scholarly journals Statins use and COVID-19 outcomes in hospitalized patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256899
Author(s):  
Samuel K. Ayeh ◽  
Enoch J. Abbey ◽  
Banda A. A. Khalifa ◽  
Richard D. Nudotor ◽  
Albert Danso Osei ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Proportional Hazards ◽  
Respiratory Infections ◽  
Invasive Mechanical Ventilation ◽  
Cox Proportional Hazards ◽  
Average Treatment Effect ◽  
Hospitalized Patients ◽  
Average Treatment ◽  
Increased Risk ◽  
Statin Use

Background There is an urgent need for novel therapeutic strategies for reversing COVID-19-related lung inflammation. Recent evidence has demonstrated that the cholesterol-lowering agents, statins, are associated with reduced mortality in patients with various respiratory infections. We sought to investigate the relationship between statin use and COVID-19 disease severity in hospitalized patients. Methods A retrospective analysis of COVID-19 patients admitted to the Johns Hopkins Medical Institutions between March 1, 2020 and June 30, 2020 was performed. The outcomes of interest were mortality and severe COVID-19 infection, as defined by prolonged hospital stay (≥ 7 days) and/ or invasive mechanical ventilation. Logistic regression, Cox proportional hazards regression and propensity score matching were used to obtain both univariable and multivariable associations between covariates and outcomes in addition to the average treatment effect of statin use. Results Of the 4,447 patients who met our inclusion criteria, 594 (13.4%) patients were exposed to statins on admission, of which 340 (57.2%) were male. The mean age was higher in statin users compared to non-users [64.9 ± 13.4 vs. 45.5 ± 16.6 years, p <0.001]. The average treatment effect of statin use on COVID-19-related mortality was RR = 1.00 (95% CI: 0.99–1.01, p = 0.928), while its effect on severe COVID-19 infection was RR = 1.18 (95% CI: 1.11–1.27, p <0.001). Conclusion Statin use was not associated with altered mortality, but with an 18% increased risk of severe COVID-19 infection.

Abstract 13093: Clinical Features and Prognosis of Acute Cardiac Injury in Hospitalized Patients With Covid-19: A Retrospective Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Li Zhang ◽  
yanting zhang ◽  
Wei Sun ◽  
CHUN WU ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Proportional Hazards ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Cardiac Injury ◽  
High Sensitivity ◽  
Final Analysis ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients

Aims: The fatalities case due to coronavirus disease 2019 (COVID-19) is escalating. However, information on critical complications in hospitalized patients of COVID-19 is scant. We aimed to explore the prevalence of acute cardiac injury and its association with in-hospital mortality in COVID-19 patients. Methods: This retrospective study analyzed COVID-19 patients in Union Hospital (Wuhan, China) from Jan 24 to March 18, 2020. Clinical outcomes (discharge, or death) were monitored to April 9, 2020, the latest date of follow-up. Demographic, clinical, laboratory, echocardiographic data, treatment and prognosis were analyzed. Results: A total of 235 COVID-19 patients were included in the final analysis. Their median age was 66 years (interquartile range 57 - 73), and 131 (55.7%) were men. 98 (41.7%) patients were diagnosed with acute cardiac injury, of whom 60 (61.2%) died. There were more comorbidities in those who with acute cardiac injury than those without. A higher proportion of patients with acute cardiac injury received glucocorticoid therapy (68.0% vs 37.0%; P < 0.001), immunoglobulin (53.1% vs 30.1%; P < 0.001) and invasive mechanical ventilation (40.8% vs 6.6%; P < 0.001) than those without. The percentage of patients who were admitted to intensive care unit (39.8 % vs 8.0%; P < 0.001) or died during hospitalization (61.2% vs 8.0%, P < 0.001) were also higher in those with acute cardiac injury. Plasma high-sensitivity troponin I level correlated significantly with plasma interleukin -6, procalcitonin and C-reactive protein levels in COVID-19 patients. Echocardiography showed that cardiac function was attenuated in acute cardiac injury patients. Multivariable Cox proportional hazards regression analysis showed acute cardiac injury was an independent risk factor for higher in-hospital mortality in COVID-19 patients (HR, 3.393; 95% CI, 1.647- 6.987, P <0.001). Conclusions: Acute cardiac injury is a common condition and may be related to inflammatory response in COVID-19 patients. In addition, our study highlights an association between acute cardiac injury and a higher risk of in-hospital mortality. It is suggested that clinicians should be alert to acute cardiac injury in COVID-19 patients and take prompt treatments to improve outcomes.

