Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries

AbstractObjectivesIn December 2019, there was an outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, and since then, the disease has been increasingly spread throughout the world. Unfortunately, the information about early prediction factors for disease progression is relatively limited. Therefore, there is an urgent need to investigate the risk factors of developing severe disease. The objective of the study was to reveal the risk factors of developing severe disease by comparing the differences in the hemocyte count and dynamic profiles in patients with severe and non-severe COVID-19.MethodsIn this retrospectively analyzed cohort, 141 confirmed COVID-19 patients were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang Province, China, from January 17, 2020 to February 26, 2020. Clinical characteristics and hemocyte counts of severe and non-severe COVID patients were collected. The differences in the hemocyte counts and dynamic profiles in patients with severe and non-severe COVID-19 were compared. Multivariate Cox regression analysis was performed to identify potential biomarkers for predicting disease progression. A concordance index (C-index), calibration curve, decision curve and the clinical impact curve were calculated to assess the predictive accuracy.ResultsThe data showed that the white blood cell count, neutrophil count and platelet count were normal on the day of hospital admission in most COVID-19 patients (87.9%, 85.1% and 88.7%, respectively). A total of 82.8% of severe patients had lymphopenia after the onset of symptoms, and as the disease progressed, there was marked lymphopenia. Multivariate Cox analysis showed that the neutrophil count (hazard ratio [HR] = 4.441, 95% CI = 1.954–10.090, p = 0.000), lymphocyte count (HR = 0.255, 95% CI = 0.097–0.669, p = 0.006) and platelet count (HR = 0.244, 95% CI = 0.111–0.537, p = 0.000) were independent risk factors for disease progression. The C-index (0.821 [95% CI, 0.746–0.896]), calibration curve, decision curve and the clinical impact curve showed that the nomogram can be used to predict the disease progression in COVID-19 patients accurately. In addition, the data involving the neutrophil count, lymphocyte count and platelet count (NLP score) have something to do with improving risk stratification and management of COVID-19 patients.ConclusionsWe designed a clinically predictive tool which is easy to use for assessing the progression risk of COVID-19, and the NLP score could be used to facilitate patient stratification management.

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Seroepidemiologic Survey of Epidemic Cholera in Haiti to Assess Spectrum of Illness and Risk Factors for Severe Disease

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.13-0208 ◽

2013 ◽

Vol 89 (4) ◽

pp. 654-664 ◽

Cited By ~ 26

Author(s):

Brendan R. Jackson ◽

Deborah F. Talkington ◽

James M. Pruckler ◽

M. D. Bernadette Fouché ◽

Elsie Lafosse ◽

...

Keyword(s):

Risk Factors ◽

Severe Disease

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Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality

BMC Infectious Diseases ◽

10.1186/s12879-021-05992-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Flook ◽

C. Jackson ◽

E. Vasileiou ◽

C. R. Simpson ◽

M. D. Muckian ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Systematic Review ◽

At Risk ◽

Risk Factor ◽

Disease Severity ◽

Severe Disease ◽

Public Health Response ◽

Wide Range ◽

Multivariable Analyses

Abstract Background Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. Methods Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. Results One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. Conclusions The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. Registration This review was registered on PROSPERO as CRD42020177714.

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Risk Factors and Prediction Nomogram Model for Psychosocial and Behavioural Problems among Children and Adolescents during the COVID-19 Pandemic: A National Multicentre Study

Journal of Affective Disorders ◽

10.1016/j.jad.2021.06.077 ◽

2021 ◽

Author(s):

Lin Wang ◽

Li Chen ◽

Feiyong Jia ◽

Xinmiao Shi ◽

Yiwen Zhang ◽

...

Keyword(s):

Risk Factors ◽

Multicentre Study ◽

Children And Adolescents ◽

Behavioural Problems

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Clinical Characteristics of Human Monkeypox, and Risk Factors for Severe Disease

Clinical Infectious Diseases ◽

10.1086/498115 ◽

2005 ◽

Vol 41 (12) ◽

pp. 1742-1751 ◽

Cited By ~ 64

Author(s):

Gregory D. Huhn ◽

Audrey M. Bauer ◽

Krista Yorita ◽

Mary Beth Graham ◽

James Sejvar ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Severe Disease

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Clinical evaluation of maxillary edentulous patients to determine the prevalence and oral risk factors of combination syndrome

Journal of Dental Sciences ◽

10.1016/j.jds.2012.04.004 ◽

2014 ◽

Vol 9 (4) ◽

pp. 394-399

Author(s):

Mehmet Ali Kilicarslan ◽

Funda Akaltan ◽

Yeliz Kasko ◽

Zahide Kocabas

Keyword(s):

Risk Factors ◽

Clinical Evaluation ◽

Edentulous Patients

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Data Quality of Longitudinally Collected Patient-Reported Outcomes (PROs) after Thoracic Surgery: A Comparison of Paper- and Web-Based Assessments (Preprint)

10.2196/preprints.28915 ◽

2021 ◽

Author(s):

Hongfan Yu ◽

Qingsong Yu ◽

Yuxian Nie ◽

Wei Xu ◽

Yang Pu ◽

...

