scholarly journals Longitudinal Study of Prevalence of Sodium Abnormalities in Hospitalized Patients With COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A630-A630
Author(s):  
Ploutarchos Tzoulis ◽  
Julian Waung ◽  
Emmanouil Bagkeris ◽  
Ziad Hussein ◽  
Aiyappa Biddanda ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Excess Mortality ◽  
Sodium Concentration ◽  
Community Acquired Pneumonia ◽  
Mortality Data ◽  
Laboratory Assessment ◽  
Plasma Urea ◽  
Longitudinal Observational Study ◽  
Median Increase ◽  
Chronic Hyponatremia

Abstract Background: Sodium abnormalities (dysnatremia) are frequently observed in patients with community-acquired pneumonia and are associated with excess mortality. Data on the prevalence of hyponatremia and hypernatremia (serum sodium [Na] < 135 and > 145 mmol/L respectively) in patients with coronavirus disease 19 (COVID-19) are currently lacking. Methods: The aim of this study was to evaluate the prevalence and etiology of hyponatremia and hypernatremia at several timepoints during hospitalization of COVID-19 patients. This retrospective, longitudinal, observational study included all COVID-19 positive adult patients admitted to two London hospitals over an 8-week period (February to May 2020). Results: Clinic records were reviewed in 488 patients, 277 males (56.8%) and 211 females (43.2%), with a median age of 68 years. Comorbidities were documented in 79.6%, with the commonest being hypertension (45.7%), diabetes mellitus (25%), and chronic kidney disease (16.4%). Prior to admission, 25 patients (5.1%) had pre-existing chronic hyponatremia. At hospital presentation, median [Na] concentration was 137 mmol/L. Dysnatremia was present in 146 patients (29.9%), including 26 (5.3%) with hypernatremia and 120 (24.6%) with hyponatremia, of whom [Na] was 130-134 mmol/L in 90 (18.4%) and < 130 mmol/L in 30 (6.2%). Only 19% of patients with < 130 mmol/L underwent adequate laboratory assessment of the etiology of hyponatremia. Of those, based on a urinary sodium cut-off of 30 mmol/L, hyponatremia was classified as hypovolemia in 75% and non-hypovolemic in 25%. For the remaining hyponatremic cases, using 5 mmol/L as the cut-off value for plasma urea, 55.7% were classified as probable hypovolemic and 44.3% non-hypovolemic hyponatremia. There was an upward trajectory of [Na] values during hospital stay with a median increase of 2 mmol/L in the first 48 hours following admission. On the fifth day of hospitalization, the prevalence was similar for hypernatremia and hyponatremia (13.8% and 14.1%, respectively). On the tenth day, hypernatremia was more common than hyponatremia (14.2% vs 10.2% respectively). Analysis of [Na] throughout the hospital stay defined four subgroups; 185 patients (37.9%) remained normonatremic throughout hospitalization; 180 (36.9%) had exposure to hyponatremia; 53 (10.9%) were exposed to hypernatremia; and 70 (14.3%) experienced both hypernatremia and hyponatremia. Conclusions: Hyponatremia, usually mild, was common at admission in Covid-19 positive patients, while hypovolemic hyponatremia appeared to be the predominant etiology. During hospital stay, abnormal sodium concentration was recorded in more than two thirds of Covid-19 positive patients. The association of dysnatremia with the outcomes in hospitalized COVID-19 patients warrants further exploration.

scholarly journals Local mortality estimates during the COVID-19 pandemic in Italy

2021 ◽  
Author(s):  
Augusto Cerqua ◽  
Roberta Di Stefano ◽  
Marco Letta ◽  
Sara Miccoli
Keyword(s):  
Machine Learning ◽  
Excess Mortality ◽  
Control Method ◽  
Local Level ◽  
Supervised Machine Learning ◽  
Machine Learning Techniques ◽  
Mortality Data ◽  
Official Method ◽  
Learning Techniques ◽  
Mortality Estimates

AbstractEstimates of the real death toll of the COVID-19 pandemic have proven to be problematic in many countries, Italy being no exception. Mortality estimates at the local level are even more uncertain as they require stringent conditions, such as granularity and accuracy of the data at hand, which are rarely met. The “official” approach adopted by public institutions to estimate the “excess mortality” during the pandemic draws on a comparison between observed all-cause mortality data for 2020 and averages of mortality figures in the past years for the same period. In this paper, we apply the recently developed machine learning control method to build a more realistic counterfactual scenario of mortality in the absence of COVID-19. We demonstrate that supervised machine learning techniques outperform the official method by substantially improving the prediction accuracy of the local mortality in “ordinary” years, especially in small- and medium-sized municipalities. We then apply the best-performing algorithms to derive estimates of local excess mortality for the period between February and September 2020. Such estimates allow us to provide insights about the demographic evolution of the first wave of the pandemic throughout the country. To help improve diagnostic and monitoring efforts, our dataset is freely available to the research community.

