In-Hospital Glycemic Dysregulation Associated With Worse Outcomes in COVID-19

Abstract Introduction: Evidence establishes that COVID-19 patients with DM2 are at increased risk for severe disease and worse outcomes. Peer reviewed data is sparse comparing glycemic control and clinical outcomes among COVID-19 patients with vs. without DM2, and thus we sought to address this gap. Methods: We selected patients at least 18 years old who expired or were discharged between March 16, 2020 through September 15, 2020. Principal analysis compared glycemic patterns among patients with DM2 vs. non-DM2. Median, coefficient of variation (CV), maximum and minimum glucose parameters were computed to characterize longitudinal glycemic patterns. Logistic regression modeling identified significant (p<.05) associations between composite outcome vs. glycemic parameters and putative risks for progression to severe COVID-19. Receiver operating characteristic (ROC) curve identified cut points for glycemic parameters. Cox regression models were employed to control for significant confounders. Continuous data summarized as median was compared using Kruskal-Wallis test. Discrete data were compared with Pearson’s chi-square test. Two-tailed p<.05 was significant. Results: Among 494 patients, 157 (32%) had DM2 with no intergroup differences in age (68 [56–79]), sex (52% male, 48% female), or race (68% Caucasian, 19% Other, 13% African American). Insulin was administered to DM2 (93%) and non-DM2 (54%) patients (p<.0001). Comorbidities were more prevalent in DM2, including cardiovascular (68% vs. 54%, p=.003), renal (72% vs. 52%, p<.0001) and obesity (51% vs. 38%, p<.0001). Markers including D-dimer (0.98 [0.61–1.95] mg/L), lactate dehydrogenase (308 [230–392] U/L), ferritin (436 [174–856] ng/mL), and triglycerides (172 [109–239] mg/dL), were not different in DM2 vs. non-DM2 (p>.05). CRP was greater in patients with (8.6 [3.6–14.6]) vs. without (6.1 [2.0–12.6]) DM2 (p=.005). Baseline glucose in DM2 (163 [121–253] mg/dL) vs. non-DM2 (107 [96–124] mg/dL) was significantly greater, with former an independent predictor of composite outcome (p=.0005). Cox modeling of other glucose parameters in DM2 vs. non-DM2 demonstrated various impact regarding risk for composite outcome including median (155 [128–209], p=.46) vs. (103 [94–118], p=.09); coefficient of variation (28 [19–38], p=.08) vs. (15 [9–20], p=.002); maximum (252 [187–362], p=.0005) vs. (129 [110–156], p=.002); and minimum (99 [79–128], p=.95) vs. (89 [81–98], p=.02). The unified baseline glucose cut point for composite outcome risk controlled for significant covariates was 138 gm/dL (p<.0001), which included respectively 20% and 10% of patients with and without DM2. Conclusion: Glycemic dysregulation in COVID-19 patients is independently associated with ICU admission and/or hospital mortality. Presence of DM2 amplifies glycemic dysregulation, but risk stratification appears warranted in all COVID-19 patients.

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Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

10.1101/2020.09.01.20186080 ◽

2020 ◽

Author(s):

Fangfei Xiang ◽

Jing Sun ◽

Po-Hung Chen ◽

Peijin Han ◽

Haipeng Zheng ◽

...

Keyword(s):

Regression Models ◽

Cox Regression ◽

Early Stage ◽

Severe Disease ◽

High Flow ◽

Adverse Outcomes ◽

Prolonged Hospitalization ◽

Severe Stage ◽

Increased Risk ◽

High Flow Oxygen

Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

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Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1710 ◽

2020 ◽

Author(s):

Fangfei Xiang ◽

Jing Sun ◽

Po-Hung Chen ◽

Peijin Han ◽

Haipeng Zheng ◽

...

