scholarly journals Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247676
Author(s):  
Diego Velasco-Rodríguez ◽  
Juan-Manuel Alonso-Dominguez ◽  
Rosa Vidal Laso ◽  
Daniel Lainez-González ◽  
Aránzazu García-Raso ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Predictive Model ◽  
Predictive Value ◽  
Demographic Data ◽  
Smoking Habit ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Male Gender ◽  
Correlated Factors ◽  
D Dimer

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

scholarly journals 265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N65-N79
Author(s):  
Luca Arcari ◽  
Michelangelo Luciano ◽  
Luca Cacciotti ◽  
Maria Beatrice Musumeci ◽  
Valerio Spuntarelli ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Natriuretic Peptides ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Good Ability ◽  
Myocardial Involvement ◽  
D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p &lt; 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p &lt; 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p &lt; 0.001 and AUC = 0.810, p &lt; 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

scholarly journals Comparison of D-dimer level measured on the third day of hospitalization with D-dimer level in predicting in-hospital mortality in COVID-19 patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Selcuk ◽  
T Cinar ◽  
N Gunay ◽  
M Keskin ◽  
V Cicek ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Hospital Death ◽  
Funding Sources ◽  
Auc Value ◽  
Wbc Count ◽  
D Dimer ◽  
Higher Sensitivity ◽  
The Ideal

Abstract Objective The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p&lt;0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p&lt;0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

scholarly journals Lower Blood pH as a High Predisposing Factor for a Fatal Outcome in Critically Ill COVID-19 Patients at Intensive Care Unit: a Multivariable Analysis

2021 ◽  
Author(s):  
Martin Kieninger ◽  
Annemarie Sinning ◽  
Timea Vadász ◽  
Michael Gruber ◽  
Wolfram Gronwald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Clinical Decision Making ◽  
Ph Value ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Blood Ph

Abstract Background: Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of this disease and to refine treatment strategies but also to improve clinical decision-making. For the last aspect in particular, predictors of a lethal course of disease would be highly relevant.Methods:In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed predictions of in-hospital mortality.Results:Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant predictors (p < 0.001) of in-hospital mortality. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential predictors and thus predisposing factors for a lethal course.Conclusions:We developed a formula that enables the easy calculation of the probability of a fatal outcome in COVID-19 intensive care patients. Currently a follow-up study with a larger group of patients is in progress to re-evaluate the established predictors.

scholarly journals Endothelium Activation Markers in Severe Hospitalized COVID-19 Patients: Role in Mortality Risk Prediction

TH Open ◽  
2021 ◽  
Vol 05 (03) ◽  
pp. e253-e263
Author(s):  
Marina Marchetti ◽  
Patricia Gomez-Rosas ◽  
Eleonora Sanga ◽  
Sara Gamba ◽  
Cristina Verzeroli ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Risk Groups ◽  
Endothelial Activation ◽  
Endothelial Damage ◽  
High Risk Group ◽  
Activation Markers ◽  
Soluble Thrombomodulin ◽  
Inflammatory Status ◽  
D Dimer

Abstract Introduction Endothelial damage and hypercoagulability are major players behind the hemostatic derangement of SARS-CoV-2 infection. Aim In this prospective study we assessed endothelial and inflammatory biomarkers in a cohort of COVID-19 patients, aiming to identify predictive factors of in-hospital mortality. Methods COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were enrolled. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, C reactive protein (CRP) and procalcitonin were assessed. Results Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of D-dimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/FiO2 were significantly associated with death. Using these variables, a linear score with 3-risk groups was generated that provided a cumulative incidence of death of 0% in the low-, 32% in the intermediate-, and 78% in the high-risk group. Conclusions COVID-19-induced hemostatic abnormalities are exacerbated by the severity of the disease and strongly correlate with the inflammatory status, underlying the link between coagulation, endothelial activation, and inflammation. Our study provides evidence for a role of vWF, together with neutrophils and PaO2/FiO2, as a significant predictor of in-hospital mortality by SARSCoV-2 infection.

scholarly journals Comparison of D-dimer Level Measured on Third Day of Hospitalization with Admission D-dimer Level in Predicting In-hospital Mortality in COVID-19 Patients

2021 ◽  
Author(s):  
Murat Selçuk ◽  
Tufan Çınar ◽  
Nuran Günay ◽  
Muhammed Keskin ◽  
Vedat Çiçek ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Hospital Death ◽  
Normal Range ◽  
Auc Value ◽  
Wbc Count ◽  
D Dimer ◽  
Higher Sensitivity ◽  
The Ideal

Objective: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

scholarly journals Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

2019 ◽  
Vol 11 (1) ◽  
pp. 22-28
Author(s):  
Leonardo A. Miana ◽  
Valdano Manuel ◽  
Aida Luísa Turquetto ◽  
Hugo Neder Issa ◽  
Gustavo Pampolha Guerreiro ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hospital Mortality ◽  
Protective Factor ◽  
Single Ventricle ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Atrioventricular Valve ◽  
Stage 1 ◽  
The Impact

