Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up

Background Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. The risk factors associated with PACS remain largely unclear. The aim of this study was to evaluate the frequency of new or persistent symptoms in COVID-19 patients post hospital discharge and identify associated risk factors. Methods Our prospective cohort comprised of PCR-confirmed COVID-19 patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia between May and July 2020. The patients were interviewed through phone calls by trained physicians from 6 weeks up to 6 months post hospital discharge. Multivariate Cox proportional hazards and logistic regression models were used to examine for predictors associated with persistence of symptoms and non-return to baseline health. Results 222 COVID-19 patients responded to follow-up phone interviews after a median of 122 days post discharge. The majority of patients were men (77%) with mean age of 52.47 (± 13.95) years. 56.3% of patients complained of persistent symptoms; 66 (29.7%) experiencing them for >21 days and 64 (28.8%) reporting not having returned to their baseline health. Furthermore, 39 patients (17.6%) reported visiting an emergency room post discharge for COVID-19-related symptoms while 16 (7.2%) had required re-hospitalization. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms at follow-up. After multivariable adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not fully recovering from acute COVID-19. Patients who were treated with interferon β-1b based triple antiviral therapy during hospital stay were less likely to experience new or persistent symptoms and more likely to return to their baseline health. Conclusions COVID-19 survivors continued to suffer from dyspnea, cough and fatigue at 4 months post hospital discharge. Several risk factors could predict which patients are more likely to experience PACS and may benefit from individualized follow-up and rehabilitation programs.

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After Elective Sigmoid Colectomy for Diverticulitis, Does Recurrence-Free Mean Symptom-Free?

The American Surgeon ◽

10.1177/000313482008600128 ◽

2020 ◽

Vol 86 (1) ◽

pp. 49-55

Author(s):

Karmina K. Choi ◽

Kevin Krautsak ◽

Jessica Martinolich ◽

Jonathan J. Canete ◽

Brian T. Valerian ◽

...

Keyword(s):

Risk Factors ◽

Irritable Bowel Syndrome ◽

Relative Risk ◽

Significant Risk ◽

Sigmoid Colectomy ◽

Persistent Symptoms ◽

Abdominal Symptoms ◽

Increased Risk ◽

Irritable Bowel

After elective sigmoidectomy for diverticulitis, patients may experience persistent abdominal symptoms. This study aimed to determine the incidence and characteristics of persistent symptoms (PSs) and their risk factors in patients who had no reported recurrence after elective sigmoidectomy. Patients who underwent elective sigmoidectomy for diverticulitis from 2002 to 2016 at a tertiary academic colorectal surgery practice were included. After retrospective review of medical records, patients were contacted with a questionnaire to inquire about recurrence of diverticulitis and persistent abdominal symptoms since resection. Outcomes examined were prevalence of and risk factors for PSs after elective sigmoidectomy. Of 662 included patients, 346 completed the questionnaire and had no recurrent diverticulitis. PSs were reported by 43.9 per cent of the patients. The mean follow-up was 87 months. Female gender and preoperative diagnosis of irritable bowel syndrome were independent risk factors for PSs (Relative Risk 1.65, P < 0.001 and Relative Risk 1.41, P = 0.014). Previous IVantibiotics treatment was associated with PSs ( P = 0.034) but not with a significant risk factor. As the follow-up interval increased, prevalence of PSs decreased ( P = 0.006). More than 40 per cent of patients experienced persistent abdominal symptoms after sigmoidectomy for diverticulitis. Female patients and those with irritable bowel syndrome were at significantly increased risk.

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Risk of a Diagnosis of Dementia for Elderly Medicare Beneficiaries after Intensive Care

Anesthesiology ◽

10.1097/aln.0000000000000821 ◽

2015 ◽

Vol 123 (5) ◽

pp. 1105-1112 ◽

Cited By ~ 14

Author(s):

