COVID-19 Prognostic Score Utilizing Hematological and Inflammatory Markers to Determine Outcomes of Hospitalized Patients

Introduction COVID-19 is an ongoing pandemic that has impacted millions of individuals throughout the world. The spectrum of clinical features of COVID-19 can vary from asymptomatic infection to severe multiorgan failure leading to death. There is no single biomarker available that can predict the trajectory of the infected patient. Few clinical reports suggest a correlation between the severity of COVID-19 and elevation of certain hematological and inflammatory markers. We used a novel COVID-19 Prognostic Score (CPS) which included lymphocyte count, elevated lactate dehydrogenase (LDH), C-reactive protein (CRP) and ferritin levels to predict the outcomes of COVID-19 patients. Methods We performed a retrospective chart review of COVID-19 patients admitted to New York Presbyterian Brooklyn Methodist Hospital between March and April of 2020. Clinical data was extracted manually from electronic medical records. Patients were divided into 2 cohorts. The first cohort included a combination of low lymphocyte count, elevated LDH, CRP and ferritin. The second cohort included normal lymphocyte count, low LDH, CRP and ferritin. Low lymphocyte count was defined as < 20% of white blood cell count (WBC), high LDH as ≥ 300 U/L, high CRP as ≥50mg/L and high ferritin as ≥600 ng/mL. Statistical analysis was performed by computing odds ratio using a p-value of < 0.05 as statistically significant. Results We analyzed 683 hospitalized patients who were diagnosed with COVID-19 confirmed via viral PCR resting. The median age was 66.5 years, males were 52.2% and blacks were 47.2%. 16.3% had coronary artery disease (CAD), 38.6% had Diabetes Mellitus (DM), 63.1% had hypertension and 21.6% had pulmonary disease. 181 patients (26.5%) were intubated and transferred to ICU. The median LDH was 438 U/L, the median CRP was 107 mg/L and the median ferritin was 687 ng/mL. 4.6% of patients developed a thromboembolic event. The overall inpatient mortality rate was 32.1%. There were 178 patients in the CPS-High cohort while there were 41 patients who qualified for the CPS-Low cohort. The median age of CPS-High was 65 years and the median age of CPS-Low was 58 years. The percentage of CAD, DM, hypertension, pulmonary disease in CPS-High and CPS-Low were 11.8%, 39.3%, 57.9%, 10.7% and 19.5%, 17.1%, 43.9%, 12.2% respectively. In the CPS-High cohort the overall inpatient mortality was 42% while the inpatient mortality rate for CPS-Low was 7.3%. In univariate analysis, patients who had CPS low had significantly reduced inpatient mortality (Odds ratio 0.108, 95% CI 0.03-0.36, p-value = 0.0003). Discussion Our study suggests that a combination of hematological characteristics and inflammatory markers can be used to assess the severity of illness with COVID-19. This study shows that there is a likelihood of 6-times higher mortality with COVID-19 if all the clinical characteristics are abnormal including lymphocyte count, LDH, CRP, and ferritin. This simple clinical prognostic score can be used at the time of hospital admission to efficiently triage patients, which may likely improve the outcomes of these patients. This prognostic tool needs to be validated in a larger dataset or prospective clinical study. Disclosures No relevant conflicts of interest to declare.

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FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN BBLR DI RUMAH SAKIT UMUM DAERAH PALEMBANG BARI TAHUN 2013

Jurnal Kebidanan : Jurnal Medical Science Ilmu Kesehatan Akademi Kebidanan Budi Mulia Palembang ◽

10.35325/kebidanan.v4i2.60 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Juliana Widyastuti Wahyuningsih Juliana Widyastuti Wahyuningsih

Keyword(s):

