scholarly journals Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study

2010 ◽  
Vol 128 (5) ◽  
pp. 289-295 ◽  
Author(s):  
Gilson Caleman ◽  
José Fausto de Morais ◽  
Maria Eduarda dos Santos Puga ◽  
Rachel Riera ◽  
Álvaro Nagib Atallah
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Burn Patients ◽  
Burnt Area ◽  
Historical Cohort ◽  
Risk Of Death ◽  
Crystalloid Solutions ◽  
De Medicina

CONTEXT AND OBJECTIVE: Among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: Non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: Burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: The use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

scholarly journals Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001785
Author(s):  
Kamal Matli ◽  
Nibal Chamoun ◽  
Aya Fares ◽  
Victor Zibara ◽  
Soad Al-Osta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Icu Admission ◽  
Therapeutic Anticoagulation ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Prophylactic Anticoagulation ◽  
Improved Outcome

BackgroundCOVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population.MethodsA retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation.Results242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation.ConclusionThe use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection.

scholarly journals Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study

2020 ◽  
Author(s):  
Guillaume Fond ◽  
Vanessa Pauly ◽  
Marc Leone ◽  
Pierre-Michel Llorca ◽  
Veronica Orleans ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Mental Illness ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Severe Mental Illness ◽  
Vulnerable Population ◽  
Icu Admission ◽  
Risk Of Death

Abstract Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08–1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62–0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.

scholarly journals A decade of neonatal sepsis caused by gram-negative bacilli—a retrospective matched cohort study

2021 ◽  
Author(s):  
Viveka Nordberg ◽  
Aina Iversen ◽  
Annika Tidell ◽  
Karolina Ininbergs ◽  
Christian G. Giske ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Late Onset ◽  
Case Fatality ◽  
Resistance Pattern ◽  
Suspected Sepsis ◽  
Gram Negative ◽  
Risk Of Death ◽  
Early Onset Sepsis ◽  
Significant Difference

AbstractThis study is to determine the incidence and outcome of neonatal gram-negative bacilli (GNB) sepsis in Stockholm, Sweden, and describe bacterial characteristics. This is a retrospective cohort study. All infants with GNB-sepsis between 2006 and 2016 were included and matched with two control groups, with suspected sepsis and uninfected neonates, respectively. Outcome was death before discharge, risk of death within 5 days after sepsis onset, and morbidity. The resistance pattern from all GNB was collected, and all available isolates were subjected to genome typing. All neonates with GNB-sepsis (n = 107) were included, and the cumulative GNB-sepsis incidence was 0.35/1000 live born. The in-hospital mortality was 30/107 (28%). GNB late-onset sepsis (LOS) was associated with an increase in mortality before discharge compared to uninfected controls (OR = 3.9; CI 1.6–9.4) but not versus suspected sepsis. The suspected LOS cases did not statistically differ significantly from uninfected controls. The case fatality rate (CFR) at 5 days was 5/33 (15%) in GNB early-onset sepsis (EOS) and 25/74 (34%) in GNB-LOS. The adjusted hazard for 5 days CFR was higher in GNB-LOS versus uninfected controls (HR = 3.7; CI 1.2–11.2), but no significant difference was seen in GNB-LOS versus suspected sepsis or in suspected sepsis versus controls. ESBL production was seen in 7/107 (6.5%) of the GNB isolates. GNB-LOS was associated with a higher 5 days CFR and in-hospital mortality compared to uninfected controls but not versus suspect sepsis. The incidence of both GNB-EOS and GNB-LOS was lower than previously reported from comparable high-income settings. The occurrence of antibiotic resistance was low.

scholarly journals Assessing the Predictive Value of TRIPS in Newborns

2021 ◽  
Vol 18 (4) ◽  
pp. 73-79
Author(s):  
R. F. Mukhametshin ◽  
N. S. Davydova ◽  
S. V. Kinzhalova
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Correlation Analysis ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Quantitative Data ◽  
Hospital Treatment ◽  
Binary Outcomes ◽  
Risk Of Death ◽  
Occlusive Hydrocephalus