Carmen Guerra ◽

May Hua ◽

Hannah Wunsch

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Critical Illness ◽

General Population ◽

Hospital Discharge ◽

Medicare Beneficiaries ◽

Risk Of Death ◽

Increased Risk ◽

Diagnosis Of Dementia

Abstract Background Critical illness is likely associated with an increased risk of dementia, but the magnitude remains uncertain. Methods The cohort was a random 2.5% sample of Medicare beneficiaries who received intensive care in 2005 and survived to hospital discharge. Patients were matched with general population controls (age, sex, and race) with 3 yr of follow-up. The authors used an extended Cox model to assess the risk of a diagnosis of dementia, adjusting for the known risk factors for dementia, and the competing risk of death. Results Among 10,348 intensive care patients who survived to hospital discharge, dementia was newly diagnosed in 1,648 (15.0%) over the 3 yr of follow-up versus 12.2% in controls (incidence per 1,000 person-years, 73.6; 95% CI, 70.0 to 77.1 vs. 45.8; 95% CI, 43.2 to 48.3; hazard ratio [HR], 1.61; 95% CI, 1.50 to 1.74; P < 0.001). After accounting for the known risk factors in the year before the index hospitalization, the risk of receiving a diagnosis of dementia remained increased in patients who received intensive care (adjusted HR, 1.43; 95% CI, 1.32 to 1.54; P < 0.001). Inclusion of identifiable risk factors accrued during the quarter of critical illness accounted for almost all of the increased risks (adjusted HR, 1.09; 95% CI, 1.00 to 1.20; P = 0.06). Conclusions Elderly critical care survivors have a 60% increased relative risk, but only 3% increased absolute risk, of receiving a diagnosis of dementia in the subsequent 3 yr compared with the general population. This increased risk is not accounted for by risk factors preexisting the critical illness. Surveillance bias, which increases the likelihood of receiving a diagnosis of dementia, could account for some or all of these additional risks.

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Epidemiology of Surgical-Site Infections Diagnosed After Hospital Discharge A Prospective Cohort Study

Infection Control and Hospital Epidemiology ◽

10.1086/501820 ◽

2001 ◽

Vol 22 (1) ◽

pp. 24-30 ◽

Cited By ~ 71

Author(s):

Miguel Delgado-Rodríguez ◽

Antonio Gómez-Ortega ◽

Maria Sillero-Arenas ◽

Javier Llorca

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Hospital Stay ◽

Hospital Discharge ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surgical Site Infections ◽

Tertiary Hospital ◽

Stepwise Logistic Regression

AbstractObjective:To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections.Design:Prospective cohort study, with telephone follow-up for 1 month after hospital discharge.Setting:The general surgery service of a tertiary hospital in Spain.Main Outcome Measure:In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician.Results:Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and postdischarge SSIs remained even after controlling for time from operation to diagnosis.Conclusions:Most predictors of in-hospital SSI were not predictors of postdischarge SSI.

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Abstract WP472: Improving Neurologic Follow-Up After Stroke Utilizing a Nurse Practitioner

Stroke ◽

10.1161/str.51.suppl_1.wp472 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Larry Dashefsky ◽

Carol Hren ◽

Tiffanie Munici ◽

Melissa Richardson

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hospital Discharge ◽

Nurse Practitioner ◽

Transitions Of Care ◽

Post Discharge ◽

Readmission Rates ◽

Discharge Disposition ◽

Increased Risk

Background: Patients who experience acute ischemic stroke are at increased risk for a secondary vascular event. Risk factor management as well as review of the medication regimen are important components to secondary prevention. Neurologic follow-up is an essential step during transitions of care to ensure these components are addressed. For a variety of reasons, stroke patients do not always complete follow up appointments. The literature suggests that such patients are at increased risk for readmission. Purpose: The purpose of this project was to improve access to neurologic follow-up for patients diagnosed with acute ischemic stroke after discharge from an acute care or rehabilitation setting. The secondary goal was to decrease readmission rates. Methods: A nurse practitioner (NP) was added to the inpatient stroke neurology service. The model of care was redesigned with the NP performing subsequent assessments after the initial evaluation was completed by the neurologist. The NP also organized the plan of care, including appropriate post discharge follow-up. Over time, due to challenges with access to appointments, the NP started an outpatient stroke clinic. Data were entered into Get With The Guidelines®-Stroke to identify the patients who had a neurology provider appointment scheduled prior to hospital discharge, regardless of discharge disposition. Results: Between the first quarter of 2018 and the second quarter of 2019, the percentage of patients with a neurologic follow-up appointment scheduled prior to hospital discharge improved from 23% to 61%. During this same time period, the readmission rates decreased from 14% to 9%. Conclusions: Adding the NP position to an inpatient stroke neurology service and using this role to lead an outpatient stroke clinic improves the percentage of patients who have appointments scheduled prior to hospital discharge. Improving access to follow-up care influences readmission rates.