Birth Weight ◽

Mortality Rate ◽

Low Birth Weight ◽

Random Sampling ◽

Maternal Age ◽

Univariate Analysis ◽

Infant Mortality Rate ◽

Survey Method ◽

P Value ◽

Chi Square

ABSTRACT Low birth weight (LBW) infants with birth weight is less than 2500 grams, regardless of gestational age. Statistically showed 90 % incidence of LBW obtained in developing countries with a mortality rate 35 times higher tinggi.Di South Sumatra Province Infant Mortality Rate ( IMR ) is 29 per 1,000 live births. In Palembang BARI hospitals incidence of LBW in 2013 amounted to 317 cases . The purpose of this study is to determine is there a relationship between the factors of age, education, and parity with the incidence of Low Birth Weight in Palembang BARI hospitals in 2013. This study used survey method crosss sectional analytic approach. The study population was all women who gave birth and was admitted to hospital obstetrics Palembang BARI installations in 2013 amounted to 901. This research was conducted in February 2014. Samples were taken with a random sampling method sistematic. Analyze data using statistical test Chi - Square. Results of univariate analysis of this study showed that 193 (69.4 %) of the respondents had low birth weight, and 85 (30.6 %) respondents had BBLN. 63 (22.7 %) of respondents with a high risk of maternal age and 215 (77.3 %) of respondents with a low risk of maternal age. 157 (56.5 %) respondents with low education mothers and 121 (43.5 %) of respondents with higher education mothers. 48 (17.3 %) respondents with high parity mothers and 230 (82.7 %) respondents with low parity mothers. So the bivariate analysis showed no significant association between maternal age with the incidence of LBW with P value = 0.035, no significant association between education and the incidence of LBW with P value = 0.006, and no significant relationship between the incidence of low birth weight with parity P value = 0.041. It is recommended for health care workers (midwives) hospital in order to be used as material information regarding the occurrence of LBW and as an input as well as the evaluation of success in good health or when needed to do counseling and care of LBW, especially to mothers who give birth to low birth weight baby. ABSTRAK Berat badan lahir rendah (BBLR) adalah bayi dengan berat lahir kurang dari 2500 gram tanpa memandang masa gestasi. Secara statistik menunjukkan 90% kejadian BBLR didapatkan di negara berkembang dengan angka kematiannya 35 kali lebih tinggi.Di Propinsi Sumatera Selatan Angka Kematian Bayi (AKB) sebesar 29 per 1.000 kelahiran hidup. Di RSUD Palembang BARI Tahun 2013 angka kejadian BBLR berjumlah 317 kasus. Tujuan Penelitian ini adalah untuk mengetahui adakah hubungan antara faktor umur, pendidikan, dan paritas dengan kejadian Berat Badan Lahir Rendah di RSUD Palembang BARI Tahun 2013. Penelitian ini menggunakan metode survey analitik dengan pendekatan crosss sectional. Populasi penelitian ini adalah semua ibu yang melahirkan dan dirawat inap di instalasi kebidanan RSUD Palembang BARI Tahun 2013 berjumlah 901. Penelitian ini dilakukan pada bulan Februari 2014. Sampel penelitian diambil dengan metode sistematic random sampling. Analisa data menggunakan uji statistik Chi – Square. Hasil penelitian analisis univariat ini menunjukkan bahwa 193 (69,4%) responden mengalami BBLR, dan 85 (30,6%) responden mengalami BBLN. 63 (22,7%) responden dengan umur ibu resiko tinggi dan 215 (77,3%) responden dengan umur ibu resiko rendah. 157 (56,5%) responden dengan ibu pendidikan rendah dan 121 (43,5%) responden dengan ibu pendidikan tinggi. 48 (17,3%) reponden dengan ibu paritas tinggi dan 230 (82,7%) responden dengan ibu paritas rendah. Sehingga analisa bivariat menunjukkan ada hubungan yang bermakna antara umur ibu dengan kejadian BBLR dengan P value = 0,035, ada hubungan yang bermakna antara pendidikan dengan kejadian BBLR dengan P value = 0,006 dan ada hubungan yang bermakna antara paritas dengan kejadian BBLR dengan P value = 0,041. Disarankan bagi petugas kesehatan (bidan) rumah sakit agar dapat dijadikan sebagai bahan informasi mengenai terjadinya BBLR dan sebagai bahan masukan serta evaluasi keberhasilan dalam pelayanan kesehatan yang baik atau bila perlu dilakukannya penyuluhan serta asuhan tentang BBLR khususnya kepada ibu yang melahirkan Bayi dengan BBLR.

