Factors Predictive of Postoperative Acute Respiratory Failure Following Inpatient Sinus Surgery

Objective: The impact of perioperative risk factors on outcomes following outpatient sinus surgery is well defined; however, risk factors and outcomes following inpatient surgery remain poorly understood. We aimed to define risk factors of postoperative acute respiratory failure following inpatient sinus surgery. Methods: Utilizing data from the Nationwide Inpatient Sample Database from the years 2010 to 2014, we identified patients (≥18 years of age) with an Internal Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code of sinus surgery. We used multivariable logistic regression to identify risk factors of postoperative acute respiratory failure. Results: We identified 4919 patients with a median age of 53 years. The rate of inpatient postoperative acute respiratory failure was 3.35%. Chronic sinusitis (57.7%) was the most common discharge diagnosis. The final multivariable logistic regression analysis suggested that pneumonia, bleeding disorder, alcohol dependence, nutritional deficiency, heart failure, paranasal fungal infections, and chronic kidney disease were associated with increased odds of acute respiratory failure (all P < .05). Conclusion: To our knowledge, this represents the first study to evaluate potential risk factors of acute respiratory failure following inpatient sinus surgery. Knowledge of these risk factors may be used for risk stratification.

Download Full-text

The presurgical controlling nutritional status (CONUT) score is independently associated with severe peristomal skin disorders: a single-center retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-98369-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takuya Shiraishi ◽

Hiroomi Ogawa ◽

Chika Katayama ◽

Katsuya Osone ◽

Takuhisa Okada ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Nutritional Status ◽

Multivariable Logistic Regression Analysis ◽

Skin Disorders ◽

Nutritional Interventions ◽

Multivariable Logistic Regression ◽

Peristomal Skin ◽

The Impact ◽

Conut Score

AbstractWhile nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no previous studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. The purpose of this study was to assess the impact of preoperative nutritional status on stoma health, and determine risk factors for postoperative PSDs, including severe PSDs. A retrospective analysis was performed of 116 consecutive patients with rectal cancer who underwent radical surgery with ileostomy or colostomy creation. PSDs were diagnosed in 32 patients (27.6%); including 10 cases (8.7%) that were defined as severe based on the ABCD-stoma score. Multivariable logistic regression showed that smoking (odds ratio [OR] 3.451, 95% confidence interval [CI] 1.240–9.607, p = 0.018) and ileostomy (OR 3.287, 95% CI 1.278–8.458, p = 0.014) were independent risk factors for PSDs. A separate multivariable logistic regression analysis of risk factors for severe PSDs, found that the only independent risk factor was the CONUT score (OR 10.040, 95% CI 1.191–84.651, p = 0.034). Severe PSDs are associated with preoperative nutritional disorders, as determined by the CONUT score. Furthermore, nutritional disorders may increase the severity of PSDs, regardless of the stoma type.

Download Full-text

Characteristics and Outcomes of COVID-19 Patients with Mature B-Cell Non-Hodgkin Lymphomas (mB-Cell NHL): A US Nationwide Electronic Health Record (EHR) Database Study

Blood ◽

10.1182/blood-2021-145042 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2418-2418

Author(s):

