scholarly journals COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253465
Author(s):  
Luis Pérez-de-Llano ◽  
Eva María Romay-Lema ◽  
Adolfo Baloira-Villar ◽  
Christian Anchorena ◽  
María Luisa Torres-Durán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Therapeutic Interventions ◽  
Outcome Variable ◽  
Multivariable Logistic Regression Analysis ◽  
Composite Outcome ◽  
Multicenter Observational Study ◽  
Risk Of Death ◽  
Hospital Beds

Introduction This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. Methods Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. Results A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39–3.63)] and [OR = 3.04 (95% CI: 1.88–4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06–1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91–0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12–0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45–2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15–5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02–1.11)]. Conclusion These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

scholarly journals Predictors of Sleep Apnea in the Canadian Population

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Ina van der Spuy ◽  
Gaungming Zhao ◽  
Chandima Karunanayake ◽  
Punam Pahwa
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Sleep Apnea ◽  
Older Age ◽  
Population Characteristics ◽  
Outcome Variable ◽  
Multivariable Logistic Regression Analysis ◽  
Canadian Population ◽  
Falling Asleep ◽  
Sleeping Problems

Older age, obesity, hypertension, snoring, and excessive daytime sleepiness have been associated with sleep apnea. The objective of this study was to determine the prevalence (crude and adjusted), as well as the risk factors, of sleep apnea in the adult Canadian population. Data from the 2009 Sleep Apnea Rapid Response (SARR) questionnaire were used to identify the risk factors, and all sleep-related questions in the SARR questionnaire were used. The outcome variable of interest was health professional-diagnosed sleep apnea. Covariates of interest were demographic variables, population characteristics, respiratory and cardiovascular diseases, and enabling resources. The multiple logistic regression model adjusted for the clustering effect was used to analyze the data. Sleep apnea was diagnosed in 858,913 adults (3.4% of the population), and more men (65.4%) than women (34.6%) were diagnosed with sleep apnea. Multivariable logistic regression analysis indicated that age (45 and older), loud snoring, sudden awakening with gasping/choking (rare/sometimes and once or more a week), and nodding off/falling asleep in driving in the past 12 months were significantly associated with diagnosed sleep apnea. Predictive probability demonstrated that in overweight and obese persons, ≥15 minutes of daily exercise significantly decreased the risk of diagnosed sleep apnea. The conclusion of this study is that in the Canadian population, sleep apnea is associated with older age, loud snoring, and sleeping problems. The protective effect of exercise warrants further investigation.

scholarly journals Invasive Mechanical Ventilation May Be an Important Factor of Mortality in Severe/Critical COVID-19 Pneumonia: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jing Wei ◽  
Lei Shi ◽  
Zhi Cheng ◽  
Xinye Jin ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Trial Registration ◽  
Hospital Death ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression

Abstract Background: Many of severe COVID-19 patients are admitted to the hospital or even to the Intensive Care Unit(ICU). The present study was aimed to investigated the risk factors in death from COVID-19.Methods: In this retrospective study, all inpatients confirmed severe or critical COVID-19 from two tertiary hospital in Huangshi were included, who had been discharged or died by March19,2020. Demographic,clinical,treatment,laboratory data and information were extracted from electronic medical records and compared between survivors group and non-survivors group. The univariable and multivariable logistic regression analysis was used to analyze the risk factors associated with in-hospital death.Results: 81 patients were included in this study, of whom 55 were discharged and 26 died in hospital. In all patients, 36(44.4%) patients had comorbidity, including hypertension(27[33.3%]), diabetes(11[13.6%]) and coronary heart disease (CHD)(11[13.6%]), and 16(19.8%) patients accompanied with more than 2 kinds of underlying diseases. The proportion of CHD in non-survivors group was significantly higher than that in survivors group(26.9% vs 7.3%, P=0.032), but there were no differences in hypertension, diabetes and COPD between the non-survivors group and the survivors group. Multivariable logistic regression analysis showed increasing odds of in-hospital death associated with aspartate aminotransferase(AST) and invasive mechanical ventilation (IMV) (P<0.001)(P=0.017）.Conclusions: Invasive Mechanical Ventilation may contribute to mortality of severe/critical COVID-19 pneumonia, and with higher AST at admission was one of the indicators of poor prognosis.Trial registration: Chinese Clinical Trial Registration; ChiCTR2000031494; Registered 02 April 2020; http://www.medresman.org

scholarly journals Is Indoor Air Pollution From Different Fuel Types Associated With the Anemia Status of Pregnant Women in Ethiopia?