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Richter Transformation of Chronic Lymphocytic Leukemia: Incidence, Risk Factors and Outcome

Blood ◽

10.1182/blood.v112.11.3179.3179 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3179-3179 ◽

Cited By ~ 2

Author(s):

Sina Alipour ◽

Heather Leitch ◽

Linda M Vickars ◽

Lynda M Foltz ◽

Paul F Galbraith ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Lymphocyte Count ◽

Rare Complication ◽

Univariate Analysis ◽

Lymphocytic Leukemia ◽

Age At Diagnosis ◽

P Value ◽

Prior Therapy ◽

Electronic Database Search ◽

Baseline Characteristics

Abstract Richter transformation (RT) is a rare complication of chronic lymphocytic leukemia (CLL). There is little information in the literature about its risk and outcome. In this study we assessed the incidence, presenting characteristics and outcomes of patients (pts) with CLL who developed RT. An electronic database search of pts with CLL who presented at St Paul’s Hospital between 1969 and 2007 was performed. Among 465 pts with CLL, 24 pts (5%) developed RT. Presenting features included B-symptoms (17%), lymph node enlargement (58%), progressive cytopenia (29%), hypercalcemia (4%), and spleno/hematomegaly (13%). The median age at diagnosis of CLL and RT were 64 y (range 33–80 y) and 67 y (range 48–81 y) respectively. The median time to transformation from CLL diagnosis was 61 months (range 1–257 m). Twenty one patients (88%) had been previously treated for CLL. Seventeen patients (71%) had received >1 prior therapy. The median lymphocyte count at diagnosis was 12 ×109/L (range 4–120 ×109/L). Six patients (25%) are still alive with a median follow up of 38 m (range: 3–66 m). The only predictive factor for better survival post-transformation on univariate analysis was age of less than 60 y at CLL diagnosis (p=0.01). Other factors such as CLL Rai stage, lymphocyte count at diagnosis were not predictive for survival. This group of patients was compared with randomly selected group of patients with CLL but did not have RT. The baseline characteristics of the groups are presented in the table. No significant differences were found between the two groups in terms of gender, age at diagnosis, Rai stage or median lymphocyte count at diagnosis. The 5 and 10 year OS for the RT group were 76% and 39% compared to 93% and 84% for the CLL group (p= 0.002), respectively. In summary, RT significantly shortens the survival of CLL patients. There were no obvious predictive factors for RT in CLL pts at diagnosis. Table: Baseline characteristics of Richter and CLL groups. Parameter Richter group (%) CLL group (%) P value Number 24 37 Sex: M/F (ratio) 16/8 (2:1) 22/15 (1.5:1) 0.052 Age at Diagnosis: Median (range) 64 (33–80) 60 (37–85) 0.6 Rai stage at diagnosis: 0, 1+2, 3+4 7, 16,1 (29, 67, 4) 23, 14, 0 (62, 38, 0) 0.3 Median lymphocyte count at diagnosis (range) 12 ×109/1 (4–120) 8 × 109/1 (5–394) 0.056 Fig: OS of pts with RT compared with CLL pts and no RT Fig:. OS of pts with RT compared with CLL pts and no RT

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Intracranial Hemorrhage in Patients with Hemophilia in the Prophylaxis Era.

Blood ◽

10.1182/blood.v112.11.3388.3388 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3388-3388

Author(s):

Char Witmer ◽

Rodney Pressley ◽

Roshni Kulkarni ◽

J. Michael Soucie ◽

Catherine Scott Manno

Keyword(s):

