scholarly journals The prognostic role of functional dependency in older inpatients with COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Galina Plotnikov ◽  
Efraim Waizman ◽  
Irma Tzur ◽  
Alexander Yusupov ◽  
Yonatan Shapira ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Functional Status ◽  
Clinical Laboratory ◽  
Prognostic Significance ◽  
Functional Dependency ◽  
Mortality Data ◽  
Elderly Persons ◽  
Risk Of Death ◽  
Group 4 ◽  
Older Inpatients

Abstract Background Coronavirus disease 2019 (COVID-19) is a pandemic infection with substantial risk of death, especially in elderly persons. Information about the prognostic significance of functional status in older patients with COVID-19 is scarce. Methods Demographic, clinical, laboratory and short-term mortality data were collected of 186 consecutive patients aged ≥ 65 years hospitalized with COVID-19. The data were compared between 4 study groups: (1) age 65–79 years without severe functional dependency; (2) age ≥ 80 years without severe functional dependency; (3) age 65–79 years with severe functional dependency; and (4) age ≥ 80 years with severe functional dependency. Multivariate logistic regressions were performed to evaluate the variables that were most significantly associated with mortality in the entire sample. Results Statistically significant differences were observed between the groups in the proportions of males (p = 0.007); of patients with diabetes mellitus (p = 0.025), cerebrovascular disease (p < 0.001), renal failure (p = 0.003), dementia (p < 0.001), heart failure (p = 0.005), pressure sores (p < 0.001) and malignant disorders (p = 0.007); and of patients residing in nursing homes (p < 0.001). Compared to groups 1 (n = 69) and 2 (n = 28), patients in groups 3 (n = 32) and 4 (n = 57) presented with lower mean serum albumin levels on admission (p < 0.001), and were less often treated with convalescent plasma (p < 0.001), tocilizumab (p < 0.001) and remdesivir (p < 0.001). The overall mortality rate was 23.1 %. The mortality rate was higher in group 4 than in groups 1 − 3: 45.6 % vs. 8.7 %, 17.9% and 18.3 %, respectively (p < 0.001). On multivariate analysis, both age ≥ 80 years and severe functional dependency were among the variables most significantly associated with mortality in the entire cohort (odds ratio [OR] 4.83, 95 % confidence interval [CI] 1.88 − 12.40, p < 0.001 and OR 2.51, 95 % CI 1.02 − 6.15, p = 0.044, respectively). Age ≥ 80 years with severe functional dependency (group 4) remained one of the variables most significantly associated with mortality (OR 10.42, 95 % CI 3.27–33.24 and p < 0.001). Conclusions Among patients with COVID-19, the association of severe functional dependency with mortality is stronger among those aged ≥ 80 years than aged 65–79 years. Assessment of functional status may contribute to decision making for care of older inpatients with COVID-19.

scholarly journals Prognostic Significance of Functional Dependency in Older Patients Hospitalized for COVID-19: An Observational Cross-Sectional Study

2021 ◽  
Author(s):  
Galina Plotnikov ◽  
Efraim Waizman ◽  
Irma Tzur ◽  
Alexander Yusupov ◽  
Yonatan Shapira ◽  
...  
Keyword(s):  
Functional Status ◽  
Older Patients ◽  
Clinical Laboratory ◽  
Prognostic Significance ◽  
Cross Sectional Study ◽  
Functional Dependency ◽  
Mortality Data ◽  
Elderly Persons ◽  
Cross Sectional ◽  
Risk Of Death

Abstract Background Coronavirus disease 2019 (COVID-19) is a pandemic infection with substantial risk of death, especially in elderly persons. Information about the prognostic significance of functional status in older patients with COVID-19 is scarce. Methods Demographic, clinical, laboratory and short-term mortality data were collected of 186 consecutive patients aged ≥ 65 years hospitalized with COVID-19. Data were compared between 4 groups: 1) age 65–79 years without severe functional dependency (n = 69); 2) age ≥ 80 years without severe functional dependency (n = 28); 3) age 65–79 years with severe functional dependency (n = 32); and 4) age ≥ 80 years with severe functional dependency (n = 57). Results Statistically significant differences were observed between the groups in the proportions of patients with hypertension, diabetes mellitus, cerebrovascular disease, renal failure, dementia, heart failure, pressure sores and malignant disorders; and of the proportions that resided in nursing homes. Compared to groups 1 and 2, patients in groups 3 and 4 presented with lower mean serum albumin levels on admission; and were treated more often with antibiotics and less often with convalescent plasma, tocilizumab and remdesivir. The mortality rate was higher in group 4 than in groups 1 − 3: 45.6% vs. 8.7%, 17.9% and 18.3%, respectively (p < 0.001). On multivariate analysis, age ≥ 80 years with severe functional dependency remained one of the variables most significantly associated with mortality (odds ratio 10.42 and 95% confidence interval 3.27–33.24). Conclusions Among patients with COVID-19, the association of severe functional dependency with mortality is stronger among those aged ≥ 80 years than aged 65–79 years. Assessment of functional status may contribute to decision making for care of older inpatients with COVID-19.

