in-hospital mortality (32% vs 17%, p=0.002). Erythrocyturia at admission was predictor for development of in-hospital AKI (odds ratio (OR) 2.94 with a 95% confidence interval (CI) of 1.35 to 6.15, p=0.002) and in-hospital mortality (OR 2.28, 95% CI of 1.28 to 3.97, p=0.002). Conclusion Erythrocyturia at admission is a common finding in hospitalized patients with COVID-19, and is associated with severity of disease and adverse outcomes in this population.

scholarly journals Impact of electrocardiographic morphology on clinical outcomes in patients with non-ST elevation myocardial infarction receiving coronary angiography and intervention: a retrospective study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8796
Author(s):  
Chiung-Jen Wu ◽  
Kuo-Ho Yeh ◽  
Hui-Ting Wang ◽  
Wen-Hao Liu ◽  
Huang-Chung Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Retrospective Study ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
T Wave ◽  
St Depression

Background The impact of electrocardiography (ECG) morphology on clinical outcomes in patients with non-ST segment elevation myocardial infarction (NSTEMI) receiving percutaneous coronary intervention (PCI) is unknown. This study investigated whether different ST morphologies had different clinical outcomes in patients with NSTEMI receiving PCI. Methods This retrospective study analyzed record-linked data of 362 patients who had received PCI for NSTEMI between January 2008 and December 2010. ECG revealed ST depression in 67 patients, inverted T wave in 91 patients, and no significant ST-T changes in 204 patients. The primary endpoint was long-term all-cause mortality. The secondary endpoint was long-term cardiac death and non-fatal major adverse cardiac events. Results Compared to those patients whose ECG showed an inverted T wave and non-specific ST-T changes, patients whose ECG showed ST depression had more diabetes mellitus, advanced chronic kidney disease (CKD) and left main artery disease, as well as more in-hospital mortality, cardiac death and pulmonary edema during hospitalization. Patients with ST depression had a significantly higher rate of long-term total mortality and cardiac death. Finally, multiple stepwise Cox regression analysis showed that an advanced Killip score, age, advanced CKD, prior percutaneous transluminal coronary angioplasty and ST depression were independent predictors of the primary endpoint. Conclusions Among NSTEMI patients undergoing coronary angiography, those with ST depression had more in-hospital mortality and cardiac death. Long-term follow-up of patients with ST depression consistently reveals poor outcomes.

scholarly journals Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

2020 ◽  
Author(s):  
Hong Li ◽  
Jia-bao Huang ◽  
Wen Pan ◽  
Cun-tai Zhang ◽  
Xiao-yan Chang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Roc Curve ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Cox Regression Analysis ◽  
Inflammatory Index

Abstract Background Our study aimed to investigate the prognostic value of a novel inflammatory index, systemic immune-inflammation index (SII), with the clinical outcomes of patients infected with coronavirus disease 2019 (COVID-19).Methods We evaluated a cohort study of COVID-19 patients (18–95 years old) in Tongji Hospital of Huazhong University of Science and Technology from January 28th 2020 to February 29th 2020. The enrolled patients were divided into two groups (including low-SII group and high-SII group) according to the cut-off point which is analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate COX regression analysis were performed to identify the factors associated with the outcomes of patients with COVID-19 infection. The primary and secondary outcome were in-hospital mortality and the development of acute respiratory distress syndrome (ARDS), respectively.Results A number of 326 adult patients (43.87% males, 61.22 ± 0.86 years) were enrolled in the final analyses. There were 147 cases (45.09%) died in hospital and 116 patients (35.58%) developed ARDS. ROC curve analysis indicated that the SII had a greater prediction accuracy in predicting the in-hospital mortality (area under the curve [AUC] = 0.789, sensitivity = 69.90%, specificity = 70.80%) and the development of ARDS (AUC = 0.736, sensitivity = 67.80%, specificity = 71.10%). Kaplan-Meier analysis revealed that patients in high-SII group had a greater risk of adverse clinical outcomes (all P < 0.001). The multivariate Cox regression analysis indicated that elevated SII was found as the risk predictor of in-hospital mortality (hazard ratio [HR] = 2.839, 95% confidence interval [CI] = 1.116–7.222, P = 0.028) and the developed ARDS (HR = 6.832, 95%CI = 2.583–18.074, P < 0.001). Additional significant independent predictor for adverse outcomes was the lymphocyte proportion. What’s more, it suggests that the invasive mechanical ventilation performed in the early stage of the disease progression may be beneficial for patients.Conclusion SII, a novel biomarker, might be a remarkable prognostic indicator to assess the in-hospital mortality and the development of ARDS in patients with COVID-19 and help for clinical risk assessment.

scholarly journals Clinical utility of aVR lead T-wave in electrocardiogram of patients with ST-elevation myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Babak Kazemi ◽  
Seyyed-Reza Sadat-Ebrahimi ◽  
Abdolmohammad Ranjbar ◽  
Fariborz Akbarzadeh ◽  
M. Reza Sadaie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clinical Utility ◽  
Wave Amplitude ◽  
Routine Clinical Practice ◽  
St Elevation Myocardial Infarction ◽  
T Wave ◽  
St Elevation ◽  
Heart Center