Keyword(s):

Regression Models ◽

Cox Regression ◽

Early Stage ◽

Severe Disease ◽

High Flow ◽

Adverse Outcomes ◽

Prolonged Hospitalization ◽

Severe Stage ◽

Increased Risk ◽

High Flow Oxygen

Abstract Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. We sought to evaluate the association between FIB-4 at an early stage of infection and COVID-19 outcomes. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

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Pregnancy and risk of COVID-19

10.1101/2021.03.22.21254090 ◽

2021 ◽

Author(s):

Maria C. Magnus ◽

Laura Oakley ◽

Håkon K. Gjessing ◽

Olof Stephansson ◽

Hilde M. Engjom ◽

...

Keyword(s):

Pregnant Women ◽

Regression Models ◽

Cox Regression ◽

Severe Disease ◽

Positive Test ◽

Specialist Care ◽

Hazard Ratios ◽

Increased Risk ◽

To Receive ◽

Similar Risk

AbstractBackgroundStudies report that pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, intensive-care and death. Whether pregnant women in general are more susceptible of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear.MethodsLinked registry-data on all women ages 15 to 45 living in Norway on March 1st, 2020 (N=1,033,699) were used in Cox regression models to estimate hazard ratios (HR) comparing pregnant to non-pregnant women, of having a positive test for SARS-CoV-2, a diagnosis of COVID-19 in specialist healthcare, or hospitalization with COVID-19, adjusting for age, marital status, education, income, country of birth and underlying medical conditions.ResultsCompared to non-pregnant women, pregnant women had a similar risk of a positive SARS-CoV-2 test (adjusted HR, 0.99; 95% confidence interval [CI], 0.92 to 1.07), a higher risk of a COVID-19 diagnosis in specialist care (HR, 3.46; 95% CI, 2.89 to 4.14), and to be hospitalized (HR, 4.70; 95% CI, 3.51 to 6.30). Pregnant women were in general not more likely to be tested for SARS-CoV-2. Pregnant women born outside Scandinavia were less likely to be tested, but at higher risk of a positive test (HR, 2.37; 95% CI, 2.51 to 8.87) and of hospitalization with COVID-19 (HR, 4.72; 95% CI, 2.51 to 8.87) than pregnant Scandinavian born women.ConclusionPregnant women were not more likely to be infected with SARS-CoV-2. However, pregnant women with COVID-19, especially those born outside of Scandinavia, were more likely to receive specialist care and to be hospitalized.

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Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study

Occupational and Environmental Medicine ◽

10.1136/oemed-2021-107764 ◽

2021 ◽

pp. oemed-2021-107764

Author(s):

Kimmo Herttua ◽

Linda Juel Ahrenfeldt ◽

Tapio Paljarvi

Keyword(s):

Oral Cancer ◽

Chronic Diseases ◽

Respiratory Disease ◽

Regression Models ◽

Cox Regression ◽

Chronic Respiratory Disease ◽

Police Force ◽

Rescue Service ◽

Active Population ◽

Increased Risk

ObjectiveTo investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries.MethodsWe performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population.ResultsHR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases.ConclusionsWe observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.

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Pendidikan Kesehatan dengan Pendekatan Model Information Motivation Behavior Skill (IMB) terhadap Peningkatan Pengetahuan dan Pola Konsumsi Sayur dan Buah pada Ibu Hamil

Jurnal Kesehatan ◽

10.26630/jk.v10i3.1433 ◽

2019 ◽

Vol 10 (3) ◽

pp. 320

Author(s):

Farhati Farhati ◽

Riska Resmana ◽

Dian Nurhadianti

Keyword(s):

Health Education ◽

Pregnant Women ◽

Consumption Patterns ◽

P Value ◽

Chi Square ◽

Increased Risk ◽

Post Test ◽

Quasi Experimental ◽

Chi Square Test ◽

Vegetables And Fruits

<p>Low consumption of vegetables and fruit causes an increased risk of chronic diseases such as cancer, heart disease, and diabetes. The results showed that the majority of pregnant women (52.9%) rarely consume vegetables and fruit in sufficient quantities as recommended. Therefore, it is necessary to provide education about the importance of vegetables and fruits consumption, one of which is through the Information Motivation Behavioral Skill (IMB) approach. This study aims to determine the effect of health education with the Information Motivation Behavior Skill (IMB) approach to increasing knowledge and consumption patterns of vegetables and fruits in pregnant women. This research is a quasi-experimental study with pre-post test design with control groups conducted in pregnant women in the city of Bandung with 60 samples using the observation sheet and questionnaire instruments. Data analysis used the chi-square test. The result of this study indicates that there are significant differences in knowledge and patterns of consumption of vegetables and fruit in pregnant women between the control and treatment groups with a p-value<0.05. Information Motivation Behavior Skill (IMB) Health Education Model approach has a role in increasing the knowledge and consumption patterns of vegetables and fruits in pregnant women.</p>

