scholarly journals Baseline clinical features of COVID-19 patients, delay of hospital admission and clinical outcome: A complex relationship

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261428
Author(s):  
Cédric Dananché ◽  
Christelle Elias ◽  
Laetitia Hénaff ◽  
Sélilah Amour ◽  
Elisabetta Kuczewski ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Access To Care ◽  
Symptom Onset ◽  
Multiple Testing ◽  
Multiple Logistic Regression Analysis ◽  
Individual Characteristics ◽  
Short Delay ◽  
Clinical Prognosis ◽  
Reactive Protein ◽  
Organization Of Care

Introduction Delay between symptom onset and access to care is essential to prevent clinical worsening for different infectious diseases. For COVID-19, this delay might be associated with the clinical prognosis, but also with the different characteristics of patients. The objective was to describe characteristics and symptoms of community-acquired (CA) COVID-19 patients at hospital admission according to the delay between symptom onset and hospital admission, and to identify determinants associated with delay of admission. Methods The present work was based on prospective NOSO-COR cohort data, and restricted to patients with laboratory confirmed CA SARS-CoV-2 infection admitted to Lyon hospitals between February 8 and June 30, 2020. Long delay of hospital admission was defined as ≥6 days between symptom onset and hospital admission. Determinants of the delay between symptom onset and hospital admission were identified by univariate and multiple logistic regression analysis. Results Data from 827 patients were analysed. Patients with a long delay between symptom onset and hospital admission were younger (p<0.01), had higher body mass index (p<0.01), and were more frequently admitted to intensive care unit (p<0.01). Their plasma levels of C-reactive protein were also significantly higher (p<0.01). The crude in-hospital fatality rate was lower in this group (13.3% versus 27.6%), p<0.01. Multiple analysis with correction for multiple testing showed that age ≥75 years was associated with a short delay between symptom onset and hospital admission (≤5 days) (aOR: 0.47 95% CI (0.34–0.66)) and CRP>100 mg/L at admission was associated with a long delay (aOR: 1.84 95% CI (1.32–2.55)). Discussion Delay between symptom onset and hospital admission is a major issue regarding prognosis of COVID-19 but can be related to multiple factors such as individual characteristics, organization of care and severe pathogenic processes. Age seems to play a key role in the delay of access to care and the disease prognosis.

scholarly journals Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

2021 ◽  
Vol 18 (3) ◽  
pp. 1242
Author(s):  
Morgan Weiland ◽  
Paula Santana ◽  
Claudia Costa ◽  
Julia Doetsch ◽  
Eva Pilot
Keyword(s):  
Infant Mortality ◽  
Access To Care ◽  
Qualitative Data ◽  
Policy Reform ◽  
Freedom Of Choice ◽  
Spatial Access ◽  
Spatial Inequalities ◽  
Organization Of Care ◽  
Maternal And Neonatal Health ◽  
Quantitative Spatial Analysis

In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infant mortality. A thematic analysis of qualitative data including interviews and surveys and a quantitative spatial analysis using Geographic Information Systems was applied. Spatial inequalities were found which may lead to avoidable infant mortality. Inequalities exist in freedom of choice and autonomy in care, within a medicalized system. Changes in approach to and organization of care would further enhance equitable spatial access to care in maternal health and reduce avoidable infant mortality.

scholarly journals C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

2008 ◽  
Vol 54 (2) ◽  
pp. 343-349 ◽  
Author(s):  
Claudia Marsik ◽  
Lili Kazemi-Shirazi ◽  
Thomas Schickbauer ◽  
Stefan Winkler ◽  
Christian Joukhadar ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Phase ◽  
Cox Regression ◽  
Disease Risk ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP &lt;5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (&gt;80 mg/L, all P &lt;0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs &gt;60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (&gt;80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

scholarly journals Early Fever Is Associated With Clinical Outcomes in Patients With Coronavirus Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Feng-ming Ding ◽  
Yun Feng ◽  
Lei Han ◽  
Yan Zhou ◽  
Yong Ji ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Symptom Onset ◽  
Critically Ill Patients ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Reactive Protein ◽  
Increased Temperature ◽  
Kaplan Meier ◽  
Image Improvement