Xiaomeng Yue ◽

David Hallett ◽

Yangyang Liu ◽

Reethi Iyengar ◽

Elisa Basa ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

B Cell ◽

Clinical Characteristics ◽

Index Date ◽

B Cell Lymphoma ◽

Male Gender ◽

Older Age ◽

Multivariable Logistic Regression ◽

The Impact

Abstract Introduction COVID-19 poses a serious concern for mB-cell NHL patients given their advanced age, high burden of comorbidities, and immune dysfunction. Limited by smaller sample sizes during the early period of the COVID-19 pandemic, previous studies were unable to thoroughly evaluate the impact of COVID-19 on patients with mB-cell NHL 1,2. We aim to describe demographics and clinical characteristics, outcomes, and risk factors associated with death and other severe outcomes among COVID-19 patients with mB-cell NHL in a large US nationwide database. Methods This retrospective cohort study was conducted using the Optum EHR database, comprising data from an integrated network of ambulatory and hospital care providers across the US. Patients with COVID-19 (diagnosis code of U07.1, U07.2, or a positive result of SARS-Cov-2 virus PCR or antigen tests) between Feb. 1, 2020 and Jan 7, 2021 (index date) and mB-cell NHL diagnosis prior to the COVID-19 diagnosis were included. Patients were excluded if they were under 18 years of age, had missing age or sex, or had <1year continuous eligibility prior to their index date (pre-index period). All baseline characteristics, including demographics and comorbidities, were determined during the one-year pre-index period. Severe outcomes, including death, hospitalization, ICU admission, and acute respiratory insufficiency (ARI), were evaluated within 30 days post-index date. Multivariable logistic regression was conducted to identify variables independently associated with severe outcomes. Results Among 2,767 patients with mB-cell NHL who were infected with SARS-CoV-2 between Feb. 1, 2020 and Jan. 7, 2021 (mean age±SD: 67.9 years±14.7, 53.9% male), majority were white (73.9%), followed by African American (10.9%), Hispanic (6.9%), and Asian (1.2%). The most common subtypes of mB-cell NHL were chronic lymphocytic leukemia/small lymphocytic lymphoma (26.9%), multiple myeloma (22.4%), diffuse large B-cell lymphoma (13.2%), and follicular lymphoma (7.3%). Of these patients, 93.4% have at least one comorbidity. The most common comorbidities were hypertension (58.5%), neurological disease (49.4%), diabetes (28.2%), ischemic heart disease (25.5%), cardiac arrhythmia/conduction disorders (24.4%), chronic kidney disease (CKD, 19.2%), heart failure/cardiomyopathy (18.1%), and COPD (12.3%). Overall, 960 patients (34.7%) developed severe outcomes, among which, 847 patients (30.6%) were hospitalized, 214 patients (7.7%) were admitted to the ICU, 201 patients (7.3%) experienced ARI, and 220 patients (8.0%) died. Multivariable logistic regression showed that increased odds of severe outcomes were independently associated with older age (85+ years vs. <65 years; adjusted odds ratio [OR], 2.0; 95% CI, 1.4-2.7), male gender (OR, 1.4; 95% CI, 1.1-1.6), insurance coverage with Medicaid (OR, 1.8; 95% CI, 1.1-2.9) and/or Medicare (vs. commercial only; OR, 1.9; 95% CI, 1.5-2.5), infected during the first quarter (OR, 5.6; 95% CI, 3.4-9.4) or second quarter of 2020 (vs. fourth quarter of 2020; OR, 1.7; 95% CI, 1.4-2.1), having CKD (OR, 1.3; 95% CI, 1.0-1.6), COPD (OR, 1.4; 95% CI, 1.0-1.8), diabetes (OR, 1.3; 95% CI, 1.1-1.6), and receiving active treatment for NHL (OR, 1.4; 95% CI, 1.0-2.0) within 30 days prior to COVID-19 diagnosis (Figure). Conclusions This study demonstrated key demographic and clinical characteristics associated with severe outcomes among COVID-19 patients with mB-cell NHL using one of the largest nationwide databases. Risk factors for severe outcomes identified in the general population, such as older age, male gender, and having certain underlying medical conditions were also identified in this study. In addition, COVID-19 infection occurring earlier in the pandemic and receiving active NHL treatments were associated with severe outcomes. These latter two observations might reflect the improvement in patient management during the latter period of the pandemic and that active mB-cell NHL disease and treatment rendered an increased risk of severe outcomes in COVID-19 patients with mB-cell NHL. These insights highlight the importance of utilizing demographic, clinical and treatment information to estimate the risk for severe outcomes, whereas prospective studies focusing on optimal COVID-19 management are required to identify specific actions that can be taken to improve outcomes of COVID-19 in patients with mB-cell NHL. Figure 1 Figure 1. Disclosures Yue: Joule: Current Employment. Hallett: AbbVie: Current Employment. Liu: AbbVie: Current Employment. Iyengar: AbbVie: Current Employment. Basa: AbbVie: Current Employment. Yang: AbbVie: Current Employment.