2021 ◽  
Vol 12 ◽  
pp. 215013272110343
Author(s):  
Sewitemariam Desalegn Andarge ◽  
Abriham Sheferaw Areba ◽  
Robel Hussen Kabthymer ◽  
Miheret Tesfu Legesse ◽  
Girum Gebremeskel Kanno
Keyword(s):  
Air Pollution ◽  
Logistic Regression ◽  
Pregnant Women ◽  
Indoor Air ◽  
Pregnancy Outcomes ◽  
Indoor Air Pollution ◽  
Adverse Pregnancy Outcomes ◽  
Outcome Variable ◽  
Multivariable Logistic Regression Analysis ◽  
Adverse Pregnancy

Background Indoor air pollution from different fuel types has been linked with different adverse pregnancy outcomes. The study aimed to assess the link between indoor air pollution from different fuel types and anemia during pregnancy in Ethiopia. Method We have used the secondary data from the 2016 Ethiopian Demographic and Health Survey data. The anemia status of the pregnant women was the dichotomous outcome variable and the type of fuel used in the house was classified as high, medium, and low polluting fuels. Logistic regression was employed to determine the association between the exposure and outcome variables. Adjusted Odds Ratio was calculated at 95% Confidence Interval. Result The proportion of anemia in the low, medium, and high polluting fuel type users was 13.6%, 46%, 40.9% respectively. In the multivariable logistic regression analysis, the use of either kerosene or charcoal fuel types (AOR 4.6; 95% CI: 1.41-18.35) and being in the third trimester (AOR 1.72; 95% CI: 1.12-2.64) were significant factors associated with the anemia status of the pregnant women in Ethiopia. Conclusion According to our findings, the application of either kerosene or charcoal was associated with the anemia status during pregnancy in Ethiopia. An urgent intervention is needed to reduce the indoor air pollution that is associated with adverse pregnancy outcomes such as anemia.

scholarly journals Predictors of Anxiety-Induced Sleep Disturbance among in-School Adolescents in Ghana: Evidence from the 2012 Global School-Based Health Survey

2021 ◽  
Vol 11 (2) ◽  
pp. 20 ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Richard Gyan Aboagye ◽  
Francis Arthur-Holmes ◽  
Abdul-Aziz Seidu ◽  
James Boadu Frimpong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Sleep Disturbance ◽  
Emotional Disorders ◽  
Health Survey ◽  
Safety Concern ◽  
Statistical Significance ◽  
Outcome Variable ◽  
Multivariable Logistic Regression Analysis ◽  
School Based ◽  
Multivariable Logistic Regression