Mortality Rate ◽

Reference Group ◽

Univariate Analysis ◽

P Value ◽

Severe Hemophilia ◽

Clinical Factors ◽

Factors Associated ◽

Annual Visit ◽

Nested Case Control

Abstract Objective: With a mortality rate of 20%, intracranial hemorrhage (ICH) accounts for the highest number of deaths from bleeding in patients with hemophilia and is a common cause of long-term disability. We performed a nested case-control study within a cohort of males with hemophilia enrolled in the Centers for Disease Control and Prevention (CDC) Universal Data Collection (UDC) project. The study objective was to identify rates and risk factors associated with ICH in the modern era of prophylaxis. Patients and methods: Study participants were males with hemophilia A or B, enrolled in the CDC UDC project, 2 years or older, who had an initial visit, and at least one follow up event between May 1998 and March 2008. Patients were followed from the initial visit until their study termination event, defined as an ICH reported during a subsequent annual visit, death, or the latest annual visit held during the study period. Cases were patients who after UDC enrollment either had an ICH or whose cause of death was from an ICH. The following clinical factors were examined for an association with ICH: hemophilia type, severity level, prior ICH, presence of an inhibitor, treatment with prophylaxis, HIV status, chronic hepatitis B, hepatitis C, alcohol abuse, elevated prothrombin time, ethnicity and age. Data analysis was conducted using SAS 9.2 (SAS Institute, Cary, NC). Factors associated with ICH were identified using a nested case control design. Interaction effects were assessed using the Breslow-Day Test for homogeneity of the odds ratios. The independent association between prophylaxis and ICH was assessed using logistic regression. All hypothesis testing was two tailed with odds ratios and confidence intervals reported. Results: During the study period 10,262 patients were identified who met the inclusion criteria. Of these, 199 (1.9%) experienced an ICH. Based on patient follow up time (mean 4.9 +/−2.46 years) the incidence rate was 3.9 per thousand patient years. Thirty-nine of the 199 ICH cases died from the event, resulting in a mortality rate of 19.6%. In 148 (74%) of the ICH cases, the subjects had severe hemophilia. See table 1 for univariate analysis of all patients. Table 1: Clinical factors associated with ICH for all patients in the cohort, N=10,262 (univariate analysis) Clinical Factors Odds Ratio (95% CI) P-Value *Reference group White (non-Hispanic). **Reference group age 10–15 years. Prior ICH 3.62 (2.66–4.92) <0.001 Severe Hemophilia 3.25 (2.01–5.25) <0.001 High Titer Inhibitor 4.01 (2.40–6.71) <0.001 Hepatitis C 1.73 (1.30–2.29) <0.001 Black (non-Hispanic)* 2.07 (1.46–2.96) <0.001 Age 2-9 years** 1.85 (1.14–2.99) 0.01 Age >41 years** 2.17 (1.34–3.50) 0.001 For the entire cohort, prophylaxis use was not associated with a statistically significantly reduced risk of ICH (0.83 (0.61–1.15) p=0.26). However, further analysis (see table 2), restricted to patients with severe hemophilia, demonstrated a protective effect of prophylaxis use that was limited only to patients who did not have an inhibitor and who were not infected with HIV. Table 2: Clinical factors independently associated with ICH among 5,485 patients with severe hemophilia (multivariate analysis) Clinical Factors Odds Ratio (95% CI) P-Value **Reference group age 10–15 years. Prophylaxis no inhibitor 0.50 (0.32–0.77) 0.002 Prophylaxis no HIV 0.52 (0.34–0.81) 0.004 Prior ICH 3.24 (2.27–4.64) <0.0001 Chronic Hepatitis B 2.99 (1.03–8.63) 0.043 Age 2–9 years** 1.92 (1.05–3.51) 0.034 Conclusion: This study demonstrates that patients with severe hemophilia who use prophylaxis and are not HIV positive and do not have an inhibitor experience a 50% risk reduction for ICH. This study confirms the previously identified risk factors for ICH including severity of disease, prior ICH, young age and the presence of an inhibitor. The strongest predictor for ICH was a history of ICH before enrollment in the UDC. Unfortunately even in the age of widely available prophylactic therapy, the mortality rate from ICH remains quite high at 19.6%.

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A Pharmacoeconomics Study for Anticoagulants used for Hospitalized COVID-19 Patients in Al-Najaf Al-Ashraf city –Iraq(Conference Paper )#

Iraqi Journal of Pharmaceutical Sciences ( P-ISSN 1683 - 3597 E-ISSN 2521 - 3512) ◽

10.31351/vol30isssuppl.pp48-59 ◽

2022 ◽

Vol 30 (Suppl.) ◽

pp. 48-59

Author(s):

Fatimah Baqer Alqubbanchi ◽

Fadya Yaqoob Al-Hamadani

Keyword(s):

Cost Effectiveness ◽

Mortality Rate ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Hospitalized Patients ◽

P Value ◽

Effectiveness Analysis ◽

Significant Difference ◽

The Cost ◽

D Dimer

Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients <60. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value >0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.