Download Full-text

Abstract TP50: A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy: A Single-Center Study

Stroke ◽

10.1161/str.51.suppl_1.tp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Aaron P Wessell ◽

Helio De Paula Carvahlo ◽

Elizabeth Le ◽

Gregory Cannarsa ◽

Matthew J Kole ◽

...

Keyword(s):

Logistic Regression ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariable Logistic Regression Analysis ◽

Procedure Time ◽

Golden Hour ◽

Poor Outcome ◽

Multivariable Logistic Regression ◽

Scale Scores ◽

The Impact

Background: Previous studies have demonstrated the importance keeping thrombectomy procedure times ≤60 min., termed the ‘golden hour’. In the current study, we further investigate the significance of the ‘golden hour’ and the impact of procedural timing on clinical outcomes after mechanical thrombectomy. Methods: We performed an analysis of 319 consecutive mechanical thrombectomy patients at a single Comprehensive Stroke Center from April 2012 through February 2019. Bivariate analyses compared patients grouped according to procedure time ≤60 min. or >60 min. and time of stroke onset-to-endovascular therapy (OTE) ≤6 hours or >6 hours. Logistic regression was used to determine independent predictors of poor outcome at 90-days defined by modified Rankin Scale (mRS) scores of 3-6. Results: A procedure time ≤60 min. was associated with increased revascularization rates (88% vs. 67%; p<0.001) and a greater percentage of good outcomes at 90-days (47% vs. 31%; p=0.003). Multivariable logistic regression revealed that greater age (OR 1.03, 95% CI 1.004-1.051; p=0.023), higher admission NIHSS score (OR 1.10, 95% CI 1.038-1.159; p=0.001), and history of diabetes mellitus (OR 1.94, 95% CI 1.049-3.580; p=0.035) were independently associated with a greater odds of poor outcome. Modified TICI scale scores of 2C (OR 0.12, 95% CI 0.047-0.313; p<0.001) and 3 (OR 0.19, 95% CI 0.079-0.445; p<0.001) were associated with a reduced odds of poor outcome. Although not statistically significant on univariate analysis, OTE ≤6 hrs. was independently associated with a reduced odds of poor outcome (OR 0.41, 95% CI 0.212-0.809; p=0.010) in the final multivariate model (AUC 0.800). Procedure time ≤60 min. did not have a significant independent association with clinical outcome on multivariate analysis (p=0.095). Conclusions: Thrombectomy procedure times beyond 60 min. are associated with lower overall revascularization rates and worse 90 day functional outcomes when compared to faster thrombectomy procedures. However, thrombectomy procedure time was not predictive of outcome on multivariable logistic regression analysis. Our study emphasizes the significance of achieving revascularization despite the requisite procedure time.

Download Full-text

Outcomes of cancer patients with takotsubo cardiomyopathy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18101 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18101-e18101

Author(s):