The objective: to determine the predictive value of TRIPS at the stage of pre-transport preparation in relation to treatment outcomes of newborns.Subjects: The cohort study included data from 604 visits of the team of the intensive case and consultation center. The TRIPS score was assessed, and the outcomes of the hospital phase of treatment were studied. The AUC ROC curve of the TRIPS score was calculated in relation to the binary outcomes of hospital treatment. The correlation analysis of the quantitative data was performed by Spearman's criterion.Results. AUC was greater than 0.8 only for the risk of death (AUC 0.827 (0.764-0.891)), the formation of severe IVH (AUC 0.831 (0.786-0.877)) and the development of occlusive hydrocephalus (AUC 0.839 (0.764-0.915)). For other binary outcomes, the score shows AUC below 0.8. A weak but significant correlation was found between the TRIPS score and the duration of intensive care (r = 0.478,p < 0.0001).Conclusion: TRIPS demonstrated an acceptable level of accuracy (AUC>0.8) in predicting hospital mortality, severe IVH, and the formation of occlusive hydrocephalus. A weak but significant correlation was found with the quantitative outcomes.

scholarly journals The association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a cohort study

2019 ◽  
Author(s):  
Yangpei Peng ◽  
Yangjing Xue ◽  
Jinsheng Wang ◽  
Huaqiang Xiang ◽  
Kangting Ji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiogenic Shock ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Albumin Ratio

Abstract Background Cardiogenic shock (CS) is a lethal complication. Given the poor outcome of CS, we performed a retrospective cohort study to identify whether the neutrophil-to-albumin ratio (NAR) was significantly associated with mortality from CS. Methods All patient data were extracted from the MIMIC III version 1.3. Comparisons between groups was made using the chi-square or Fisher’s exact tests for categorical variables and the variance analysis or the Kruskal-Wallis test was used for continuous variables. The primary outcome was 30-day mortality and the secondary ones were 90-day and 365-day mortality. We used Cox proportional hazards models to evaluate the association between the various categories of NAR and survival. To further identify the association, subgroup analyses were performed. Results A total of 475 patients with CS were enrolled. A significant positive correlation between NAR levels and 30-day, 90-day or 365-day mortality was observed. For the primary outcome of 30-day mortality, the HR (95% CI) values given NAR levels 23.54–27.86 and > 27.86 were 1.72 (1.17, 2.53) and 1.96 (1.34, 2.87) compared with the reference (NAR < 23.47) in tertile analysis. In multivariate analyses, the HR (95% CI) values were still of statistical significance[1.98 (1.25, 3.15) and 2.03 (1.26, 3.26)]. When quintiles were applied to grouping patients according to NAR level, similar associations were also observed. For the secondary outcomes, the upward trend remained statistically significant. Conclusions NAR level was associated with survival from CS. NAR appeared to be an independent and readily-available prognostic biomarker of mortality in patients with CS.

scholarly journals In-Hospital Mortality in Patients with Idiopathic Pulmonary Fibrosis: A US Cohort Study

Lung ◽  
2019 ◽  
Vol 197 (6) ◽  
pp. 699-707 ◽  
Author(s):  
Michael T. Durheim ◽  
Jennifer Judy ◽  
Shaun Bender ◽  
Dorothy Baumer ◽  
Joseph Lucas ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Hospital Mortality ◽  
Lung Transplant ◽  
Primary Outcome ◽  
Chronic Obstructive ◽  
Index Visit ◽  
Risk Of Death