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Faktor Risiko Kematian Neonatal Dini di Rumah Sakit Bersalin

Kesmas National Public Health Journal ◽

10.21109/kesmas.v6i6.83 ◽

2012 ◽

Vol 6 (6) ◽

pp. 283

Author(s):

Andi Zulkifli Abdullah ◽

M. Furqaan Naiem ◽

Nurul Ulmy Mahmud

Keyword(s):

Risk Factor ◽

Birth Weight ◽

Mortality Rate ◽

Antenatal Care ◽

Neonatal Mortality ◽

Odds Ratio ◽

Case Control ◽

P Value ◽

Low Birth Weight Infants ◽

Early Neonatal Mortality

Angka kematian bayi di Indonesia masih tergolong tinggi, kematian neona- tal 50% terjadi pada bayi berat lahir rendah (BBLR) dan lebih dari 50% ke- matian bayi adalah kematian neonatal dini. Penelitian ini bertujuan untuk mengetahui faktor-faktor antenatal care (ANC), status imunisasi Tetanus Toxoid (TT) ibu hamil, anemia pada saat hamil, berat lahir, status paritas, dan status hipotermia terhadap kematian neonatal dini. Penelitian meng- gunakan desain penelitian case control di Rumah Sakit Bersalin Kota Makassar dengan sampel 40 kasus dan 120 kontrol. Data diperoleh melalui wawancara langsung dengan responden. Hasil penelitian menunjukkan bahwa faktor risiko kejadian kematian neonatal dini meliputi ANC (nilai p = 0,000; odds ratio, OR = 7,333; CI 95% = 2,966 - 18,129), status imunisasi TT (nilai p = 0,000; OR = 19,205; CI 95% = 7,902 - 46,678), anemia ibu hamil (nilai p = 0,000; OR = 32,818; CI 95% = 7,549 - 142,674), berat lahir (nilai p = 0,000; OR = 122,212; CI 95% = 32,324 - 462,068), status paritas (nilai p = 0,000; OR = 5,537; CI 95% = 2,029 - 15,111), status asfiksia (ni- lai p = 0,000; OR = 8,197; CI 95% = 0,452 - 2,745). Status hipotermia bukan merupakan faktor risiko kematian neonatal dini (nilai p = 0,815; OR = 1,114; CI 95% = 3,646 mukan bahwa berat lahir bayi merupakan faktor yang paling berisiko ter- hadap kematian neonatal dini (nilai p = 0,000). Kata kunci: Faktor risiko kematian, neonatal dini, angka kematian bayi, bayi berat lahir rendahAbstractInfant mortality rate in Indonesia is still high. Fifty percent of the neonatal mortality occurred among low birth weight infants (LBWI) and neonatal mortality within 7 days of life accounted for 50% of total infant mortalities. This study was aimed to examine the extent of early neonatal mortality risk by antenatal care (ANC), Tetanus Toxoid (TT) immunization status of pregnant women, anemia during pregnancy, birth weight of neonatal, parity status, and hypothermia status.This study was a case control study with direct interview to respondents, conducted in the Maternity Hospital of Makassar with 40 cases and 120 controls. Samples were selected by purposive sam- pling. Study results indicated that risk factor of early neonatal mortality were ANC (p value = 0,000; odds ratio, OR = 7,33; CI 95% = 2,966 - 18,129), TT immunization status (p value = 0,000; OR = 19,205; CI 95% = 7,902 - 46,678), pregnancy anemia (p value = 0,000; OR = 32,818; CI 95% = 7,549 - 142,674), birth weight (p value = 0,000; OR = 122,212; CI 95% = 32,324 - 462,068), parity status (p value = 0,000; OR = 5,537; CI 95% = 2,029 - 15,111), asphyxia status (p value = 0,000; OR = 8,197; CI 95% = 0,452 - 2,745), whereas hypothermia status (p value = 0,815; OR = 1,114; 0,452 - 2,745) was not a risk factor. Results of logistic regression multivariate analysis indicated that infant’s birth weight was the most risk factor of early neonatal mortality (p value = 0,000). Specific surveillance program for high risk neonatal needed to be arranged in all health centers.Key words: Mortality risk factor, early neonatal, infant mortality rate, low birth weight infants

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Efficacy of HPV Vaccination in Women Receiving LEEP for Cervical Dysplasia: A Single Institution’s Experience

Vaccines ◽

10.3390/vaccines8010045 ◽

2020 ◽

Vol 8 (1) ◽

pp. 45 ◽

Cited By ~ 3

Author(s):

Marco Petrillo ◽

Margherita Dessole ◽

Elettra Tinacci ◽

Laura Saderi ◽

Narcisa Muresu ◽

...