(1) Background: Psychological problems of adolescents have become a global health and safety concern. Empirical evidence has shown that adolescents experience diverse mental health conditions (e.g., anxiety, depression, and emotional disorders). However, research on anxiety-induced sleep disturbance among in-school adolescents has received less attention, particularly in low- and middle-income countries. This study’s central focus was to examine factors associated with t anxiety-induced sleep disturbance among in-school adolescents in Ghana. (2) Methods: Analysis was performed using the 2012 Global School-based Health Survey (GSHS). A sample of 1342 in-school adolescents was included in the analysis. The outcome variable was anxiety-induced sleep disturbance reported during the past 12 months. Frequencies, percentages, chi-square, and multivariable logistic regression analyses were conducted. Results from the multivariable logistic regression analysis were presented as crude and adjusted odds ratios at 95% confidence intervals (CIs) and with a statistical significance declared at p < 0.05. (3) Results: Adolescents who went hungry were more likely to report anxiety-induced sleep disturbance compared to their counterparts who did not report hunger (aOR = 1.68, CI = 1.10, 2.57). The odds of anxiety-induced sleep disturbance were higher among adolescents who felt lonely compared to those that never felt lonely (aOR = 2.82, CI = 1.98, 4.01). Adolescents who had sustained injury were more likely to have anxiety-induced sleep disturbance (aOR = 1.49, CI = 1.03, 2.14) compared to those who had no injury. Compared to adolescents who never had suicidal ideations, those who reported experiencing suicidal ideations had higher odds of anxiety-induced sleep disturbance (aOR = 1.68, CI = 1.05, 2.71). (4) Conclusions: Anxiety-induced sleep disturbance among in-school adolescents were significantly influenced by the psychosocial determinants such as hunger, loneliness, injury, and suicidal ideation in this study. The findings can help design appropriate interventions through effective strategies (e.g., early school-based screening, cognitive-behavioral therapy, face-face counseling services) to reduce psychosocial problems among in-school adolescents in Ghana.

scholarly journals Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

2017 ◽  
Vol 27 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Anthony L. Asher ◽  
Clinton J. Devin ◽  
Brandon McCutcheon ◽  
Silky Chotai ◽  
Kristin R. Archer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Lumbar Spine ◽  
Smoking Status ◽  
Patient Characteristics ◽  
Lumbar Spine Surgery ◽  
Multivariable Logistic Regression Analysis ◽  
Insurance Status ◽  
Quality Outcomes

OBJECTIVEIn this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration.METHODSA total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present.RESULTSIn total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients’ smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients’ propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers.CONCLUSIONSUsing a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

COVID-19 and hematologic diseases: Risk factors and long-term follow-up of CHRONOS19 Registry.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18715-e18715
Author(s):  
Kristina Zakurdaeva ◽  
Olga A. Gavrilina ◽  
Anastasia N. Vasileva ◽  
Sergei Dubov ◽  
Vitaly S. Dubov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Disease Progression ◽  
Primary Endpoint ◽  
Acute Leukemias ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Long Term Follow Up

e18715 Background: Pts with hem diseases are at high risk of COVID-19 severe course and mortality. Emerging data on risk factors and outcomes in this patient population is of great value for developing strategies of medical care. Methods: CHRONOS19 is an ongoing nationwide observational cohort study of adult (≥18 y) pts with hem disease (both malignant and non-malignant) and lab-confirmed or suspected (clinical symptoms and/or CT) COVID-19. Primary objective was to evaluate treatment outcomes. Primary endpoint was 30-day all-cause mortality. Long-term follow-up was performed at 90 and 180 days. Data from 14 centers was collected on a web platform and managed in a deidentified manner. Results: As of data cutoff on January 27, 2021, 575 pts were included in the registry, 486 of them eligible for primary endpoint assessment, n(%): M/F 243(50%)/243(50%), median age 56 [18-90], malignant disease in 452(93%) pts, induction phase/R/R/remission 160(33%)/120(25%)/206(42%). MTA in 93(19%) pts, 158(33%) were transfusion dependent, comorbidities in 278(57%) pts. Complications in 335(69%) pts: pneumonia (67%), CRS (8%), ARDS (7%), sepsis (6%). One-third of pts had severe COVID-19, 25% were admitted to ICU, 20% required mechanical ventilation. All-cause mortality at 30 days – 17%; 80% due to COVID-19 complications. At 90 days, there were 14 new deaths: 6 (43%) due to hem disease progression. Risk factors significantly associated with OS are listed in Tab 1. In multivariate analysis – ICU+mechanical ventilation, HR, 53.3 (29.1-97.8). Acute leukemias were associated with higher risk of death, HR, 2.40 (1.28-4.51), less aggressive diseases (CML, CLL, MM, non-malignant) – with lower risk of death, HR, 0.54 (0.37-0.80). No association between time of COVID-19 diagnosis (Apr-Aug vs. Sep-Jan) and risk of death. COVID-19 affected treatment of hem disease in 65% of pts, 58% experienced treatment delay for a median of 4[1-10] weeks. Relapse rate on Day 30 and 90 – 4%, disease progression on Day 90 detected in 13(7%) pts; 180-day data was not mature at the time of analysis. Several cases of COVID-19 re-infection were described. Conclusions: Thirty-day all-cause mortality in pts with hem disease was higher than in general population with COVID-19. Longer-term follow-up (180 days) for hem disease outcomes and OS will be presented. [Table: see text]