Excess Mortality During the COVID-19 Pandemic in Philadelphia

2021 ◽  
pp. e1-e6
Author(s):  
Megan Todd ◽  
Meagan Pharis ◽  
Sam P. Gulino ◽  
Jessica M. Robbins ◽  
Cheryl Bettigole
Keyword(s):  
Public Health ◽  
Excess Mortality ◽  
Poisson Model ◽  
People Of Color ◽  
Mortality Data ◽  
Registration System ◽  
Vital Registration System ◽  
All Cause Mortality ◽  
Race Ethnicity ◽  
Excess Deaths

Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n=2725) were attributed to COVID-19 on the death certificate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; official counts significantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306285 )

scholarly journals How COVID-19 affects voting for incumbents: Evidence from local elections in France

2021 ◽  
Author(s):  
Davide Morisi ◽  
Héloïse Cloléry ◽  
Guillaume Kon Kam King ◽  
Max Schaub
Keyword(s):  
Propensity Score ◽  
Excess Mortality ◽  
Indirect Evidence ◽  
Mortality Data ◽  
Local Elections ◽  
Municipal Elections ◽  
Fine Grained ◽  
Dependent Variables ◽  
Left And Right ◽  
Fear And Anxiety

How do voters react to an ongoing natural threat? We address this question by investigating voters’ reactions to the early spread of COVID-19 in the 2020 French municipal elections. Using a novel, fine-grained measure of the circulation of the virus based on excess-mortality data, we find that support for incumbents increased in the areas that were particularly hit by the virus. Incumbents from both left and right gained votes in areas more strongly affected by COVID-19. The results are robust to a placebo test and hold across different methods, including regressions with lagged dependent variables, a differences-in-differences approach and propensity score matching. We also provide indirect evidence for two mechanisms that can explain our findings: an emotional channel related to feelings of fear and anxiety, and a prospective-voting channel, related to the ability of incumbents to act more swiftly against the diffusion of the virus than challengers.

scholarly journals Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia

2019 ◽  
Vol 67 (4) ◽  
pp. 239-247 ◽  
Author(s):  
Fatma TOKGÖZ AKYIL ◽  
Mustafa AKYIL ◽  
Meltem ÇOBAN AĞCA ◽  
Aylin GÜNGÖR ◽  
Erdal OZANTÜRK ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients

Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial

The Lancet ◽  
2011 ◽  
Vol 377 (9782) ◽  
pp. 2023-2030 ◽  
Author(s):  
Sabine CA Meijvis ◽  
Hans Hardeman ◽  
Hilde HF Remmelts ◽  
Rik Heijligenberg ◽  
Ger T Rijkers ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Double Blind ◽  
Double Blind Placebo

Community-acquired pneumonia: influence of management practices on length of hospital stay

2004 ◽  
Vol 34 (3) ◽  
pp. 91-97 ◽  
Author(s):  
R. Laing ◽  
C. Coles ◽  
S. Chambers ◽  
C. Frampton ◽  
L. Jennings ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Management Practices ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia

scholarly journals Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial

2018 ◽  
Vol 51 (4) ◽  
pp. 1701389 ◽  
Author(s):  
Fahim Ebrahimi ◽  
Stavros Giaglis ◽  
Sinuhe Hahn ◽  
Claudine A. Blum ◽  
Christine Baumgartner ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Neutrophil Extracellular Traps ◽  
Community Acquired Pneumonia ◽  
Extracellular Traps ◽  
Clinical Instability ◽  
Randomised Controlled ◽  
The Impact ◽  
Clinical Stability

Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia (CAP) is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.This is a secondary analysis of a randomised controlled, multicentre trial. Patients with CAP were randomly assigned to either 50 mg prednisone or placebo for 7 days. The primary end-point was time to clinical stability; main secondary end-points were length of hospital stay and mortality.In total, 310 patients were included in the analysis. Levels of cell-free nucleosomes as surrogate markers of NETosis were significantly increased at admission and declined over 7 days. NETs were significantly associated with reduced hazards of clinical stability and hospital discharge in multivariate adjusted analyses. Moreover, NETs were associated with a 3.8-fold increased adjusted odds ratio of 30-day mortality. Prednisone treatment modified circulatory NET levels and was associated with beneficial outcome.CAP is accompanied by pronounced NET formation. Patients with elevated serum NET markers were at higher risk for clinical instability, prolonged length of hospital stay and 30-day all-cause mortality. NETs represent a novel marker for outcome and a possible target for adjunct treatments of pneumonia.

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