Abstract 15633: Clinical Features and Prognosis of Acute Cardiac Injury in Hospitalized Patients With Covid-19: A Retrospective Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Li Zhang ◽  
Yuji Xie ◽  
yanting zhang ◽  
Wei Sun ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Proportional Hazards ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Cardiac Injury ◽  
Final Analysis ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
High Flow Oxygen

Background: The number of fatalities due to coronavirus disease 2019 (COVID-19) is escalating. However, information on critical complications in hospitalized patients of COVID-19 is scant. We aimed to explore the prevalence of acute cardiac injury and its association with in-hospital mortality in COVID-19 patients. Method: This retrospective study analyzed patients confirmed with COVID-19 in Union Hospital (Wuhan, China) from Jan 24 to March 18, 2020. Clinical outcomes (discharge, or death) were monitored to April 9, 2020, the latest date of follow-up. Demographic, clinical, laboratory, echocardiographic data as well as treatment and prognosis were analyzed. Comparisons were made between patients with acute cardiac injury and those without. An association of acute cardiac injury and in-hospital mortality was identified. Results: A total of 235 COVID-19 patients were included in the final analysis. Their median age was 66 years (interquartile range 57 - 73 years), and 131 (55.7%) were men. 98 (41.7%) patients were diagnosed with acute cardiac injury, of whom 60 (61.2%) died. There were more comorbidities in those who had acute cardiac injury than those who did not have. A higher proportion of patients with acute cardiac injury received glucocorticoid therapy (68.0% vs 37.0%; P < 0.001), immunoglobulin (53.1% vs 30.1%; P < 0.001), high-flow oxygen (79.6% vs 43.1%; P < 0.001), and invasive mechanical ventilation (40.8% vs 6.6%; P < 0.001) than those without acute cardiac injury. The percentage of patients who were admitted to intensive care unit (39.8 % vs 8.0%; P < 0.001) or died during hospitalization (61.2% vs 8.0%, P < 0.001) were also higher in those with acute cardiac injury. Plasma high-sensitivity troponin I levels correlated significantly with plasma interleukin -6, procalcitonin and C-reactive protein levels in COVID-19 patients. Echocardiography showed the cardiac function was attenuated in acute cardiac injury patients. Multivariable Cox proportional hazards regression analysis showed acute cardiac injury was an independent risk factor for higher in-hospital mortality in COVID-19 patients (HR, 3.393; 95% CI, 1.647- 6.987, P <0.001).

scholarly journals Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 236 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Sorkko Thirunavukkarasu ◽  
Tananchai Petnak ◽  
Api Chewcharat ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Serum Potassium ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Tertiary Referral Hospital ◽  
Increased Risk ◽  
One Year ◽  
End Stage

Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L.