Fever is one of the typical symptoms of coronavirus disease (COVID-19). We aimed to investigate the association between early fever (EF) and clinical outcomes in COVID-19 patients. A total of 1,014 COVID-19 patients at the Leishenshan Hospital were enrolled and classified into the EF and non-EF groups based on whether they had fever within 5 days of symptom onset. Risk factors for clinical outcomes in patients with different levels of disease severity were analyzed using multivariable analyses. Time from symptom onset to symptom alleviation, CT image improvement, and discharge were longer for patients with moderate and severe disease in the EF group than in the non-EF group. Multivariable analysis showed that sex, EF, eosinophil number, C-reactive protein, and IL-6 levels were positively correlated with the time from symptom onset to hospital discharge in moderate cases. The EF patients showed no significant differences in the development of acute respiratory distress syndrome, compared with the non-EF patients. The Kaplan–Meier curve showed no obvious differences in survival between the EF and non-EF patients. However, EF patients with increased temperature showed markedly lower survival than the non-EF patients with increased temperature. EF had no significant impact on the survival of critically ill patients, while an increase in temperature was identified as an independent risk factor. EF appears to be a predictor of longer recovery time in moderate/severe COVID-19 infections. However, its value in predicting mortality needs to be considered for critically ill patients with EF showing increasing temperature.

scholarly journals Comparison laboratory data between children with Kawasaki Disease and COVID-19

2021 ◽  
Author(s):  
Xiaoping Liu ◽  
Ying-Hsien Huang ◽  
Yuh-Chyn Tsai ◽  
Shih-Feng Liu ◽  
Ho-Chang Kuo
Keyword(s):  
New York ◽  
Kawasaki Disease ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Reactive Protein ◽  
First Case ◽  
Neutrophil Percentage ◽  
Adults And Children ◽  
Novel Coronavirus

Abstract Background: The 2019 coronavirus disease (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years old. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6-10 times increase when compared with previous years. We conducted this article to compare characters and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 COVID-19 children from the literature review and 234 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD had higher levels of white blood cell (WBC), platelet, neutrophil percentage, C-reactive protein (CRP), procalcitonin, Aspartate Aminotransferase (AST), and body temperature, while patients with COVID-19 had higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBC, platelet, procalcitonin, and AST provide identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide precision treatment with intravenous immunoglobulin (IVIG) for KD or multisystem inflammatory syndrome in children (MIS-C).

scholarly journals Platelet Activation and Plasma Levels of Furin Are Associated With Prognosis of Patients With Coronary Artery Disease and COVID-19

2021 ◽  
Author(s):  
Carolin Langnau ◽  
Anne-Katrin Rohlfing ◽  
Sarah Gekeler ◽  
Manina Günter ◽  
Simone Pöschel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Respiratory Failure ◽  
Coronary Artery ◽  
Hospital Admission ◽  
Platelet Activation ◽  
Plasma Levels ◽  
Clinical Prognosis ◽  
Il Interleukin ◽  
Increased Risk ◽  
Artery Disease

Objective: Patients with coronary artery disease (CAD) are at increased risk for cardiac death and respiratory failure following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Platelets are crucially involved in pathogenesis of CAD and might also contribute to pathophysiology of SARS-CoV-2 infection. Approach and Results: We enrolled a cohort of 122 participants from February 2020 to July 2020 including 55 patients with preexisting CAD and acute SARS-CoV-2 infection (CAD-SARS-CoV-2 positive ), 28 patients with CAD and without SARS-CoV-2 (CAD-SARS-CoV-2 negative ), and 39 healthy controls. Clinical and cardiac examination of the CAD-SARS-CoV-2 positive group included blood sampling, echocardiography, and electrocardiography within 24 hours after hospital admission. Phenotyping of platelets was performed by flow cytometry; plasma levels of chemokines were analyzed by ELISA. Respiratory failure of patients was stratified by the Horovitz index as moderately/severely impaired when Horovitz index <200 mm Hg. The clinical end point was defined as Horovitz index <200 mm Hg with subsequent mechanical ventilation within a follow-up of 60 days. CAD-SARS-CoV-2 positive patients display a significant enhanced platelet activation and hyper-inflammation early at time of hospital admission. Circulating platelet/leukocyte co-aggregates correlate with plasma levels of cytokines/chemokines like IL (interleukin)-6, CCL2, and CXCL10 as well as activation of platelets is associated with CCL5 and elevation of pulmonary artery pressure. Furthermore, furin is stored and released from activated platelets. High furin plasma levels are associated with poor clinical prognosis in CAD-SARS-CoV-2 positive patients. Conclusions: Patients with CAD and SARS-CoV-2 infection exhibit elevated systemic platelet activation and enhanced plasma levels of the subtilisin-like proprotein convertase furin, which may contribute to an unfavorable clinical prognosis.

scholarly journals Correlation Between Early Plasma Interleukin 37 Responses With Low Inflammatory Cytokine Levels and Benign Clinical Outcomes in Severe Acute Respiratory Syndrome Coronavirus 2 Infection

2020 ◽  
Author(s):  
Ang Li ◽  
Yun Ling ◽  
Zhigang Song ◽  
Xiaobo Cheng ◽  
Longfei Ding ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Inflammatory Cytokine ◽  
Inflammatory Responses ◽  
Clinical Intervention ◽  
Protective Role ◽  
Interferon Α ◽  
Type I ◽  
C Reactive Protein ◽  
Clinical Prognosis ◽  
Reactive Protein