Achuta Kumar Guddati ◽

Gagan Kumar ◽

Iuliana Shapira ◽

Parijat Saurav Joy

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Cancer Patients ◽

Logistic Regression Analysis ◽

Takotsubo Cardiomyopathy ◽

Primary Diagnosis ◽

Multivariable Logistic Regression Analysis ◽

Solid Organ ◽

Multivariable Logistic Regression

e18101 Background: Chemotherapy induced cardiomyopathy is an important complication of some chemotherapeutic agents. The stress of a cancer diagnosis and ongoing chemotherapy may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCP) in cancer patients is unknown. The incidence of TCP and related outcomes in cancer patients was investigated in this study. Methods: The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCP with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis. Results: From 2007 through 2013, an estimated 122,750 adults were admitted with a diagnosis of TCP. In 2013, the incidence of admissions in US of patients with coexisting TCP and malignancy was 1.13%. Admissions in 34,957 patients were for a primary diagnosis of TCP with 91.7% females; overall, 665 (2.1%) had solid organ cancer, 237 (0.74%) had hematological malignancy and 354 (1.11%) had metastatic cancer. Patients admitted for TCP with coexisting malignancy had a significantly higher mortality (13.8% vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29291 vs. $ 36231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCP and without any underlying malignancy, males had a higher mortality (4.02% vs. 1.03%, p < 0.0001) whereas there was no gender difference in mortality in those with coexisting malignancy (6.25% vs 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001), venous thromboembolic disease (OR 4.52, p = 0.004), malnutrition (OR 2.41, p = 0.006) and heart failure (OR 1.918, p = 0.004). Conclusions: Outcomes are significantly worse in patients with TCP and solid malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCP is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.

Download Full-text

Switching to centrifugal pumps may decrease hemolysis rates among pediatric ECMO patients

Perfusion ◽

10.1177/0267659120982572 ◽

2021 ◽

pp. 026765912098257

Author(s):

Kevin N Johnson ◽

Benjamin Carr ◽

George B Mychaliska ◽

Ronald B Hirschl ◽

Samir K Gadepalli

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Centrifugal Pumps ◽

Single Center ◽

Free Hemoglobin ◽

Risk Of Death ◽

Multivariable Logistic Regression ◽

Increased Risk ◽

The Impact ◽

Significant Factors

Recent advances in ECLS technology have led to the adoption of centrifugal pumps for the majority of patients worldwide. Despite several advantages of centrifugal pumps, they remain controversial because a number of studies have shown increased rates of hemolysis. The aim of this study was to assess the impact of transitioning from roller to centrifugal pumps on hemolysis rates at our center. A retrospective analysis of all pediatric ECMO patients at a single center between 2005 and 2017 was undertaken. Hemolysis was defined as a plasma free hemoglobin >50 mg/dL. Multivariable logistic regression was performed correcting for several factors to determine risk factors for hemolysis and analyze outcomes among patients with hemolysis. Significant findings were those with p < 0.05. A total of 590 patients were identified during the study period. Multivariable logistic regression for risk factors for hemolysis showed roller pumps (OR 1.92, CI 1.11–3.33) and ECMO duration (OR 1.002 per hour, CI 1.00–1.01) to be significant factors. Rates of hemolysis significantly improved following conversion from roller to centrifugal pumps, with significantly lower rates of hemolysis in 2012, 2015, 2016, and 2017 when compared to the historical average with roller pumps from 2005 to 2009 (34.7%). Additionally, hemolysis was associated with an increased risk of death (OR 3.59, CI 2.05–6.29) when correcting for other factors. These data suggest decreasing rates of hemolysis with centrifugal pumps compared to roller pumps. Since hemolysis was also associated with increased risk of death, these data support the switch from roller to centrifugal pumps at ECMO centers.

Download Full-text

Predictive Factors of Acute Respiratory Failure in Esophagectomy for Esophageal Malignancy

The American Surgeon ◽

10.1177/000313481207801002 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1024-1028 ◽

Cited By ~ 3

Author(s):