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Long-Term Follow up of Renal and Other Acute Organ Failure in Survivors of Critical Illness Due to Covid-19

Journal of Intensive Care Medicine ◽

10.1177/08850666211062582 ◽

2021 ◽

pp. 088506662110625

Author(s):

Sudham Chand ◽

Sumit Kapoor ◽

Ali Naqvi ◽

Jyotsana Thakkar ◽

Melissa J. Fazzari ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Discharge ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Kidney Injury ◽

Persistent Symptoms ◽

Increased Risk ◽

Telephone Questionnaire

Background Little is known about the long-term health sequelae and outcomes of various organ failures in ICU survivors of Covid-19. The aim of our research was to study the characteristics of 120-day ICU survivors of the initial pandemic surge and report their long term (>6 months) outcomes. Methods We conducted a telephone questionnaire-based follow up study of 120- day survivors of Covid-19 admitted to ICUs at Montefiore Medical Center, Bronx, NY from 3/10/2020 to 4/11/2020. The study period was 2 months (11/1/2020-12/31/2020). Results 126 out of 300 (42%) survived to 120-days post-hospital discharge. The median age of survivors was 54 (47-61) years. Seventy-eight (62%) patients developed acute kidney injury (AKI); thirty-five (44.9%) of them required renal replacement therapy (RRT). One hundred-five (83.3%) required invasive mechanical ventilation; ten of them required tracheotomy. 103 (81.7%) completed the telephone questionnaire-based study, at a median (IQR) of 216.5 (200-234.5) days after hospital discharge. 29 (28.2%) patients reported persistent shortness of breath, 24, (23.3%) complained of persistent cough, and persistent anosmia in 9 (8.8%). AKI resolved completely in 58 (74.4%) patients. Of 35 AKI patients who required initiation of RRT during hospitalization, 27 (77%) were liberated from RRT and 20 (57%) had resolution of AKI. Of 20 patients without AKI resolution, 12 developed chronic kidney disease, whereas 8 still require RRT. Thirty-three (32.4%) patients developed post-traumatic stress disorder (PTSD) and 10 (11.8%) reported major depression. Many of the patients (68%) regained baseline functional status. Readmissions occurred in 22.3% patients within first 6 months after discharge. Conclusion Persistent symptoms of long Covid have been reported in ICU survivors of Covid-19 for extended durations. Outcomes of Covid-19 associated acute kidney injury are excellent. There is a high incidence of PTSD and depression in COVID-19 ICU survivors. Functional outcomes are good, but these patients remain at increased risk of hospital readmission.

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Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

Sleep And Breathing ◽

10.1007/s11325-020-02287-8 ◽

2021 ◽

Author(s):

Maria Värendh ◽

Christer Janson ◽

Caroline Bengtsson ◽

Johan Hellgren ◽

Mathias Holm ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Health ◽

Smoking Status ◽

Northern Europe ◽

Nasal Breathing ◽

Nasal Symptoms ◽

Increased Risk ◽

Study Population ◽

Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

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Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

Scientific Reports ◽

10.1038/s41598-021-89216-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Robert Terziev ◽

Dimitri Psimaras ◽

Yannick Marie ◽

Loic Feuvret ◽

Giulia Berzero ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

High Grade Glioma ◽

High Grade ◽

Nucleotide Polymorphisms ◽

Increased Risk ◽

Radiation Induced ◽

Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

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Stroke in hemodialysis patients randomized to different intravenous iron strategies: a prespecified analysis from the PIVOTAL trial

Kidney360 ◽

10.34067/kid.0004272021 ◽

2021 ◽

pp. 10.34067/KID.0004272021

Author(s):

Patrick B. Mark ◽

Pardeep S. Jhund ◽

Matthew R. Walters ◽

Mark C. Petrie ◽

Albert Power ◽

...