Risk factors for tibial tuberosity fracture after tibial tuberosity advancement in dogs

2015 ◽  
Vol 28 (02) ◽  
pp. 116-123 ◽  
Author(s):  
A. E. Nutt ◽  
P. Garcia-Fernandez ◽  
F. San Roman ◽  
T. Parkin ◽  
I. Calvo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Body Weight ◽  
Surgical Technique ◽  
Medical Records ◽  
Tibial Tuberosity ◽  
Teaching Hospitals ◽  
Outcome Variable ◽  
Careful Attention ◽  
Tibial Tuberosity Fracture

SummaryObjective: To retrospectively identify factors that predispose to tibial tuberosity (TT) fracture after tibial tuberosity advancement (TTA) in dogs.Methods: The medical records and radio-graphs of a group of control dogs (n = 212) that had TTA surgery (n = 241 procedures) and did not sustain a fracture between 2008 and 2013, and those of 12 dogs that did sustain a fracture (n = 13 procedures) between 2008 and 2013 at two veterinary teaching hospitals were evaluated to determine the effect of signalment, body weight and surgical inaccuracies on TT fracture. Multivariable logistic regression was performed with the occurrence of TT fracture as the outcome variable of interest.Results: Signalment and body weight were not found to be associated with TT fracture. Of the surgical inaccuracies, osteotomy shape (p = 0.003), plate position (p = 0.009), and cage position (p = 0.039) were factors significantly associated with TT fracture.Clinical significance: This study provides data to support the hypothesis that poor plate position, poor cage position, and narrow distal osteotomy width are associated with TT fracture after TTA. We conclude that it is of paramount importance to pay careful attention to surgical technique in order to reduce this risk.

scholarly journals Risk factors for E. coli Susceptibility in Bloods Stream Infections in England Between 2013-2017

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Aliabadi ◽  
K Honeyford ◽  
E Jauneikaite ◽  
B Muller-Pebody ◽  
C Costelloe
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bloodstream Infections ◽  
Visual Assessment ◽  
Outcome Variable ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
E Coli ◽  
Routine Surveillance ◽  
Potential Risk Factors

Abstract Antimicrobial resistance (AMR) is a significant threat to global health. Escherichia coli is a frequent cause of Gram-Negative Bloodstream Infections (GNBSIs) and a key organism that contributes to the burden of AMR. This was a cross-sectional surveillance study that looked at 154,791 isolates between 1st January 2013 and 31st December 2017. Analysis was performed using routine surveillance data from Public Health England (PHE) containing data on the incidence and susceptibility results of E. coli bacteraemia. Exposure variables extracted were potential risk factors for AMR. The outcome variable was resistance to at least one antibiotic. Descriptive statistics and graphs were used to summarise the data. Associations between variables and the resistance to at least one antibiotic were assessed using univariate logistic regression. A multivariable logistic regression examined adjusted associations between the variables and resistance to at least one antibiotic. The final model included variables that showed strong evidence of association with resistance to at least one antibiotic. 43.2% of isolates were resistant to at least one antibiotic. Logistic regression showed an association between resistance of E. coli isolates to at least one antibiotic and children of school age (1.39 OR, 95% CI: 1.18-1.64; p ≤ 0.001), isolates taken from patients in Greater Manchester (1.50 OR, 95% CI: 1.41-1.60; p ≤ 0.001) and isolates taken from male patients (1.14 OR, 95% CI: 1.11-1.17; p ≤ 0.001), on adjustment. Visual assessment of trend graphs showed a decrease in resistance for common carbapenems and piperacillin/tazobactam. Prevalence of resistance has increased for common cephalosporins, gentamicin, and co-amoxiclav. Initial analyses suggest an increase in rates of E. coli resistance to at least one antibiotic in GNBSIs between 2013 and 2017 in England. Findings of this study have implications for appropriate antibiotic prescribing guidelines and for directing future AMR policies. Key messages Initial analysis of the dataset suggests that rates of AMR of E. coli in BSIs have increased between 2013 and 2017. There is evidence of an increase in E.coli infections that are resistant to cephalosporins over time and a decrease in E.coli infections that are resistant to carbapenems.