Keyword(s):

Risk Factors ◽

Thoracic Surgery ◽

Data Quality ◽

Severe Disease ◽

Sampling Bias ◽

Patient Reported Outcome ◽

Web Based ◽

Quality Of Life Scale ◽

Patient Reported

BACKGROUND High-frequent patient-reported outcome (PRO) assessments are used to measure patients’ symptoms after surgery for surgical research; however, quality of those longitudinal PRO data has seldom been discussed. OBJECTIVE To describe errors, to identify factors influencing the data quality, and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based-assessment (ePRO) after thoracic surgery. METHODS We extracted longitudinal PRO data from two prospective clinical studies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations models and two-piecewise models were used to describe trajectories of error incidence over time and to identify the risk factors. RESULTS Among 629 patients with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.44% of patients had at least 1 error, including 1) missing items (64.69%), 2) modifications without signatures (27.99%), 3) selection of multiple options (3.02%), 4) missing patient signatures (2.54%), 5) missing researcher signatures (1.45%) and 6) missing completion dates (0.3%). ePRO patients had fewer errors than P&P patients (30.16% vs. 57.73%, p <0.0001). Compared with ePRO patients, those using P&P were older, less educated and sicker. Common risk factors of having errors were with a lower education level (P&P, OR=1.39, 95%CL=1.20-1.62, p<.0001; ePRO, OR=1.82, 95%CI=1.22-2.72, p=0.0032), treated in a provincial hospital (P&P, OR=3.34, 95%CI=2.10-5.33, p<.0001; ePRO, OR=4.73, 95%CI=2.18-10.25, p<.0001) and with severe disease (P&P, OR=1.63, 95%CI=1.33-1.99, p<.0001; ePRO, OR=2.70, 95%CI=1.53-4.75, p=0.0006). Errors peaked on postoperative day (POD) 1 for P&P, and on POD 2 for ePRO. CONCLUSIONS ePRO might be superior to P&P in terms of data quality. However, sampling bias needs to be considered for studies using longitudinal PROs as major outcomes.

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Social contacts and other risk factors for respiratory infections among internally displaced people in Somaliland

10.1101/2021.08.20.21262338 ◽

2021 ◽

Author(s):

Kevin van Zandvoort ◽

Mohamed Omer Bobe ◽

Abdirahman Ibrahim Hassan ◽

Mohamed Ismail Abdi ◽

Mohamed Saed Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Infections ◽

Severe Disease ◽

Social Contact ◽

Physical Contact ◽

Cross Sectional ◽

Internally Displaced ◽

Internally Displaced People ◽

Social Mixing ◽

Displaced People

Background Populations affected by humanitarian crises experience high burdens of acute respiratory infections (ARI), potentially driven by risk factors for severe disease such as poor nutrition and underlying conditions, and risk factors that may increase transmission such as overcrowding and the possibility of high social mixing. However, little is known about social mixing patterns in these populations. Methods We conducted a cross-sectional social contact survey among internally displaced people (IDP) living in Digaale, a permanent IDP camp in Somaliland. We included questions on household demographics, shelter quality, crowding, travel frequency, health status, and recent diagnosis of pneumonia, and assessed anthropometric status in children. We calculated age-standardised social contact matrices to assess population mixing, and conducted regression analysis on risk factors for recent self-reported pneumonia. Results We found crowded households with high proportions of recent self-reported pneumonia (46% in children). 20% of children younger than five are stunted, and crude death rates are high in all age groups. ARI risk factors are common, but we did not find any significant associations with self-reported pneumonia. Participants reported around 10 direct contacts per day. Social contact patterns are assortative by age, and physical contact rates are very high (78%). Conclusions ARI risk factors are very common in this population, while the large degree of contacts that involve physical touch could further increase transmission. Such IDP settings potentially present a perfect storm of risk factors for ARIs and their transmission, and innovative approaches to address such risks are urgently needed.

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Alkaline Phosphatase Is Associated with Red Cell Alloimmunization in the Pulmonary Hypertension and Hypoxic Response (PUSH) Sickle Cell Disease Cohort

Blood ◽

10.1182/blood-2020-143036 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 20-20

Author(s):

Victoria Brooks ◽

Oluwalonimi Adebowale ◽

Victor R. Gordeuk ◽

Sergei Nekhai ◽

James G. Taylor

Keyword(s):

Risk Factors ◽

Alkaline Phosphatase ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Research Funding ◽