Abstract Background The immune protective mechanisms during severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection remain to be deciphered for the development of an effective intervention approach. Methods We examined early responses of interleukin 37 (IL-37), a powerful anti-inflammatory cytokine, in 254 SARS-CoV-2–infected patients before any clinical intervention and determined its correlation with clinical prognosis. Results Our results demonstrated that SARS-CoV-2 infection causes elevation of plasma IL-37. Higher early IL-37 responses were correlated with earlier viral RNA negative conversion, chest computed tomographic improvement, and cough relief, consequently resulted in earlier hospital discharge. Further assays showed that higher IL-37 was associated with lower interleukin 6 and interleukin 8 (IL-8) and higher interferon α responses and facilitated biochemical homeostasis. Low IL-37 responses predicted severe clinical prognosis in combination with IL-8 and C-reactive protein. In addition, we observed that IL-37 administration was able to attenuate lung inflammation and alleviate respiratory tissue damage in human angiotensin-converting enzyme 2–transgenic mice infected with SARS-CoV-2. Conclusions Overall, we found that IL-37 plays a protective role by antagonizing inflammatory responses while retaining type I interferon, thereby maintaining the functionalities of vital organs. IL-37, IL-8, and C-reactive protein might be formulated as a precise prediction model for screening severe clinical cases and have good value in clinical practice.

scholarly journals Changes in the Clinical Characteristics of 62 Patients Who Died from Coronavirus Disease 2019

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Jingli Chen ◽  
Jishi Ye ◽  
Hui Li ◽  
Zhongyuan Xia ◽  
Hong Yan
Keyword(s):  
Disease Progression ◽  
Median Time ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Multiple Organ ◽  
Rapid Progression ◽  
Cytokine Storm ◽  
Reactive Protein ◽  
Clinical Changes

Background. Since the first reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in December 2019 in Wuhan, China, the virus has spread to other parts of China and across the world. Although a few studies have assessed the clinical course of coronavirus disease 2019 (COVID-19), the changes in clinical characteristics during disease progression remain unclear. Methods. We retrospectively analyzed the clinical characteristics of 62 patients who died from COVID-19 at the Central Hospital of Wuhan between January 26 and February 17, 2020. We compared the clinical features on admission and at the last follow-up before death. Results. Of the 62 patients with COVID-19, 41 (66%) patients were male, and 21 (34%) were female. The median age was 72 years (interquartile range (IQR), 54-88), and 45 (72.5%) patients had preexisting conditions. The median time from symptom onset to the first visit at the clinic was three days, while the median time from symptom onset to death was 18.5 days. During disease progression, the amounts of arterial gases worsened, and liver, renal, and heart dysfunction was observed. Due to the cytokine storm, infection-related biomarkers, including lactic acid, C-reactive protein, and interleukine-6, gradually worsened during hospitalization. Conclusion. Our findings suggest that during hospitalization, many COVID-19 patients experienced multiple organ dysfunction and cytokine storm. The time from symptom onset to death was only 18.5 days, highlighting the disease’s rapid progression. The better understanding of the clinical changes during disease progression might provide further insight into the COVID-19 pathophysiology.

scholarly journals Serum uromodulin is inversely associated with biomarkers of subclinical inflammation in the population-based KORA F4 study

2020 ◽  
Author(s):  
Cornelia Then ◽  
Christian Herder ◽  
Holger Then ◽  
Barbara Thorand ◽  
Cornelia Huth ◽  
...  
Keyword(s):  
Multiple Testing ◽  
Physiological Role ◽  
Systemic Circulation ◽  
Population Based ◽  
Future Research ◽  
Subclinical Inflammation ◽  
Linear Regression Models ◽  
Reactive Protein ◽  
Superoxide Dismutase 3 ◽  
Factor Α

Abstract Background Uromodulin is a kidney-specific glycoprotein synthesized in tubular cells of Henle’s loop exerting nephroprotective and immunomodulatory functions in the urinary tract. A small amount of uromodulin is also released into the systemic circulation, where its physiological role is unknown. Serum uromodulin (sUmod) has been associated with metabolic risk factors and with cardiovascular events and mortality, where these associations were partly stronger in men than in women. In this study, we investigated the associations of sUmod with biomarkers of subclinical inflammation in a population-based sample of women and men. Methods Associations of sUmod with 10 biomarkers of subclinical inflammation were assessed in 1065 participants of the Cooperative Health Research in the Region of Augsburg (KORA) F4 study aged 62–81 years using linear regression models adjusted for sex, age, body mass index, estimated glomerular filtration rate and diabetes. Analyses were performed in the total study sample and stratified by sex. Results sUmod was inversely associated with white blood cell count, high-sensitive C-reactive protein, interleukin (IL)-6, tumour necrosis factor-α, myeloperoxidase, superoxide dismutase-3, IL-1 receptor antagonist and IL-22 after multivariable adjustment and correction for multiple testing (P &lt; 0.001 for each observation). There was a trend towards a stronger association of sUmod with pro-inflammatory markers in men than in women, with a significant P for sex interaction (&lt;0.001) regarding the relation of sUmod with IL-6. Conclusions sUmod was inversely associated with biomarkers of subclinical inflammation in older participants of the KORA F4 study. The association of sUmod with IL-6 differed between women and men. Future research should focus on whether the immunomodulatory properties of sUmod are one explanation for the association of sUmod with cardiovascular outcomes and mortality.