Objectives: Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. Methods: Medical records of 81 consecutive patients with moderate or severe AAV regurgitation who were submitted to AVV repair or replacement during any stage of univentricular palliation between January 2013 and May 2017 were examined. We studied demographic data and perioperative factors looking for predictors that might have influenced the results. Binary logistic regression was used to assess the impact on postoperative ventricular dysfunction and mortality. Results: Median age and weight were seven months (interquartile range [IQR]: 3-24) and 5.2 kg (IQR: 3.7-11.2), respectively. Seventy (86.4%) patients underwent AVV repair, and 11 (13.6%) patients underwent AVV replacement. There was an association between AVV repair effectiveness and timing of intervention ( P = .004). Atrioventricular valve intervention at the time of initial surgical palliation was associated with more ineffective repairs ( P = .001), while AVV replacement was more common between Glenn and Fontan procedures ( P = .004). Overall 30-day mortality was 30.5% (25 patients). In-hospital mortality was 49.4%, and it was higher when AVV repair was performed concomitant with initial (stage 1) palliation (64.1% vs 35.7%; P = .01) and when an effective repair was not achieved (75% vs 41%; P = .008). Multivariable analysis identified timing concomitant with stage 1 palliation as an independent risk factor for mortality ( P = .01); meanwhile, an effective repair was a protective factor against in-hospital mortality ( P = .05). Conclusion: Univentricular physiology with AVV regurgitation is a high-risk group of patients. Surgery for AVV regurgitation at stage 1 palliation was associated with less effective repair and higher mortality in this initial experience. On the other hand, effective repair determined better outcomes, highlighting the importance of experience and the learning curve in the management of such patients.

scholarly journals A New Predictor of Disease Severity in Patients with COVID-19 in Wuhan, China

2020 ◽  
Author(s):  
Ying Zhou ◽  
Zhen Yang ◽  
Yanan Guo ◽  
Shuang Geng ◽  
Shan Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
Predictive Value ◽  
Demographic Data ◽  
Characteristic Curve ◽  
Severe Pneumonia ◽  
Internal Validation ◽  
Predictive Values ◽  
Radiological Data ◽  
D Dimer

AbstractBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, Hubei, China. This study sought to elucidate a novel predictor of disease severity in patients with coronavirus disease-19 (COVID-19) cased by SARS-CoV-2.MethodsPatients enrolled in this study were all hospitalized with COVID-19 in the Central Hospital of Wuhan, China. Clinical features, chronic comorbidities, demographic data, and laboratory and radiological data were reviewed. The outcomes of patients with severe pneumonia and those with non-severe pneumonia were compared using the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) to explore clinical characteristics and risk factors. The receiver operating characteristic curve was used to screen optimal predictors from the risk factors and the predictive power was verified by internal validation.ResultsA total of 377 patients diagnosed with COVID-19 were enrolled in this study, including 117 with severe pneumonia and 260 with non-severe pneumonia. The independent risk factors for severe pneumonia were age [odds ratio (OR): 1.059, 95% confidence interval (CI): 1.036–1.082; p < 0.001], N/L (OR: 1.322, 95% CI: 1.180–1.481; p < 0.001), CRP (OR: 1.231, 95% CI: 1.129–1.341; p = 0.002), and D-dimer (OR: 1.059, 95% CI: 1.013–1.107; p = 0.011). We identified a product of N/L*CRP*D-dimer as having an important predictive value for the severity of COVID-19. The cutoff value was 5.32. The negative predictive value of less than 5.32 for the N/L*CRP*D-dimer was 93.75%, while the positive predictive value was 46.03% in the test sets. The sensitivity and specificity were 89.47% and 67.42%. In the training sets, the negative and positive predictive values were 93.80% and 41.32%, respectively, with a specificity of 70.76% and a sensitivity of 89.87%.ConclusionsA product of N/L*CRP*D-dimer may be an important predictor of disease severity in patients with COVID-19.

scholarly journals Clinical Traits of SARS-CoV-2 Infection

2020 ◽  
Vol 30 (6) ◽  
pp. 28-39
Author(s):  
O. Yu. Zolnikova ◽  
N. L. Dzhakhaya ◽  
N. D. Potskherashvili ◽  
K. B. Puzakov ◽  
O. Yu. Кiseleva ◽  
...  
Keyword(s):  
Demographic Data ◽  
Clinical Manifestations ◽  
Male Gender ◽  
C Reactive Protein ◽  
Diagnostic Pcr ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Duration Of Disease ◽  
Coronavirus Infection ◽  
D Dimer

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients.

scholarly journals Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

2018 ◽  
Vol 12 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Aroldo Bacellar ◽  
Telma Assis ◽  
Bruno B. Pedreira ◽  
Gersonita Costa ◽  
Osvaldo J.M. Nascimento
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Low Socioeconomic Status ◽  
Neurological Disorders ◽  
Risk Model ◽  
Medical Center ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Neurological Complications ◽  
Low Socioeconomic

Background: Neurological disorders (NDs) are associated with high hospital mortality. We aimed to identify predictors of hospital mortality among elderly inpatients with NDs. Methods: Patients aged ≥60 years admitted to the hospital between January 1, 2009 and December 31, 2010 with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic data, NDs, and comorbidities as independent predictors of hospital mortality. Logistic regression was performed for multivariable analysis. Results: Overall, 1540 NDs and 2679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8±9.1). Of these, 54.5% were female. Diagnostic frequency of NDs ranged between 0.3% and 50.8%. Diagnostic frequency of comorbidities ranged from 5.6% to 84.5%. Comorbidities varied from 0 to 9 per patient (90% of patients had ≥2 comorbidities), mean 3.2±1.47(CI, 3.1-3.3). Patients with multimorbidities presented with a mean of 4.7±1.7 morbidities per patient. Each ND and comorbidity were associated with high hospital mortality, producing narrow ranges between the lowest and highest incidences of death (hospital mortality = 18%) (95% CI, 15%-21%). After multivariable analysis, advanced age (P<0.001) and low socioeconomic status (P=0.003) were recognized as predictors of mortality, totaling 9% of the variables associated with hospital mortality. Conclusion: Neither a particular ND nor an individual comorbidity predicted hospital mortality. Age and low socioeconomic class accounted for 9% of predictors. We suggest evaluating whether functional, cognitive, or comorbidity scores will improve the risk model of hospital mortality in elderly patients admitted with ND.

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