Keyword(s):

Hpv Vaccine ◽

Odds Ratio ◽

Protective Factor ◽

Hpv Vaccination ◽

Univariate Analysis ◽

Cervical Dysplasia ◽

Protective Role ◽

P Value ◽

Cervical Lesions

The aim of this study was to assess the role of a human papilloma virus (HPV) vaccine after loop electrosurgical excision procedure (LEEP) in reducing recurrent cervical dysplasia. A series of 503 women with cervical dysplasia received LEEP between January 2012 and October 2018. Of these patients, 379 were treated between January 2012 and June 2017, thus ensuring an adequate follow-up time. We made three attempts to establish telephone contact with each patient; 77 women did not respond and were excluded from the final study population, which consisted of 302 patients. One hundred eighty-two (60.7%) women were vaccinated with an HPV vaccine within 4 weeks of LEEP and 103 (34.3%) were followed up with but not vaccinated. Recurrence of cervical dysplasia requiring a further LEEP procedure occurred in 30 (10.5%) women, of whom 17 (16.5%) were not vaccinated and 13 (7.1%) were vaccinated (p-value = 0.010). At univariate analysis, HPV vaccination after LEEP (odds ratio (OR) = 0.4, p-value = 0.020) emerged as an independent protective factor. Choosing as an outcome of the analysis only recurrence as severe cervical lesions, the protective role of HPV vaccination after LEEP was found to be much more relevant with an odds ratio of 0.2 (95% CI = 0.1–0.6, p-value = 0.02). Administration of an HPV vaccine after LEEP seems to reduce the risk of recurrence, thus suggesting that HPV vaccination has a role as an adjuvant treatment after LEEP.

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The Prognostic Role of Clinical and Microbiological Factors on Mortality Related to Candida Bloodstream Infections in Hospitalized Patients with Hematologic Malignancies.

Blood ◽

10.1182/blood.v110.11.3861.3861 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3861-3861

Author(s):

Ricardo S. Bigni ◽

Eduardo D. Velasco ◽

Jane A. Dobbin

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Adult Population ◽

Performance Status ◽

Univariate Analysis ◽

Poor Performance ◽

Hospitalized Patients ◽

Poor Performance Status ◽

Respiratory Dysfunction ◽

Epidemiological Characteristics

Abstract Between January 2001 and June 2005 a prospective cohort study of hospitalized patients with hematological malignancies including 47 adults and 30 children with candidemia was conducted at a tertiary oncology care center in Brazil in order to compare the epidemiological characteristics, concurrent illnesses and the clinical microbiological data of both groups that may influence the outcome. The crude mortality was higher in the adult population than in children (46,8% vs. 20,0%) (figure 1). A univariate analysis indicated that in the adult population were lymphoma, neutropenia, presence of comorbidities, a non-removed central venous catheter (CVC), a poor performance status, lack of CVC, use of steroid, hepatic dysfunction, previous surgery, hypotension and severe respiratory dysfunction were risk factors significantly associated with death. Among children the predictors of mortality were acute leukemia, neutropenia, presence of comorbidities, lack of CVC, poor performance status, hypotension, concomitant infected sites, pulmonary infiltrates and severe respiratory dysfunction. Although no major differences was detected in survival rates following fungemia with C. albicans and all Candida non-albicans species, episodes with Candida glabrata, krusei and tropicalis subgroup species had the highest crude death rate compared with C. albicans and other isolates (59,4% vs. 35,3% vs. 10,7%; P<0.01) (figure 2). Candidemia due to C. parapsilosis was associated with the lowest mortality rate. Two variables remained statistically associated with mortality among adults in the multivariate analysis: CVC retention (OR 6.41; 95% CI 1.04–39.55) and presence of comorbidities (OR 2.17; 95% CI 1.33–3.53). Among children only the presence of comorbidities (OR 2.61; 95% CI 1.46–4.66) affected independently the outcome. Our data demonstrate children had a significant lower mortality rate than adults, despite the higher incidence of candidemia in this lower age subjects. There were significant differences of epidemiological, clinical characteristics and other risk factors between both groups. Concurrent comorbidities were the most important independent prognostic factor in both groups of patients.