Keyword(s):

Risk Factors ◽

Stroke Risk ◽

Controlled Trial ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

High Dose ◽

Pivotal Trial ◽

Increased Risk ◽

Iv Iron

Background: People with kidney failure treated with hemodialysis (HD) are at increased risk of stroke compared to similarly aged people with normal kidney function. One concern is that treatment of renal anemia might increase stroke risk. We studied risk factors for stroke in a prespecified secondary analysis of a randomized controlled trial of intravenous iron treatment strategies in HD. Methods: We analyzed data from the Proactive IV IrOn Therapy in HaemodiALysis Patients (PIVOTAL) trial focusing on variables associated with risk of stroke. The trial randomized 2,141 adults, who had started hemodialysis <12 months earlier and who were receiving an erythropoiesis-stimulating agent (ESA), to high-dose IV iron administered proactively or low-dose IV iron administered reactively in a 1:1 ratio. Possible stroke events were independently adjudicated. We performed analyses to identify variables associated with stroke during follow-up and assessed survival following stroke. Results: During a median 2.1 years follow-up, 69 (3.2%) patients experienced a first post randomization stroke. 57 (82.6%) were ischemic strokes and 12 (17.4%) hemorrhagic strokes. There were 34 post randomization strokes in the proactive arm and 35 in the reactive arm (hazard ratio (95% confidence interval): 0.90 (0.56, 1.44), p=0.66). In multivariable models, female gender, diabetes, history of prior stroke at baseline, higher baseline systolic blood pressure, lower serum albumin and higher C-reactive protein were independently associated with stroke events during follow up. Hemoglobin, total iron or ESA dose were not associated with risk of stroke. 58% of patients with a stroke event died during follow-up, compared to 23% without a stroke. Conclusions: In hemodialysis patients, stroke risk is broadly associated with risk factors previously described to increase cardiovascular risk in this population. Proactive intravenous iron does not increase stroke risk.

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Community prevalence of SARS-CoV-2 in England: Results from the ONS Coronavirus Infection Survey Pilot

10.1101/2020.07.06.20147348 ◽

2020 ◽

Cited By ~ 4

Author(s):

Koen B Pouwels ◽

Thomas House ◽

Julie V Robotham ◽

Paul Birrell ◽

Andrew B Gelman ◽

...

Keyword(s):

Risk Factors ◽

Credible Interval ◽

Control Measures ◽

Cross Sectional ◽

Direct Patient Contact ◽

Increased Risk ◽

Potential Risk Factors ◽

Coronavirus Infection ◽

Over Time

Objective: To estimate the percentage of individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) over time in the community in England and to quantify risk factors. Design: Repeated cross-sectional surveys of population-representative households with longitudinal follow-up if consent given. Setting: England. Participants: 34,992 Individuals aged 2 years and over from 16,722 private residential households. Data were collected in a pilot phase of the survey between 26 April and 28 June 2020. Main outcome measures: Percentage of individuals in the community testing positive for SARS-CoV-2 RNA using throat and nose swabs. Individuals were asked about any symptoms and potential risk factors. Results: The percentage of people in private-residential households testing positive for SARS-CoV-2 reduced from 0.32% (95% credible interval (CrI) 0.19% to 0.52%) on 26 April to 0.08% (95% CrI 0.05% to 0.12%) on 28 June, although the prevalence stabilised near the end of the pilot. Factors associated with an increased risk of testing positive included having a job with direct patient contact (relative exposure (RE) 4.06, 95% CrI 2.42 to 6.77)), working outside the home (RE 2.49, 95% CrI 1.39 to 4.45), and having had contact with a hospital (RE 2.20, 95% CrI 1.09 to 4.16 for having been to a hospital individually and RE 1.95, 95% CrI 0.81 to 4.09 for a household member having been to a hospital). In 133 visits where individuals tested positive, 82 (61%, 95% CrI 53% to 69%) reported no symptoms, stably over time. Conclusion: The percentage of SARS-CoV-2 positive individuals declined between 26 April and 28 June 2020. Positive tests commonly occurred without symptoms being reported. Working outside your home was an important risk factor, indicating that continued monitoring for SARS-CoV-2 in the community will be essential for early detection of increases in infections following return to work and other relaxations of control measures.

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Perioperative changes of response to antiplatelet medication in vascular surgery patients

PLoS ONE ◽

10.1371/journal.pone.0244330 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244330

Author(s):

Thomas Hummel ◽

Saskia Hannah Meves ◽

Andreas Breuer-Kaiser ◽

Jan-Ole Düsterwald ◽

Dominic Mühlberger ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Vascular Surgery ◽

Reactive Protein ◽

Antiplatelet Medication ◽

Impedance Aggregometry ◽

Increased Risk ◽

Potential Risk Factors ◽

Artery Disease

Introduction Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.

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