Hossein Masoomi ◽

Brian Nguyen ◽

Brian R. Smith ◽

Michael J. Stamos ◽

Ninh T. Nguyen

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Patient Characteristics ◽

Surgical Decision ◽

Preoperative Risk Factors ◽

Nationwide Inpatient Sample Database ◽

Total Esophagectomy ◽

Potential Risks ◽

Independent Risk Factors

Acute respiratory failure (ARespF) is a common complication after esophagectomy that contributes to higher morbidity and mortality. Using the Nationwide Inpatient Sample database, we sought to identify predictors of ARespF in 6352 patients who underwent esophagectomy for malignancy between 2006 and 2008. Multivariate regression analyses were performed to identify preoperative factors (patient characteristics, comorbidities, procedural type, tumor's location, hospital teaching status, and payer type) predictive of ARespF in esophagectomy. The overall rate of ARespF was 27.08 per cent. For comorbidities, independent risk factors for higher rate of ARF included weight loss (adjusted odds ratio [AOR], 3.63; 95% confidence interval [CI], 3.02 to 4.37), pulmonary hypertension (AOR, 2.38; 95% CI, 1.85 to 3.45), congestive heart failure (AOR, 2.35; 95% CI, 1.77 to 3.13), liver disease (AOR, 1.95; 95% CI, 1.22 to 3.12), chronic lung disease (AOR, 1.40; 95% CI, 1.17 to 1.66), and anemia (AOR, 1.26; 95% CI, 1.04 to 1.51). Cervical location of malignancy (AOR, 2.32; 95% CI, 1.51 to 3.56), total esophagectomy (AOR, 1.64; 95% CI, 1.41 to 1.90), and non-teaching hospital (AOR, 1.45; 95% CI, 1.20 to 1.75) were independent risk factors for ARespF. There was no effect of age, gender, race, hypertension, diabetes, renal failure, obesity, smoking, peripheral vascular disorder, or payer type on ARespF. We identified multiple preoperative risk factors that have an impact on development of ARespF after esophagectomy. Surgeons can use these factors to inform patients of potential risks and should consider these factors during surgical-decision making.

Download Full-text

Risk factors for stillbirth among pregnant women infected with syphilis from 2010–2016, Zhejiang Province, China

10.21203/rs.2.16820/v1 ◽

2019 ◽

Author(s):

Cuicui Duan ◽

Xiao-hui Zhang ◽

Shan-shan Li ◽

Wei Wu ◽

Li-qian Qiu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pregnant Women ◽

Logistic Regression Analysis ◽

Zhejiang Province ◽

Multivariable Logistic Regression Analysis ◽

Adequate Treatment ◽

Multivariable Logistic Regression ◽

Latent Syphilis

Abstract Background: Syphilis infection is one of the most common maternal factors related to stillbirth. The study aims to determine the risk factors for stillbirth among pregnant women infected with syphilis. Methods : This was a retrospective study. Data on stillbirth and gestational syphilis were extracted from the PMTCT program database 2010–2016 in Zhejiang Province. A total of 8724 pregnancy women infected with syphilis were included. Multivariable logistic regression analysis was performed to assess the associations between gestational syphilis and stillbirth. Results : The stillbirth rate among pregnant women infected with syphilis was 1.74% (152/8724) in Zhejiang Province, China, from 2010–2016. Compared with live birth, stillbirth was significantly associated with lower maternal age, not being married, lower gravidity, previous history of syphilis, non-latent syphilis stage, and higher maternal serum titer for syphilis, inadequate treatment for syphilis, and later first antenatal care visit. With multivariable logistic regression analysis, non-latent syphilis (adjusted OR=2.03; 95% CI 1.17–3.53) and maternal titers over 1:4 (adjusted OR=1.78; 95% CI 1.25–2.53) were risk factors for stillbirth. Adequate treatment was the only protective factor for stillbirth (adjusted OR=0.16; 95% CI 0.10–0.25). Conclusions : Adequate treatment is effective in reducing the incidence of stillbirths among pregnant women infected with syphilis, and this is particularly important in women diagnosed with high RPR titer (under 1:4). Keywords: risk factors, syphilis, stillbirth, pregnant, syphilis stage, RPR

Download Full-text

POS0403 RISK FACTORS FOR PROGRESSION OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE: REASSURING IMPACT OF METHOTREXATE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4157 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 431.2-431

Author(s):

C. Lucas ◽

A. Tremblay ◽

S. Jouneau ◽

A. Perdriger

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Logistic Regression ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Respiratory Function Tests ◽