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IL-6 and Other Biomarkers associated with Poor Prognosis in a Cohort of Hospitalized Patients with COVID-19 in Madrid

Biomarker Insights ◽

10.1177/11772719211013363 ◽

2021 ◽

Vol 16 ◽

pp. 117727192110133

Author(s):

Encarnación Donoso-Navarro ◽

Ignacio Arribas Gómez ◽

Francisco A Bernabeu-Andreu

Keyword(s):

Lymphocyte Count ◽

Univariate Analysis ◽

Fatal Outcome ◽

Hospitalized Patients ◽

Blood Concentrations ◽

Cox Proportional Hazard ◽

Lower Blood ◽

The Difference ◽

Cox Proportional Hazard Regression ◽

Relationship Of

Objectives: There are several published works on the prognostic value of biomarkers in relation to the severity or fatal outcome of coronavirus disease 2019 (COVID-19). In Spain, the second European country in incidence of the disease at the time of data collection, there are few studies that include both laboratory parameters and clinical parameters. Our aim is to study the relationship of a wide series of biomarkers with admission to intensive care and death in a hospital in the Autonomous Community of Madrid (Spain), with special attention to IL-6 due to its role in the systemic inflammatory response associated with a worse prognosis of the disease. Methods: Data were collected from 546 hospitalized patients with COVID-19. All of them had IL-6 results, in addition to other biochemical and haematological parameters. The difference of the medians for the selected parameters between the groups (ICU vs non-ICU, dead vs survivors) was studied using a Mann-Whitney analysis. The independent variables that predicted death were studied using a Cox proportional hazard regression model. Results: Higher age and blood concentrations of ALT, creatinine, CK, cTnI, LDH, NT-proBNP, CRP, IL-6, leucocyte count and D-dimer together with lower blood concentrations of albumin and lymphocyte count were associated with mortality in univariate analysis. Age, LDH, IL-6 and lymphocyte count remained associated with death in multivariate analysis. Conclusions: Age, LDH, IL-6 and lymphocyte count, as independent predictors of death, could be used to establish more aggressive therapies in COVID-19 patients.

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Can We Improve the Predictive Value of Interim PET/CT Using a New Prognostic Model for Advanced Hodgkin Lymphoma?

Blood ◽

10.1182/blood.v128.22.3001.3001 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3001-3001

Author(s):

Eldad J. Dann ◽

Osnat Bairey ◽

Rachel Bar-Shalom ◽

Tanya Mashiach ◽

Elinor Barzilai ◽

...

Keyword(s):