scholarly journals Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns

Life ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 979
Author(s):  
Antonella D’Arminio Monforte ◽  
Alessandro Tavelli ◽  
Francesca Bai ◽  
Daniele Tomasoni ◽  
Camilla Falcinella ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Laboratory ◽  
Flow Diagram ◽  
Hospital Death ◽  
Relative Reduction ◽  
Risk Of Death ◽  
Background Mortality ◽  
Hospitalised Patients ◽  
Vaccination Campaigns ◽  
Second Wave

Background: Mortality rate from COVID-19 in Italy is among the world’s highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020–January 2021) compared to the first one (February–May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. Methods: Data collected related to in-patients’ demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. Results: A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3–28.5) and 15.9% (95% CI: 13.7–18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. Conclusions: Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.

scholarly journals Severity of Vitamin D Deficiency Predicts Mortality in Ischemic Stroke Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jarosław Wajda ◽  
Maciej Świat ◽  
Aleksander J. Owczarek ◽  
Aniceta Brzozowska ◽  
Magdalena Olszanecka-Glinianowicz ◽  
...  
Keyword(s):  
Vitamin D ◽  
Ischemic Stroke ◽  
Secondary Hyperparathyroidism ◽  
Functional Status ◽  
Fibroblast Growth Factor 23 ◽  
Mortality Rates ◽  
Mortality Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Background. Vitamin D (VD) deficiency is considered an independent risk factor for death due to cardiovascular events including ischemic stroke (IS). We assessed the hypothesis that decreased levels of 25-hydroxyvitamin D (25-OH-D) are associated with increased risk of mortality in patients with IS. Methods. Serum 25-OH-D, intact parathyroid hormone (iPTH), and intact fibroblast growth factor 23 (iFGF23) levels were assessed in serum of 240 consecutive patients admitted within the 24 hours after the onset of IS. Mortality data was obtained from the local registry office. Results. Only three subjects (1.3%) had an optimal 25-OH-D level (30-80 ng/mL), 25 (10.4%) had a mildly reduced (insufficient) level, 61 (25.4%) had moderate deficiency, and 151 (62.9%) had a severe VD deficiency. 20% subjects had secondary hyperparathyroidism. The serum 25-OH-D level was significantly lower than that in 480 matched subjects (9.9±7.1 vs. 21.0±8.7 ng/mL). Of all the patients, 79 (32.9%) died during follow-up observation (44.9 months). The mortality rates (per year) were 4.81 and 1.89 in a group with and without severe VD deficiency, respectively (incidence rate ratio: 2.52; 95% CI: 1.44–4.68). There was no effect of secondary hyperparathyroidism and iFGF23 levels on mortality rates. Age, 25−OH−D<10 ng/mL, and functional status (modified Rankin scale) were significant factors increasing the risk of death in multivariable Cox proportional hazard regression test. Conclusions. Severe VD deficiency is an emerging, strong negative predictor for survival after IS, independent of age and functional status. VD supplementation in IS survivals may be considered due to high prevalence of its deficiency. However, it is uncertain whether it will improve their survival.

scholarly journals Predictor of enhanced mortality in patients with multimorbidity and atrial fibrillation in an acute hospital setting

QJM ◽  
2019 ◽  
Vol 113 (5) ◽  
pp. 330-335
Author(s):  
I Iñiguez Vázquez ◽  
M Matesanz Fernández ◽  
E M Romay Lema ◽  
M T Seoane Pillado ◽  
R Monte Secades ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mortality Rate ◽  
Prognostic Significance ◽  
Age Groups ◽  
Hospital Setting ◽  
Female Age ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
And Gender ◽  
Acute Hospital Setting