Multivariable Logistic Regression Analysis ◽

High Resolution Computed Tomography ◽

The Impact

Background:Factors associated with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) progression and prognosis are not well identified, especially the impact of methotrexate.Objectives:Identify risk factors of ILD progression in RA-ILD patients in a longitudinal study.Methods:RA patients with ILD confirmed in 2 high resolution computed tomography (HRCT) chest scans spaced at least 6 months apart (T0: date of the first HRCT chest scan describing ILD; Tx: date of the last HRCT chest scan available) were consecutively included in this retrospective multi-centric study from 2010 to 2020. HRCT chest scans were analyzed for each patient at T0 and Tx by 2 independent radiologists to determinate ILD pattern (definite UIP, probable UIP, indeterminate UIP, non-UIP) and progression during the follow-up including variation of the fibrosis score (aggravated or non-aggravated). Characteristics of patients (demographic-clinical-biological findings, respiratory function tests, and treatments exposure) at ILD diagnosis and during the follow-up (T0-Tx) were analyzed as potential determinants of ILD progression through multivariable logistic regression analysis. Overall survival was analyzed using Kaplan-Meier method.Results:74 RA-ILD patients were included. During a mean duration between T0-Tx of 2.8 years ± 2.4, 26 patients (35%) had ILD progression. Thirty-three patients (45%) were treated by methotrexate at ILD diagnosis (T0) and 29 of them (39%) continued methotrexate during T0-Tx. Logistic regression in multivariate analysis revealed that a treatment by methotrexate at ILD diagnosis was protective against ILD progression (OR=0.14 [0.04-0.52]; p=0.0031). Non-UIP pattern at ILD diagnosis was also protective against ILD progression (OR=0.09 [0.02-0.36]; p=0.0005). The follow-up for survival analysis was 5.1 years ± 2.9. Thirty-three patients (31%) died, and the 3-year survival rate was 80%. Survival was better for non-aggravated ILD patients (HR=3.5 [1.46-8.4]; p=0.004) and for patients treated by methotrexate during T0-Tx (HR= 0.36 [0.15-0.84]; p=0.018) and worse for definite UIP patterns (HR=2.570 [1.078-6.128]; p=0.0332).Conclusion:In RA-ILD patients, non-UIP pattern and methotrexate treatment are associated with better ILD evolution and prognosis.Disclosure of Interests:None declared

Download Full-text

Invasive Mechanical Ventilation May Be an Important Factor of Mortality in Severe/Critical COVID-19 Pneumonia: A Retrospective Cohort Study

10.21203/rs.3.rs-105230/v1 ◽

2020 ◽

Author(s):

Jing Wei ◽

Lei Shi ◽

Zhi Cheng ◽

Xinye Jin ◽

Wei Zhao ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Invasive Mechanical Ventilation ◽

Trial Registration ◽

Hospital Death ◽

Multivariable Logistic Regression Analysis ◽

Multivariable Logistic Regression

Abstract Background: Many of severe COVID-19 patients are admitted to the hospital or even to the Intensive Care Unit(ICU). The present study was aimed to investigated the risk factors in death from COVID-19.Methods: In this retrospective study, all inpatients confirmed severe or critical COVID-19 from two tertiary hospital in Huangshi were included, who had been discharged or died by March19,2020. Demographic,clinical,treatment,laboratory data and information were extracted from electronic medical records and compared between survivors group and non-survivors group. The univariable and multivariable logistic regression analysis was used to analyze the risk factors associated with in-hospital death.Results: 81 patients were included in this study, of whom 55 were discharged and 26 died in hospital. In all patients, 36(44.4%) patients had comorbidity, including hypertension(27[33.3%]), diabetes(11[13.6%]) and coronary heart disease (CHD)(11[13.6%]), and 16(19.8%) patients accompanied with more than 2 kinds of underlying diseases. The proportion of CHD in non-survivors group was significantly higher than that in survivors group(26.9% vs 7.3%, P=0.032), but there were no differences in hypertension, diabetes and COPD between the non-survivors group and the survivors group. Multivariable logistic regression analysis showed increasing odds of in-hospital death associated with aspartate aminotransferase(AST) and invasive mechanical ventilation (IMV) (P<0.001)(P=0.017）.Conclusions: Invasive Mechanical Ventilation may contribute to mortality of severe/critical COVID-19 pneumonia, and with higher AST at admission was one of the indicators of poor prognosis.Trial registration: Chinese Clinical Trial Registration; ChiCTR2000031494; Registered 02 April 2020; http://www.medresman.org