Risk Factors ◽

Radiation Therapy ◽

Disease Progression ◽

Hodgkin Lymphoma ◽

Lymphocyte Count ◽

Prognostic Score ◽

Univariate Analysis ◽

Disease Stage ◽

Interim Pet ◽

Pet Ct

Abstract Introduction: The treatment of advanced Hodgkin lymphoma (HL) has undergone many changes in recent years. The original International Prognostic Score (IPS) introduced by Hasenclever et al (1998) was based on a cohort of 1618 patients (pts) mainly treated with MOPP-ABV or ABVD between the years 1983 and 1992. One third (33%) of those pts also underwent involved field radiation therapy (IFRT). Staging was based on CT. The 5-y freedom from progression (FFP) results ranged between 84% and 42%, depending on the presence of 0-≥5 risk factors. The IPS has been validated in a number of studies and settings. Currently, staging is based on baseline PET/CT, which upgrades the disease stage in 15% and downgrades it in 5% of pts compared to CT scan. Positive interim PET/CT (PET-2) is predictive of an inferior prognosis in pts with early and advanced HL. Based on these findings, several studies have used a positive PET-2 as an indication for therapy escalation. However, the majority of relapses still occur in pts with negative PET-2, highlighting the need for additional prognostic markers. We evaluated baseline factors and lab results in a prospectively collected database of pts enrolled in a multicenter clinical trial (NCT00392314) where treatment was modified based on PET-2 results. The current study aimed to develop a model for refined prediction of HL progression risk in advance-disease pts with negative PET-2, using baseline risk factors. Methods: Pts with advanced classic Hodgkin lymphoma (HL) were stratified according to their baseline IPS; treatment was modified according to PET-2 results. Pts with IPS 0-2 initially received 2 ABVD cycles and those with IPS ≥ 3 received 2 cycles of escalated BEACOPP (EB). In the former group, if PET-2 was positive without evidence of disease progression, therapy was escalated to EB with involved site radiation therapy (ISRT) given to residual masses. If PET-2 was negative in both IPS strata, 4 additional ABVD cycles were administered. We evaluated whether traditional IPS parameters continued to predict relapse when treatment was modified based on PET-2 results, and assessed the need for new cutoffs based on ROC curves using univariate and multivariate Cox proportional hazard models. Results: Of 185 enrolled pts, 33 (18%) experienced disease progression and 27 (15%) had a positive PET-2. The 5-y PFS for the whole group, PET-2 negative and PET-2 positive subgroups was 80%, 82% and 68%, respectively (p=0.07). Eight of 33 (28%) relapsed pts had a positive Deauville score (≥3). On univariate analysis of traditional IPS parameters, male gender, age >45, stage IV disease were not found to be associated with a significantly increased hazard ratio (HR) for progression. New cutoffs for lymphocyte count and albumin level predictive of relapse were determined. The following parameters were significantly (P<0.006) associated with lower PFS on univariate analysis: albumin <3.5gm/dL, hemoglobin <10.5 gm/dL, lymphocyte count <1400 or <11% of white blood cell (WBC) count. On multivariate analysis, albumin <3.5gm/dL, lymphocyte count <1400 or <11% of WBC remained significantly associated with relapse, with adjusted HRs of 2.2 (95% CI 1.1-4.5; P<0.03) and 2.6 (95% CI 1.1-6.2; P<0.025), respectively. Hence, a score was constructed using 0, 1 or 2 of these factors. Pts with 0-1 or 2 new risk factors and negative PET-2 had a relapse rate (RR) of 10% and 42%, respectively (HR=4.7; 95% CI 4.7-11), while in pts with positive PET-2 the RR was 30% (Table 1). However, one should bear in mind that pts with IPS 0-2 initiated therapy with ABVDx2 and those with IPS≥3 initiated therapy with EBx2. Conclusions: The current analysis, using data prospectively collected during a phase II study but analyzed retrospectively after pts had been stratified by IPS, suggests a scoring model that could refine the IPS-based identification of pts at a higher risk for disease progression, even if their PET-2 is negative. The findings imply that pts with 2 new risk factors (19% of pts) may need to initiate more intensive therapy than ABVD. However, given the retrospective nature of the analysis, its results should be interpreted with caution. The model needs to be verified in an independent cohort of pts with advanced HL using uniform treatment protocols. Table 1 Table 1. Disclosures Bairey: Janssen: Consultancy.

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CORRELATIONS BETWEEN MOTHER’S KNOWLEDGE LEVEL OF EXCLUSIVE BREASTFEEDING AND THE PATTERN IN THE 6-MONTH CHILD IN POSYANDU OF JATIMULYO VILLAGE, PETANAHAN SUB-DISTRICT, KEBUMEN REGENCY, CENTRAL JAVA, INDONESIA

Epidemiology and Society Health Review (ESHR) ◽

10.26555/eshr.v2i2.2217 ◽

2020 ◽

Vol 2 (2) ◽

pp. 53

Author(s):

Hastin Ika Indriyastuti ◽

Wuri Utami ◽

Juad Juad

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Exclusive Breastfeeding ◽

Quantitative Methods ◽

Univariate Analysis ◽

Infant Mortality Rate ◽

Bivariate Analysis ◽

P Value ◽

Central Java ◽

Level Of Knowledge

Background: Globally, the infant mortality rate (IMR) is still extremely high. One of the efforts to improve children's health is exclusive breastfeeding for six months. Exclusive breastfeeding can reduce infant mortality rate caused by various infectious diseases. Thus, the community, especially mothers need to have proper knowledge about exclusive breastfeeding, and then they are expected to practice it. This study aims to determine the relationship between mothers’ knowledge of exclusive breastfeeding and the breastfeeding patterns of 6-month children in Jatimulyo Village, Petanahan Sub-district, Kab, Indonesia. Kebumen Regency, Central Java Province, Indonesia.Methods: The study was conducted in Jatimulyo Village using quantitative methods and correlation design with a cross-sectional approach. This study sample consisted of 56 mothers who had children aged 6-24 months selected based on the total sampling approach. Data were analyzed using univariate analysis and bivariate analysis using chi-square statistical tests.Results: This study found that most of the respondents are 26-30 years old and have a high school education level with multigravida parity and have a moderate level of knowledge. The study showed a relationship between the level of exclusive breastfeeding knowledge and breastfeeding patterns with a p-value of 0.002 (<0.05) and a correlation value of 0.499.Conclusions: Therefore, it can be concluded that there is a relationship between the level of knowledge about exclusive breastfeeding and breastfeeding patterns with a p-value of 0.002 (<0.05) and a correlation value of 0.499.

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