Abstract Background Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. Aim To identify factors associated with mortality in hospitalized AF patients. Design Retrospective cohort study. Methods Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. Results Of 74 220 patients (170 978 hospitalizations), 52 939 had multimorbidity (14 181 had AF; 38 758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021–1.165; P = 0.010] and in those aged &gt;80 years (RR 1.153; 95% CI, 1.1–1.2; P &lt; 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422–1.574; P &lt; 0.001). Conclusions Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.

scholarly journals Longitudinal Trajectories of Diet Quality and Subsequent Mortality Among Chinese Adults: Results from the China Health and Nutrition Survey 1997–2015

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 544-544
Author(s):  
Ming-wei Liu ◽  
Rebecca Leech ◽  
Sarah McNaughton ◽  
Qi-qiang He
Keyword(s):  
Mortality Rate ◽  
Diet Quality ◽  
Dietary Guidelines ◽  
Chinese Adults ◽  
Nutrition Survey ◽  
Risk Of Death ◽  
Health And Nutrition ◽  
Group 4 ◽  
History Of ◽  
Group 2

Abstract Objectives China has witnessed a significant nutritional transition. But there is a gap in the literature investigating the effect of change of diet on mortality among Chinese. Thus, we aimed to explore the longitudinal trajectories of diet quality over ten years (from 1997 to 2006) and the subsequent risk of death from 2009 through 2015 among Chinese adults. Methods Data from the China Health and Nutrition Survey were analyzed in 6398 adults. Dietary intake was assessed using three consecutive 24-h recalls. Diet quality was assessed by the Chinese Healthy Eating Index (CHEI), which includes 17 components and is based on the Dietary Guidelines for Chinese. The Latent Class Growth Analysis was conducted to derive trajectories of diet quality over ten years. And logistic models were used to calculate hazard ratios for total mortality. Models adjusted for age, sex, residence, education, household income, marital status, physical activity, smoke status, BMI, history of hypertension, and history of diabetes. Results Four distinct CHEI trajectories were identified: 1) persistently moderate; 2) acutely elevated from low to moderate and steady; 3) high and slightly elevated; 4) acutely descend and acutely elevated to moderate and steady. The “high and slightly elevated” group had the lowest mortality rate (6.0%) in the subsequent 6 years, while the two groups with a history of low diet quality had a higher mortality rate (8.8% for group 2 and 10.7% for group 4). The fully adjusted model showed that, as compared to the “persistently moderate” group, the mortality rates were higher among the two groups with a history of low diet quality. The relative risks and 95% confidence intervals were 1.58 (1.004, 2.47) for group 2 and 1.84 (1.20, 2.81) for group 4. Results for the “high and slightly elevated” group was not significant. Conclusions Long-term improved diet quality and adherence to the Dietary Guidelines for Chinese may decrease the risk of death in Chinese adults. Funding Sources None.

Perbandingan Linieritas Dalam Pendeteksian Faktor-Faktor Yang Mempengaruhi Angka Kematian Bayi Di Provinsi Aceh

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Desfira Ahya ◽  
Inas Salsabila ◽  
Miftahuddin
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Linear Model ◽  
Health Workers ◽  
Additive Model ◽  
Infant Mortality Rate ◽  
Mortality Data ◽  
Important Indicator ◽  
Penalized Spline ◽  
Aceh Province

Angka Kematian Bayi/ Infant Mortality Rate (IMR) merupakan indikator penting dalam mengukur keberhasilan pengembangan kesehatan. Nilai IMR juga dapat digunakan untuk mengetahui tingkat kesehatan ibu, kondisi kesehatan lingkungan dan secara umum, tingkat pengembangan sosio-ekonomi masyarakat. Penelitian ini bertujuan untuk memperoleh model IMR terbaik menggunakan tiga pendekatan: Model Linear, Model Linear Tergeneralisir dan Model Aditif Tergeneralisir dengan basis P-spline. Sebagai tambahan, berdasarkan model tersebut akan terlihat variabel yang mempengaruhi tingkat kematian bayi di provinsi Aceh. Penelitian ini menggunakan data jumlah kematian bayi di tahun 2013-2015. Data dalam penelitian ini diperoleh dari Profil Kesehatan Aceh. Hasil menunjukkan bahwa model terbaik dalam menjelaskan angka kematian bayi di provinsi Aceh tahun 2013-2015 ialah Model Linear Tergeneralisir dengan basis P-spline menggunakan parameter penghalusan 100 dan titik knots 8. Faktor yang sangat mempengaruhi angka kematian ialah jumlah pekerja yang sehat.   Infant mortality rate (IMR) is an important indicator in measuring the success of health development. IMR also can be used to knowing the level of maternal health, environmental health conditions and generally the level of socio-economic development in community. This research aims to get the best model of infant mortality data using three approaches: Linear Model, Generalized Linear Model and Generalized Additive Model with Penalized Spline (P-spline) base. In addition, based on the model can be seen the variables that affect to infant mortality in Aceh Province. This research uses data number of infant mortality in Aceh Province period 2013-2015. The data in this research were obtained from Aceh’s Health Profile. The results show that the best model can be explain infant mortality rate in Aceh Province period 2013-2015 is GAM model with P-spline base using smoothing parameter 100 and knots 8. Factor that high effect to infant mortality is number of health workers.

