Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

BACKGROUND: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES: Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10-1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

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Evaluation of N/LP Ratio as a Predictor of Disease Progression and Mortality in COVID-19 Patients Admitted to the Intensive Care Unit

Medeniyet Medical Journal ◽

10.5222/mmj.2021.95676 ◽

2021 ◽

Author(s):

Başak Çakır Güney ◽

Mert Hayıroğlu ◽

Didar Şenocak ◽

Vedat Çiçek ◽

Tufan Çınar ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Operating Characteristic ◽

Characteristic Curve ◽

Multivariable Analysis ◽

Hospital Death ◽

Survival Status ◽

Inflammatory Index ◽

Icu Stay

Objective: This research aimed to evaluate whether the neutrophil to lymphocyte and platelet (N/LP) ratio may be used to predict the risk of admission to the intensive care unit (ICU), the need for mechanical ventilation and in-hospital mortality in Coronavirus disease 2019 (COVID-19) cases. Methods: The study was conducted retrospectively on the data of 134 COVID-19 patients who were admitted to the ICU. The N/LP ratio was calculated as follows: neutrophil count x 100 / (lymphocyte count x platelet count). Each member of the research cohort was categorised into 1 of 2 groups based on their survival status (survivor and non-survivor groups). Results: In total, 82 (61%) patients died during the ICU stay. Patients who required mechanical ventilation and died in the ICU stay had significantly higher N/LP ratio than those who did not require it and survived [10 (IQR=4.94-19.38) vs 2.51 (IQR=1.67-5.49), p<0.001] and [11.27 (IQR=4.53-30.02) vs 1.65 (IQR=1-3.24), p<0.001], respectively. The N/LP ratio was linked with the requirement of mechanical ventilation and in-hospital death according to multivariable analysis. In receiver operating characteristic curve analysis, we found that N/LP in predicting admission to the ICU was >4.18 with 61% sensitivity and 62% specificity, it was >5.07 with 74% sensitivity and 73% specificity for the need for mechanical ventilation, and >3.69 with 81% sensitivity and 81% specificity to predict in-hospital death. Conclusion: To our knowledge, this is the first study showing that the N/LP ratio, which is a novel and widely applicable inflammatory index, may be used to predict the risk of ICU admission, mechanical ventilation and in-hospital death in patients with COVID-19 disease.

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Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Infection ◽

10.1007/s15010-021-01624-7 ◽

2021 ◽

Author(s):

A. Oliva ◽

G. Ceccarelli ◽

C. Borrazzo ◽

M. Ridolfi ◽

G. D.’Ettorre ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Features ◽

Multivariable Analysis ◽

Invasive Pulmonary Aspergillosis ◽

Lower Percentage ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Single Centre Study ◽

Male Sex

Abstract Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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Going back for more: An evaluation of clinical outcomes and characteristics of readmissions to a pediatric intensive care unit*

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000269400.67463.ac ◽

2007 ◽

Vol PAP ◽

Cited By ~ 11

Author(s):

Folafoluwa O. Odetola ◽

Sarah J. Clark ◽

Ronald E. Dechert ◽

Thomas P. Shanley

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Outcomes ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care

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Assessment of the Incidence of Neonatal Sepsis, its Risk Factors, Antimicrobials Use and Clinical Outcomes in Bishoftu General Hospital, Neonatal Intensive Care Unit, Debrezeit-Ethiopia

Pediatrics & Therapeutics ◽

10.4172/2161-0665.1000214 ◽

2014 ◽

Vol 04 (04) ◽

Cited By ~ 1

Author(s):

Minyahil Alebachew Woldu

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

General Hospital ◽

Clinical Outcomes ◽

Neonatal Sepsis ◽

Neonatal Intensive Care

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Feeding Practices of Severely Ill Intensive Care Unit Patients: An Evaluation of Energy Sources and Clinical Outcomes

Journal of the American Dietetic Association ◽

10.1016/j.jada.2006.12.012 ◽

2007 ◽

Vol 107 (3) ◽

pp. 458-465 ◽

Cited By ~ 33

Author(s):

Mary E. Hise ◽

Kelly Halterman ◽

Byron J. Gajewski ◽

Melissa Parkhurst ◽

Michael Moncure ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Outcomes ◽

Feeding Practices ◽

Energy Sources

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Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

10.21203/rs.3.rs-923773/v1 ◽

2021 ◽

Author(s):

Zi-Hong Xiong ◽

Xue-Mei Zheng ◽

Guo-Ying Zhang ◽

Meng-Jun Wu ◽

Yi Qu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nutritional Status ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Phase Angle ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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Clinical course and severity outcome indicators among COVID 19 hospitalized patients in relation to comorbidities distribution Mexican cohort

10.1101/2020.07.31.20165480 ◽

2020 ◽

Author(s):

Genny Carrillo ◽

Nina Mendez Dominguez ◽

Kassandra D Santos Zaldivar ◽

Andrea Rochel Perez ◽

Mario Azuela Morales ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Diseases ◽