Download Full-text

Covid -19, An Acute on Chronic Metabolic Syndrome? HbA1c-A Marker of Severe Infection.

10.21203/rs.3.rs-518074/v1 ◽

2021 ◽

Author(s):

Susanne Rysz ◽

Malin Jonsson Fagerlund ◽

Claire Rimes-Stigare ◽

Emma Larsson ◽

Francesca Campoccia Jalde ◽

...

Keyword(s):

Metabolic Syndrome ◽

Logistic Regression ◽

Regression Analysis ◽

Respiratory Failure ◽

Logistic Regression Analysis ◽

Multivariable Logistic Regression Analysis ◽

The Metabolic Syndrome ◽

Multivariable Logistic Regression ◽

Uncontrolled Diabetes ◽

Increased Risk

Abstract Background: The comorbidities commonly observed in severe Covid-19 are diagnoses that comprise the metabolic syndrome. The metabolic status of patients when infected with SARS-Cov-2 and its significance for the severity of the disease is not yet fully understood. We investigated the association between respiratory symptoms and the levels of HbA1c in hospitalized patients infected with SARS-CoV-2. Methods: In this retrospective observational study, we included all inpatients at the Karolinska University Hospital, Sweden who had both a positive SARS-CoV-2 test and who had a HbA1c test obtained within 3 months of admission. The primary reasons for hospitalization included trauma, stroke, myocardial infarction, acute or elective surgery as well as infection. Based on HbA1c level and diabetes history, we classified patients into the following dysglycemia categories: prediabetes, unknown diabetes, controlled diabetes or uncontrolled diabetes. We used multivariable logistic regression analysis adjusted for age, sex and body mass index, to assess the association between dysglycemia categories and development of respiratory failure when infected with SARS-CoV-2. Primary outcome was respiratory failure associated with SARS-CoV-2.Results: Of the 385 study patients, 88 (22.9%) had prediabetes, 68 (17.7%) had unknown diabetes, 36 (9.4%) had controlled diabetes, and 83 (21.6%) had uncontrolled diabetes. Overall, 299 (77.7%) patients were admitted with or developed SARS-CoV-2-assoociated respiratory failure during hospitalization. The proportion of patients in need of intensive care (62.5% vs 26.7%, p<0.001), mechanical ventilation (60.9% vs. 26.7%, p<0.001) and renal replacement therapy (14% vs. 1.2%, p<0.001) were all higher in patients with SARS-CoV-2 associated respiratory failure vs. patients without. In addition, 83% of the ICU patients with SARS-CoV-2 associated respiratory failure had a HbA1c > 42 mmol/mol. In multivariable logistic regression analysis compared with no chronic dysglycemia, prediabetes (OR 14.41, 95% CI 5.27-39.43), unknown diabetes (OR 15.86, 95% CI 4.55-55.36), and uncontrolled diabetes (OR 17.61, 95% CI 5.77-53.74) was independently associated with increased risk of SARS-CoV-2-induced respiratory failure.Conclusion: Metabolic imbalance, reflected by elevated HbA1c with or without previous diagnosed diabetes mellitus, was associated with a more severe course of SARS-CoV-2-respratory infection. We suggest that HbA1c could be used as a marker of risk for severe Covid-19.

Download Full-text