Reducing Time to Diagnosis Does Not Improve Outcomes for Women With Symptomatic Ovarian Cancer: A Report From the Australian Ovarian Cancer Study Group

2011 ◽  
Vol 29 (16) ◽  
pp. 2253-2258 ◽  
Author(s):  
Christina M. Nagle ◽  
Jane E. Francis ◽  
Anne E. Nelson ◽  
Helen Zorbas ◽  
Karen Luxford ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Symptom Onset ◽  
Case Control Study ◽  
Medical Practitioner ◽  
Population Based ◽  
Short Delay ◽  
Stage Of Disease ◽  
Gynecology And Obstetrics ◽  
Time To Diagnosis ◽  
Control Study

Purpose To determine if time to diagnosis is associated with stage of disease at diagnosis or survival among women with symptomatic ovarian cancer. Methods A representative sample of Australian women (n = 1,463) with ovarian cancer diagnosed between 2002 and 2005 who participated in a population-based case-control study were interviewed regarding the events leading to their diagnosis and were observed for mortality for 5 years. Results Of the 1,318 women (90%) who presented to a medical practitioner with symptoms, 55% presented within 1 month, 70% in less than 2 months, and 92% within 6 months of symptom onset. There were no significant differences in the time from symptom onset to first medical practitioner consultation (P = .19) or symptom onset to diagnosis (P = .64) among women with borderline, early (International Federation of Gynecology and Obstetrics [FIGO] stages I to II) or late (FIGO stages III to IV) disease. There was also no association between time to diagnosis and survival; adjusted hazard ratio for long delay (> 12 months from symptom onset to diagnosis) versus short delay (≤ 1 month) was 0.94 (95% CI, 0.68 to 1.30). Women who had asymptomatic cancers diagnosed incidentally (n = 145) were younger and were more likely to have borderline or stage I disease compared with women who had symptomatic ovarian cancer. Conclusion The results of this study suggest that, once ovarian cancer is symptomatic, reducing the time to diagnosis would not greatly alter stage of disease at diagnosis or survival.

Critical factors determining access to acute stroke care

Neurology ◽  
1998 ◽  
Vol 51 (2) ◽  
pp. 427-432 ◽  
Author(s):  
Sindhu C. Menon ◽  
Dilip K. Pandey ◽  
Lewis B. Morgenstern
Keyword(s):  
Access To Care ◽  
Acute Stroke ◽  
Symptom Onset ◽  
Multivariate Regression ◽  
Stroke Care ◽  
Care Physician ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Hospital Arrival ◽  
Ambulance Transport

Objective: Our objective was to assess gender, ethnic, and access-to-care factors critical in delay time (DT) for presentation to the hospital for acute stroke.Background: Little information is available on the effect of gender, ethnicity, and access issues on DT.Design: Demographic, access-to-care, and DT information was obtained from emergency department (ED) documentation of stroke patients admitted from July 1995 through June 1997 at Hermann Hospital, Houston, TX. Univariate and multivariate regression analyses were performed.Results: Of the 241 eligible patients, 126 were African American (AA), 82 were non-Hispanic white (NHW), and 33 were Hispanic American (HA). Median DT from symptom onset to presentation to the ED was 222 minutes for AAs, 280 minutes for HAs, and 230 minutes for NHWs. A multivariate regression model estimated DT to ED arrival decreased with ambulance transport (p= 0.003) and increased in patients with a primary care physician(p = 0.145) and in women (p = 0.052). DT to see an ED physician after hospital arrival decreased with ambulance transport (p < 0.001), hemorrhage patients (p = 0.006), and worse stroke severity (p = 0.038), and increased in women (p = 0.041). DT to see a neurologist decreased with hemorrhage (p = 0.002) and ambulance arrival (p = 0.010). Neurologists saw patients within 3 hours of symptom onset in 34% of NHWs, 28% of AAs, and 18% of HAs.Conclusion: Gender and access-to-care issues may be important determinants of delay in acute stroke care. Less than 20% of HAs presented to the ED within 3 hours of symptom onset.

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