Risk Estimation ◽

Clinical Manifestations ◽

Case Fatality ◽

Hospitalized Patients ◽

Hospital Death ◽

Outcome Indicators

Introduction: COVID-19 affected worldwide, causing to date, around 500,000 deaths. In Mexico, by April 29, the general case fatality was 6.52%, with 11.1% confirmed case mortality and hospital recovery rate around 72%. Once hospitalized, the odds for recovery and hospital death rates depend mainly on the patients' comorbidities and age. In Mexico, triage guidelines use algorithms and risk estimation tools for severity assessment and decision-making. The study's objective is to analyze the underlying conditions of patients hospitalized for COVID-19 in Mexico concerning four severity outcomes. Materials and Methods: Retrospective cohort based on registries of all laboratory-confirmed patients with the COVID-19 infection that required hospitalization in Mexico. Independent variables were comorbidities and clinical manifestations. Dependent variables were four possible severity outcomes: (a) pneumonia, (b) mechanical ventilation (c) intensive care unit, and (d) death; all of them were coded as binary Results: We included 69,334 hospitalizations of laboratory-confirmed and hospitalized patients to June 30, 2020. Patients were 55.29 years, and 62.61% were male. Hospital mortality among patients aged<15 was 9.11%, 51.99% of those aged >65 died. Male gender and increasing age predicted every severity outcome. Diabetes and hypertension predicted every severity outcome significantly. Obesity did not predict mortality, but CKD, respiratory diseases, cardiopathies were significant predictors. Conclusion: Obesity increased the risk for pneumonia, mechanical ventilation, and intensive care admittance, but it was not a predictor of in-hospital death. Patients with respiratory diseases were less prone to develop pneumonia, to receive mechanical ventilation and intensive care unit assistance, but they were at higher risk of in-hospital death.

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Beginning to See the Light: Lessons Learned From the Development of the Circadian System for Optimizing Light Conditions in the Neonatal Intensive Care Unit

Frontiers in Neuroscience ◽

10.3389/fnins.2021.634034 ◽

2021 ◽

Vol 15 ◽

Author(s):

Esther M. Hazelhoff ◽

Jeroen Dudink ◽

Johanna H. Meijer ◽

Laura Kervezee

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Clinical Outcomes ◽

Neonatal Intensive Care ◽

Circadian System ◽

Lessons Learned ◽

Preterm Neonates ◽

Negative Effects ◽

Beneficial Effects

The circadian timing system optimizes health by temporally coordinating behavior and physiology. During mammalian gestation, fetal circadian rhythms are synchronized by the daily fluctuations in maternal body temperature, hormones and nutrients. Circadian disruption during pregnancy is associated with negative effects on developmental outcomes in the offspring, highlighting the importance of regular and robust 24-h rhythms over gestation. In the case of preterm birth (before 37 weeks of gestation), maternal cues no longer synchronize the neonate’s circadian system, which may adversely affect the neonate. There is increasing evidence that introducing robust light-dark cycles in the Neonatal Intensive Care Unit has beneficial effects on clinical outcomes in preterm infants, such as weight gain and hospitalization time, compared to infants exposed to constant light or constant near-darkness. However, the biological basis for these effects and the relationship with the functional and anatomical development of the circadian system is not fully understood. In this review, we provide a concise overview of the effects of light-dark cycles on clinical outcomes of preterm neonates in the NICU and its alignment with the development of the circadian system.

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COVID outcome prediction in the emergency department (COPE): using retrospective Dutch hospital data to develop simple and valid models for predicting mortality and need for intensive care unit admission in patients who present at the emergency department with suspected COVID-19

BMJ Open ◽

10.1136/bmjopen-2021-051468 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051468

Author(s):

David van Klaveren ◽

Alexandros Rekkas ◽

Jelmer Alsma ◽

Rob J C G Verdonschot ◽

Dick T J J Koning ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Outcome Prediction ◽

Characteristic Curve ◽

Hospital Death ◽

Hospital Data ◽

Dutch Hospital ◽

Icu Admission ◽

Second Wave

ObjectivesDevelop simple and valid models for predicting mortality and need for intensive care unit (ICU) admission in patients who present at the emergency department (ED) with suspected COVID-19.DesignRetrospective.SettingSecondary care in four large Dutch hospitals.ParticipantsPatients who presented at the ED and were admitted to hospital with suspected COVID-19. We used 5831 first-wave patients who presented between March and August 2020 for model development and 3252 second-wave patients who presented between September and December 2020 for model validation.Outcome measuresWe developed separate logistic regression models for in-hospital death and for need for ICU admission, both within 28 days after hospital admission. Based on prior literature, we considered quickly and objectively obtainable patient characteristics, vital parameters and blood test values as predictors. We assessed model performance by the area under the receiver operating characteristic curve (AUC) and by calibration plots.ResultsOf 5831 first-wave patients, 629 (10.8%) died within 28 days after admission. ICU admission was fully recorded for 2633 first-wave patients in 2 hospitals, with 214 (8.1%) ICU admissions within 28 days. A simple model—COVID outcome prediction in the emergency department (COPE)—with age, respiratory rate, C reactive protein, lactate dehydrogenase, albumin and urea captured most of the ability to predict death. COPE was well calibrated and showed good discrimination for mortality in second-wave patients (AUC in four hospitals: 0.82 (95% CI 0.78 to 0.86); 0.82 (95% CI 0.74 to 0.90); 0.79 (95% CI 0.70 to 0.88); 0.83 (95% CI 0.79 to 0.86)). COPE was also able to identify patients at high risk of needing ICU admission in second-wave patients (AUC in two hospitals: 0.84 (95% CI 0.78 to 0.90); 0.81 (95% CI 0.66 to 0.95)).ConclusionsCOPE is a simple tool that is well able to predict mortality and need for ICU admission in patients who present to the ED with suspected COVID-19 and may help patients and doctors in decision making.

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