Mathematical Model and Software for Prognosis the of Probability of the Lethal Outcome of Oncosurgical Patients Exposed to Radiation Exposure in the Conditions of Production

2018 ◽  
Vol 63 (2) ◽  
pp. 25-32
Author(s):  
Ю. Удалов ◽  
Yu. Udalov ◽  
Ирина Васильева ◽  
Irina Vasil'eva ◽  
А. Гордиенко ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mathematical Model ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Ionizing Radiation ◽  
Mathematical Models ◽  
Prognostic Model ◽  
Fisher Criterion ◽  
Lethal Outcome ◽  
Risk Of Death

Purpose: Identification of risk factors that influence the outcome of the patient, their ranking on the contribution to the outcome of treatment, as well as determining the possibility of their additional diagnostic evaluation and correction in the deviation at the preoperative preparation stage with the subsequent construction of a prognostic model. Material and methods: The study included patients who received treatment in the surgical department in A. I. Burnasyan Federal Medical Biophysical Center from January 2009 to July 2017, including workers of nuclear facilities that are exposed to ionizing radiation in professional conditions. The study was conducted in 112 patients, 42 of whom (37.5 %) were men and 70 (62.5 %) women aged 25 to 85 years (59.6 ± 13.2). Among the persons included in the study, 25 men and 26 women were exposed to long-term exposure to ionizing radiation from external sources under production conditions during labor activity within the limits of annual maximum permissible doses, averaged 124.6 ± 10.7 mSv. The work experience under conditions of exposure to ionizing radiation ranged from 5 to 35 years, an average of 24 years. The mean age was 59.1 ± 13.4 years. At the end of hospitalization after surgical treatment, 51 patients were discharged (45.5 %), and 61 (54.5 %) died. In all patients, the parameters of the functioning of various organs and systems were collected, including taking into account the anamnestic data of oncological patients, with differentiation in the final outcome of surgical treatment. To determine the leading risk factors for the lethal outcome of the oncosurgical patient, the Fisher criterion χ2 was used. Based on the leading risk factors for constructing mathematical models, the logistic regression equation was used. The mathematical models were analyzed by researching the area under the ROC curves. Results: Using the Fisher criterion χ2, factors were determined by which the groups of survivors and died patients differ: patient age, body mass index, history of heart rhythm disorders, fraction of cardiac output, Hb level in the blood, presence of protein in urine, INR indicator in coagulograms. Based on the identified factors, twelve mathematical models were constructed using the binary logistic regression method, allowing patients to be divided into groups with the outcomes of hospitalization died / survived after surgery. A mathematical model with the best discriminating ability was chosen. Based on the prognostic model, a decision rule was designed that allows to rank patients into three groups: green (patients with a minimal risk of death), yellow (patients who need preoperative correction), red (patients with the maximum risk of death, decision about surgery is necessary to be solved on a consultation).

scholarly journals MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tarek Abdellatif ◽  
Abdullah Hamad ◽  
Mohamad Alkadi ◽  
Essa Abuhelaiqa ◽  
Muftah Othman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Mortality Rate ◽  
General Population ◽  
Hospital Stay ◽  
Laboratory Tests ◽  
Length Of Hospital Stay ◽  
Dialysis Patients ◽  
Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p&lt;0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

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