Abstract Background aVR lead is often neglected in routine clinical practice largely because of its undefined clinical utility specifications. Nevertheless, positive T-wave in aVR lead has been reported to be associated with poor clinical outcomes in some cardiovascular diseases. This study aimed to prospectively investigate the prognostic value and clinical utility of T-wave amplitude in aVR lead in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 340 STEMI patients admitted to a tertiary heart center were consecutively included. Patients were categorized into four strata, based on T wave amplitude in aVR lead in their admission ECG (i.e. < − 2, − 1 to − 2, − 1 to 0, and ≥ 0 mV). Patients’ clinical outcomes were also recorded and statistically analyzed. Results In-hospital mortality, re-hospitalization, and six-month-mortality significantly varied among four T wave strata and were higher in patients with a T wave amplitude of ≥ 0 mV (p 0.001–0.002). The groups of patients with higher T wave amplitude in aVR, had progressively increased relative risk (RR) of in-hospital mortality (RRs ≤ 0.01, 0.07, 1.00, 2.30 in four T wave strata, respectively). T wave amplitude in the cutoff point of − 1 mV exhibited a sensitivity and specificity of 95.83 (95% CI 78.88–99.89) and 49.68 (95% CI 44.04–55.33). Conclusion Our study demonstrated a significant association of positive T wave in aVR lead and adverse clinical outcomes in STEMI patients. Nevertheless, the clinical utility of T-wave amplitude at aVR lead is limited by its low discriminative potential toward prognosis of STEMI.

scholarly journals Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients

2020 ◽  
Author(s):  
Matthew P. Crotty ◽  
Ronda Akins ◽  
An Nguyen ◽  
Rania Slika ◽  
Kristen Rahmanzadeh ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Hospitalized Patients ◽  
Corticosteroid Administration ◽  
Cox Regression Analysis ◽  
Icu Admission ◽  
Cell Counts ◽  
Increased Risk

AbstractBackgroundSARS-CoV-2 has drastically affected healthcare globally and causes COVID-19, a disease that is associated with substantial morbidity and mortality. We aim to describe rates and pathogens involved in co-infection or subsequent infections and their impact on clinical outcomes among hospitalized patients with COVID-19.MethodsIncidence of and pathogens associated with co-infections, or subsequent infections, were analyzed in a multicenter observational cohort. Clinical outcomes were compared between patients with a bacterial respiratory co-infection (BRC) and those without. A multivariable Cox regression analysis was performed evaluating survival.ResultsA total of 289 patients were included, 48 (16.6%) had any co-infection and 25 (8.7%) had a BRC. No significant differences in comorbidities were observed between patients with co-infection and those without. Compared to those without, patients with a BRC had significantly higher white blood cell counts, lactate dehydrogenase, C-reactive protein, procalcitonin and interleukin-6 levels. ICU admission (84.0 vs 31.8%), mechanical ventilation (72.0 vs 23.9%) and in-hospital mortality (45.0 vs 9.8%) were more common in patients with BRC compared to those without a co-infection. In Cox proportional hazards regression, following adjustment for age, ICU admission, mechanical ventilation, corticosteroid administration, and pre-existing comorbidities, patients with BRC had an increased risk for in-hospital mortality (adjusted HR, 3.37; 95% CI, 1.39 to 8.16; P = 0.007). Subsequent infections were uncommon, with 21 infections occurring in 16 (5.5%) patients.ConclusionsCo-infections are uncommon among hospitalized patients with COVID-19, however, when BRC occurs it is associated with worse clinical outcomes including higher mortality.

scholarly journals Clinical Utility of aVR Lead T-Wave in Electrocardiogram of Patients With ST-Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Babak Kazemi-Arbat ◽  
Seyyed-Reza Sadat-Ebrahimi ◽  
Abdolmohammad Ranjbar ◽  
Fariborz Akbarzadeh ◽  
Mohammad Reza Sadaie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clinical Utility ◽  
Wave Amplitude ◽  
Progressive Increase ◽  
St Elevation Myocardial Infarction ◽  
T Wave ◽  
St Elevation ◽  
Heart Center

Abstract Background aVR lead is often neglected in routine clinical practice largely because of its undefined clinical utility specifications. Nevertheless, positive T-wave in aVR lead has been reported to be associated with poor clinical outcomes in some cardiovascular diseases. This study aimed to prospectively investigate the prognostic value and clinical utility of T-wave amplitude in aVR lead in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 340 STEMI patients admitted to a tertiary heart center were consecutively included. Patients were categorized into four strata, based on T wave amplitude in aVR lead in their admission ECG (i.e. < -2, -1 to -2, -1 to 0, and ≥ 0 mV). Patients’ clinical outcomes were also recorded and statistically analyzed. Results In-hospital mortality, re-hospitalization, and six-month-mortality significantly varied among four T wave strata and were higher in patients with a T wave amplitude of ≥ 0 mV (p-values, 0.001 to 0.002). As the T wave amplitude in aVR increased, there was a progressive increase in relative risk (RR) of in-hospital mortality (RRs = < 0.01, 0.07, 1.00, 2.30 in four T wave strata, respectively). T wave amplitude in the cutoff point of -1 mV exhibited a sensitivity and specificity of 95.83 (95% CI, 78.88–99.89) and 49.68 (95% CI, 44.04–55.33). Conclusion Our study demonstrated a significant association of positive T wave in aVR lead and adverse clinical outcomes in STEMI patients. Nevertheless, the clinical utility of T-wave amplitude at aVR lead is limited by its low discriminative potential toward prognosis of STEMI.

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