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

2020 ◽  
Author(s):  
David Spirk ◽  
Tim Sebastian ◽  
Stefano Barco ◽  
Martin Banyai ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mortality Rate ◽  
Recurrence Rate ◽  
Anticoagulation Therapy ◽  
Early Mortality ◽  
Recurrence Rates ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

scholarly journals AB0393 PRE-EXISTING MORBIDITY AS A RISK FACTORS FOR MORTALITY IN IgA VASCULITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1224.3-1225
Author(s):  
J. Nossent ◽  
D. Preen ◽  
W. Raymond ◽  
H. Keen ◽  
C. Inderjeeth
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Mortality Rate ◽  
Data Collection ◽  
Premature Death ◽  
Iga Vasculitis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Serious Infections ◽  
Western Australian

Background:IgA vasculitis is generally considered to be a self-limiting condition, but this is at odds with the increased mortality observed in adult patients with IgA vasculitis (1).Objectives:With sparse data on prognostic factors in IgAV, we investigated whether pre-existing conditions are risk factors for mortality in adult IgAV patients.Methods:Observational population-based cohort study using state-wide linked longitudinal health data for adults with IgAV (n=267) and matched controls (n=1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from the WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and time dependent survival analysis assessed the risk of death. Age and gender specific mortality rate data were obtained from the Australian Bureau of Statistics.Results:During 9.9 (±9.8) years lookback IgAV patients accrued higher CCI scores (2.60 vs1.50 p<0.001) and had higher risk of SI (OR 8.4, p<0.001), not fully explained by CCI scores. During 19 years follow-up, the risk of death in IgAV patients (n=137) was higher than in controls (n=397) (MRR 2.06, CI 1.70-2.50, p<0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p<0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7 %) and twenty years (45.2% vs. 65.6 %) (both p<0.05). CCI (HR1.88, CI:1.25 - 2.73, p=0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p=0.03) and prior SI (HR 1.48, CI:1.01 – 2.16, p=0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p=0.02) was significantly more frequent in IgAV patients.Conclusion:Premorbid accrual of comorbidity is increased and predicts premature death in IgAV patients. However, comorbidity does not fully explain the increased risk of serious infections prior to diagnosis or the increased mortality due to infections in IgAV.References:[1]Villatoro-Villar M, Crowson CS, Warrington KJ, Makol A, Ytterberg SR, Koster MJ. Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study. Mayo Clin Proc. 2019;94(9):1769-80.Acknowledgements:The authors would like to acknowledge the support of the Arthritis Foundation of WA and acknowledge the Western Australian Data Linkage Branch, the Western Australian Department of Health, and the data custodians of, the Hospital and Morbidity Data Collection, the Emergency Department Data Collection the WA Cancer Register and the WA Death Register for their assistance with the study.Disclosure of Interests:None declared

scholarly journals Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

2020 ◽  
Vol 15 (8) ◽  
pp. 1139-1145 ◽  
Author(s):  
Jun Wu ◽  
Jushuang Li ◽  
Geli Zhu ◽  
Yanxia Zhang ◽  
Zhimin Bi ◽  
...  
Keyword(s):  
Clinical Features ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Cardiac Injury ◽  
Hemodialysis Patients ◽  
Hospitalized Patients ◽  
Maintenance Hemodialysis ◽  
Computed Tomographic ◽  
Risk Of Death ◽  
Novel Coronavirus

Background and objectivesPrevious reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis.Design, setting, participants, & measurements In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020.ResultsThe median age of 101 patients was 62 years (interquartile range, 49–72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase–muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died.ConclusionsThe main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.

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