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Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

Biomedicines ◽

10.3390/biomedicines9111653 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1653

Author(s):

Bianca Olivia Cojan-Minzat ◽

Alexandru Zlibut ◽

Ioana Danuta Muresan ◽

Rares-Ilie Orzan ◽

Carmen Cionca ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Dilated Cardiomyopathy ◽

Predictive Value ◽

Left Atrial ◽

Cox Proportional Hazards ◽

Lv Function ◽

Composite Outcome ◽

Chi Square ◽

Increased Risk

Left atrial (LA) geometry and phasic functions are frequently impaired in non-ischaemic dilated cardiomyopathy (NIDCM). Cardiac magnetic resonance (CMR) can accurately measure LA function and geometry parameters. We sought to investigate their prognostic role in patients with NIDCM. We prospectively examined 212 patients with NIDCM (49 ± 14.2-year-old; 73.5% males) and 106 healthy controls. LA volumes, phasic functions, geometry, and fibrosis were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. LA phasic functions, sphericity index (LASI) and late gadolinium enhancement (LA-LGE) were considerably impaired in the diseased group (p < 0.001) and significantly correlated with impaired LV function parameters (p < 0.0001). After multivariate analysis, LA volumes, LASI, LA total strain (LA-εt) and LA-LGE were associated with increased risk of composite outcome (p < 0.001). Kaplan–Meier analysis showed significantly higher risk of composite endpoint for LA volumes (all p < 0.01), LASI > 0.725 (p < 0.003), and LA-εt < 30% (p < 0.0001). Stepwise Cox proportional-hazards models demonstrated a considerable incremental predictive value which resulted by adding LASI to LA-εt (Chi-square = 10.2, p < 0.001), and afterwards LA-LGE (Chi-Square = 15.8; p < 0.0001). NIDCM patients with defective LA volumes, LASI, LA-LGE and LA-εt had a higher risk for an outcome. LA-εt, LASI and LA-LGE provided independent incremental predictive value for outcome.

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A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191602 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1067

Author(s):

Mallikarjuna Rao I. ◽

Usha Kiran Prayaga ◽

Dharma Rao Uppada ◽

Ramachandra Rao E. ◽

B. L. Kudagi

Keyword(s):

Depressive Disorders ◽

Low Dose ◽

Rating Scale ◽

Controlled Study ◽

P Value ◽

Chi Square ◽

Double Blind ◽

Increased Risk ◽

Significant Difference ◽

Chi Square Test

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

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CIP4 Expression is Associated With The Prognosis in Colorectal Cancer

10.21203/rs.3.rs-95046/v1 ◽

2020 ◽

Author(s):

Keqian Zhang ◽

Tianqi Mao ◽

Zhicheng He ◽

Xiaojiao Wu ◽

Yu Peng ◽

...

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Prognostic Significance ◽

Lymphatic Invasion ◽

Chi Square ◽

Interacting Protein ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Chi Square Test ◽