Factors that contribute to urban–rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers

2021 ◽  
pp. 000486742110096
Author(s):  
Oleguer Plana-Ripoll ◽  
Patsy Di Prinzio ◽  
John J McGrath ◽  
Preben B Mortensen ◽  
Vera A Morgan
Keyword(s):  
Confidence Interval ◽  
Western Australia ◽  
Urban Areas ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Indigenous Status ◽  
Increased Risk ◽  
The Relationship ◽  
Western Australian

Introduction: An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. Methods: We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia ( N = 428,784) and Denmark ( N = 1,357,874). Children were categorised according to the level of urbanicity of their mother’s residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. Results: During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). Discussion: Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.

scholarly journals Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

2020 ◽  
Author(s):  
Yuko Yamaguchi ◽  
Marta Zampino ◽  
Toshiko Tanaka ◽  
Stefania Bandinelli ◽  
Yusuke Osawa ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Differentiation Factor ◽  
Hazards Model ◽  
Increased Risk ◽  
The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P&lt;.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

scholarly journals Towards refining WCRF/AICR cancer prevention recommendations for red and processed meat intake: Insights from Alberta’s Tomorrow Project cohort

2021 ◽  
pp. 1-38
Author(s):  
Ala Al Rajabi ◽  
Geraldine Lo Siou ◽  
Alianu K. Akawung ◽  
Kathryn L McDonald ◽  
Tiffany R. Price ◽  
...  
Keyword(s):  
Cancer Prevention ◽  
Proportional Hazards ◽  
Red Meat ◽  
Cox Proportional Hazards ◽  
Processed Meat ◽  
Carcinogenic Effect ◽  
Meat Intake ◽  
Increased Risk ◽  
Red Meats ◽  
Red And Processed Meat

ABSTRACT Current cancer prevention recommendations advise limiting red meat intake to <500g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined the associations of processed meat derived from red vs. non-red meats with cancer risk in a prospective cohort of 26,218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median (IQR) follow-up of 13.3 (5.1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and gender. The median (IQR) consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat were 267.9 (269.9), 53.6 (83.3), and 11.9 (31.8), respectively. High intakes (4th Quartile) of processed meat from red meat was associated with increased risk of gastro-intestinal cancer Adjusted Hazard Ratio (AHR) (95% CI): 1.68 (1.09 – 2.57) and colorectal cancers AHR (95% CI): 1.90 (1.12 – 3.22), respectively in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggests that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence toward refining cancer prevention recommendations for red and processed meat intake.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

scholarly journals Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients

2021 ◽  
Vol 14 ◽  
pp. 175628482199735
Author(s):  
Steven Deitelzweig ◽  
Allison Keshishian ◽  
Amiee Kang ◽  
Amol D. Dhamane ◽  
Xuemei Luo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Proportional Hazards ◽  
Bleeding Event ◽  
Cox Proportional Hazards ◽  
High Rate ◽  
Gi Bleeding ◽  
Increased Risk ◽  
Gi Bleed

Background: Gastrointestinal (GI) bleeding is the most common type of major bleeding associated with oral anticoagulant (OAC) treatment. Patients with major bleeding are at an increased risk of a stroke if an OAC is not reinitiated. Methods: Non-valvular atrial fibrillation (NVAF) patients initiating OACs were identified from the Centers for Medicare and Medicaid Services ( CMS) Medicare data and four US commercial claims databases. Patients who had a major GI bleeding event (hospitalization with primary diagnosis of GI bleeding) while on an OAC were selected. A control cohort of patients without a major GI bleed during OAC treatment was matched to major GI bleeding patients using propensity scores. Stroke/systemic embolism (SE), major bleeding, and mortality (in the CMS population) were examined using Cox proportional hazards models with robust sandwich estimates. Results: A total of 15,888 patients with major GI bleeding and 833,052 patients without major GI bleeding were included in the study. Within 90 days of the major GI bleed, 58% of patients discontinued the initial OAC treatment. Patients with a major GI bleed had a higher risk of stroke/SE [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.42–1.74], major bleeding (HR: 2.79, 95% CI: 2.64–2.95), and all-cause mortality (HR: 1.29, 95% CI: 1.23–1.36) than patients without a major GI bleed. Conclusion: Patients with a major GI bleed on OAC had a high rate of OAC discontinuation and significantly higher risk of stroke/SE, major bleeding, and mortality after hospital discharge than those without. Effective management strategies are needed for patients with risk factors for major GI bleeding.

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