Severe Disease ◽

Case Control ◽

Red Cell ◽

Cell Disease ◽

History Of

Background: Blood transfusion is a common therapy for sickle cell disease (SCD). Although, highly effective, a major limitation is development of alloantibodies to minor blood group antigens on donor red cells. Alloimmunization has a prevalence of 2-5% for transfusions in the general population, but it is significantly higher in SCD. Risk factors for alloimmunization have been poorly characterized, although number of lifetime transfusions is an important risk factor. Alloimmunization has been clinically observed in children with a prevalence of about 7%. With development of each antibody, blood donor matching becomes increasingly difficult and expensive with an increased risk for transfusion reactions and diminished availability of compatible red cell units for treatment of SCD. The ability to identify risk factors for developing alloantibodies would be beneficial for clinicians. To identify markers for alloimmunization in SCD, we have analyzed children and adults who developed this complication. Methods: We analyzed The Pulmonary Hypertension and Hypoxic Response in Sickle Cell Disease (PUSH) study, which enrolled n=468 pediatric and n=59 adult SCD subjects. In both children and adults, alloimmunization cases were defined as a history of at least 1 alloantibody. Controls in both cohorts were defined as subjects with no history of alloantibodies and receipt of more than 10 lifetime red cell transfusions. All others within the study who did not meet these criteria were assigned to a third comparison group. To identify differences between cases, controls and all others, we performed univariate analyses (using ANOVA or Kruskal Wallace where appropriate) for clinical parameters and laboratories. Case control comparisons were also performed for selected variables and plasma levels for 11 cytokines. Results were further analyzed using regression modeling. Results: The overall prevalence of alloimmunization was 7.3% among children (34/468 subjects; median age 12, range 3-20 years) compared to 28.8% in adults (17/59 subjects; median age 37, range 18-73 years). When only considering those with >10 lifetime transfusions, the prevalence was considerably higher at 29.3% and 54.8% in children and adults, respectively. At the same time, 8 pediatric (23.5%) and 5 adult (29.4%) alloimmunization cases had received fewer than 10 transfusions. In a 3-way pediatric cohort comparison (cases, controls and all others), risk factors associated with alloimmunization included SS genotype, older age and markers of more severe disease (higher ferritin, WBCs, platelets and total bilirubin). Comparison of cases to controls showed alkaline phosphatase (P=0.05) was significantly lower in cases, whereas AST (P=0.02) was significantly higher even with adjustment for age. Levels of plasma cytokines MCP-1 (P=0.01) and IFNgamma (P=0.08) were lower in cases from a subset of the pediatric cohort. In adults, only 4/59 (6.8%) subjects had never received a lifetime transfusion (all non-SS). In the adult 3-way comparisons, only SS genotype and higher ferritin were associated with alloimmunization. The adult case control analysis showed higher absolute monocyte count (P=0.02), absolute eosinophil count (P=0.04) and absolute basophil count (P=0.008) in association with alloimmunization cases. In addition, alkaline phosphatase was again significantly lower among cases (P=0.02) as seen in the pediatric cohort. There were no significant differences in cytokine levels among adults. Conclusions: When considering only transfused SCD patients, the prevalence of alloimmunization is higher than 30%. As seen in prior studies, higher lifetime red cell transfusions are an important risk factor especially among adults where most patients have received transfusions. Children who develop alloantibodies appear to have laboratory markers of more severe disease, but this is not observed in adults. A novel association observed across both pediatric and adult subjects is a significantly lower serum alkaline phosphatase in those with alloantibodies. The results of this study suggest a need for improved tracking of red cell transfusion therapy in the US for SCD patients due to a high prevalence of alloimmunization. Further study is also needed to elucidate the significance of the alkaline phosphatase association. Disclosures Gordeuk: CSL Behring: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; Novartis: Consultancy; Ironwood: Research Funding; Imara: Research Funding.

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Predictive risk factors for worse outcomes in COVID-19 patients with different clinical features at baseline

Archives of Medical Science ◽

10.5114/aoms/130374 ◽

2021 ◽

Author(s):

Elisabetta Schiaroli ◽

Anna Gidari ◽

Giovanni Brachelente ◽

Sabrina Bastianelli ◽

Alfredo Villa ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Critical Illness ◽

Serum Ferritin ◽

Logistic Regression Analysis ◽

Severe Disease ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Neutrophil Lymphocyte Ratio

IntroductionCOVID-19 is characterized by a wide range of clinical expression and by possible progression to critical illness and death. Therefore it is essential to identify risk factors predicting progression towards serious and fatal diseases. The aim of our study was to identify laboratory predictive markers of clinical progression in patients with moderate/severe disease and in those with acute respiratory distress syndrome (ARDS).Material and methodsUsing electronic medical records for all demographic, clinical and laboratory data, a retrospective study on all consecutive patients with COVID-19 admitted to the Infectious Disease Clinic of Perugia was performed. The PaO2/FiO2 ratio (P/F) assessment cut‑off of 200 mm Hg was used at baseline to categorize the patients into two clinical groups. The progression towards invasive ventilation and/or death was used to identify critical outcome. Statistical analysis was performed. Multivariate logistic regression analysis was adopted to identify risk factors of critical illness and mortality.ResultsIn multivariate logistic regression analysis neutrophil/lymphocyte ratio (NLR) was the only significant predictive factor of progression to a critical outcome (p = 0.03) and of in-hospital mortality (p = 0.03). In ARDS patients no factors were associated with critical progression. Serum ferritin > 1006 ng/ml was the only predictive value of critical outcome in COVID-19 subjects with moderate/severe disease (p = 0.02).ConclusionsNeutrophil/lymphocyte ratio and serum ferritin are the only biomarkers that can help to stratify the risk of severity and mortality in patients with COVID-19.

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