Student’S T

Abstract Background: This study was conducted to detect the expression of Cdc42 interacting protein 4 (CIP4) in patients with colorectal cancer (CRC), and explore the role of CIP4 in prognosis of CRC patients.Methods: The expression of CIP4 mRNA was determined by quantitative real-time PCR (qRT-CPR) and compared by student’s t-test between groups. Relationships of clinical characteristics and CIP4 expression were analyzed by Chi-square test. Kaplan-Meier curves were used to estimate the overall survival of CRC patients. And Cox regression analysis was conducted to identify the prognostic biomarkers for CRC patients.Results: The qRT-PCR results showed that CRC tissues were detected with significantly high CIP4 mRNA expression compared with adjacent normal controls (P<0.0001). The overexpression of CIP4 in CRC tissues was influenced by distant metastasis (P=0.021), lymphatic invasion (P=0.012) and TNM stage (P=0.006). But, other clinical factors including age, gender, differentiation and tumor site were proved to have no obvious effects on CIP4 expression (all, P>0.05). The survival curves showed that patients with high CIP4 expression generally lived shorter than those with low CIP4 expression (P<0.001). In addition, the multivariate analysis revealed that differentiation (P=0.044, HR=1.631, 95%CI=1.013-2.626) and CIP4 expression (P=0.000, HR=5.283, 95%CI=3.138-8.893) were of great prognostic significance for CRC patients.Conclusion: Taken together, up-regulation of CIP4 in CRC tissues represented poor prognosis for patients.

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Changes in the frequency of food intake among children and teenagers: monitoring in a reference service

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692013000400020 ◽

2013 ◽

Vol 21 (4) ◽

pp. 973-981 ◽

Cited By ~ 4

Author(s):

Larissa Soares Mariz ◽

Carla Campos Muniz Medeiros ◽

Caroline Evelin Nascimento Kluczynik Vieira ◽

Bertha Cruz Enders ◽

Alexsandro Silva Coura

Keyword(s):

Food Intake ◽

Nursing Care ◽

Soft Drinks ◽

Overweight Children ◽

Chi Square ◽

Increased Risk ◽

Fried Foods ◽

Chi Square Test ◽

Reference Service ◽

Food Intake Patterns

PURPOSE: to identify changes in the food intake patterns among overweight children and teenagers, treated at a reference medical centre. METHOD: the method used is that of a cohort study, between April 2010 and April 2011. A total of 109 children and teenagers, either obese or overweight, took part in the study. The population was divided into two subgroups depending on the permanence period (more than 6 months, and less than 6 months off the treatment). The chi-square test and logistic regression were carried out. RESULTS: the group which had been longer off the treatment tended to consume more soft drinks, pasta and fried foods, and less fruit and vegetables. The group with less time showed an improvement, with a reduction of consumption of soft drinks and other goodies. There was confirmation of an increased risk for consumption of soft drinks, pasta and goodies in general, as also detachment from the treatment in adolescence. CONCLUSIONS: The group with a longer period of monitoring has had a positive change in food intake frequency. The main contribution made by this study is that of showing that multiprofissional treatment, including some nursing care, is efficient in progressively changing the food intake of children and adolescents who are overweight.

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Analysis of Scoring Sequences in Matches of the Portuguese Premier League

Journal of Human Kinetics ◽

10.1515/hukin-2017-0199 ◽

2018 ◽

Vol 64 (1) ◽

pp. 255-263

Author(s):

José M. Pratas ◽

Anna Volossovitch ◽

Ana I. Carita

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Cox Model ◽

Positive Association ◽

Descriptive Statistics ◽

Chi Square ◽

Cox Regression Analysis ◽

Premier League ◽

Chi Square Test

AbstractThe aim of this study was to examine the sequences of the first two goals scored in soccer matches in accordance with a range of different match contexts. Data from 1506 matches played in the Portuguese Premier League during six consecutive competitive seasons (2009-10 to 2014-2015) were analysed using descriptive statistics and the chi-square test in order to verify the association between variables and a Cox regression analysis was used to predict the time the second goal was scored in function of the time of the first goal scored in the match and the scoreline. The results revealed a higher frequency of the second goals being scored in the second half of a match (58%) and in the last 5 min periods of each half. A positive association was found for home teams and score-doubling goals (58%), as well as for away teams and score-equalizing goals (56%). For home and away teams the score-doubling goal of a match was strongly and positively associated with a win outcome for home (93%) and away teams (92%), while the score-equalizing goals were associated with a draw (home and away teams: 44%) and loss outcome (home: 33% and away teams: 32%). Finally, the Cox model showed that if the first goal was scored in the second half of the match, the probability of the second goal being scored was three times higher compared to the first half.

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