Abstract Purpose In patients with idiopathic pulmonary fibrosis (IPF), hospitalizations are associated with high mortality. We sought to determine in-hospital mortality rates and factors associated with in-hospital mortality in patients with IPF. Methods Patients with IPF were identified from the Premier Healthcare Database, a representative administrative dataset that includes > 20% of hospital discharges in the US, using an algorithm based on diagnostic codes and billing data. We used logistic regression to analyze associations between patient-, hospital-, and treatment-related characteristics and a composite primary outcome of death during the index visit, lung transplant during the index visit and > 1 day after admission, or death during a readmission within 90 days. Results The cohort comprised 6665 patients with IPF hospitalized between October 2011 and October 2014. A total of 963 (14.4%) met the primary outcome. Factors significantly associated with a higher risk of the primary outcome included mechanical ventilation [odds ratio 4.65 (95% CI 3.73, 5.80)], admission to the intensive care unit [1.83 (1.52, 2.21)], treatment with opioids (3.06 [2.57, 3.65]), and a diagnosis of pneumonia [1.44 (1.21, 1.71)]. Factors significantly associated with a lower risk included concurrent chronic obstructive pulmonary disease [0.65 (0.55, 0.77)] and female sex [0.67 (0.57, 0.79)]. Conclusions Patients with IPF, particularly those receiving mechanical ventilation or intensive care, are at substantial risk of death or lung transplant during hospitalization or death during a readmission within 90 days.

scholarly journals Supernormal Antithrombin Activity Is an Independent Predictor of In-Hospital Mortality in Patients With Sepsis: A Retrospective Observational Study

2020 ◽  
Vol 26 ◽  
pp. 107602962091282
Author(s):  
Takeo Azuhata ◽  
Mineji Hayakwa ◽  
Kunihiko Maekawa ◽  
Tomohide Komatsu ◽  
Tsukasa Kuwana ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Intensive Care ◽  
Retrospective Study ◽  
Survival Rate ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Statistical Significance ◽  
Nonlinear Regression Analysis

Supernormal antithrombin (AT) activity is rare in patients with sepsis. This study compared mortality rate of patients with sepsis and supernormal AT activity with that of other patients. This retrospective study included patients with sepsis from 42 intensive care units (ICUs) in Japan. Patients were included if their AT activity was measured on ICU admission, and if they did not receive AT concentrate. They were categorized into low, normal, and supernormal with respective AT activity of ≤70%, >70% to ≤100%, and >100%. The primary outcome was hospital in-patient mortality. Nonlinear regression analysis showed that mortality risk gradually increased with AT activity in the supernormal range, but without statistical significance. Survival rate was significantly lower in low (67%) and supernormal (57%) AT groups than in the normal AT group (79%; P < .001 and P = .008, respectively). After adjusting for disease severity and AT activity on day 2, supernormal AT activity was the only independent predictor of mortality. Sepsis with supernormal AT activity associated with high mortality, independent of disease severity, might be a predictor of in-hospital mortality.

scholarly journals Inappropriate Use of Oral Antithrombotic Combinations in an Outpatient Setting and Associated Risks: A French Nationwide Cohort Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2367
Author(s):  
Lorène Zerah ◽  
Dominique Bonnet-Zamponi ◽  
Aya Ajrouche ◽  
Jean-Philippe Collet ◽  
Yann De Rycke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Study Entry ◽  
Healthcare Database ◽  
Historical Cohort ◽  
Subdistribution Hazard ◽  
Medical Progress ◽  
Risk Of Death ◽  
Increased Risk

With the increase in prevalence of cardiovascular diseases, multimorbidity, and medical progress, oral antithrombotic (AT) combinations are increasingly prescribed. The aims of this study were to estimate the incidence of oral AT combinations, their appropriateness (defined as indications compliant with guidelines), and the related risk of major bleeding (i.e., leading to hospitalization) or death, among new users. We conducted a 5-year historical cohort study, using the French national healthcare database, including all individuals ≥ 45 years old with a first delivery of oral ATs between 1 January 2013 and 31 December 2017. The cumulative incidence of oral AT combinations was estimated with the Fine and Gray method, taking into account the competitive risk of death. We compared the cumulative incidence of major bleeding according to the type of oral AT treatment initiated at study entry (monotherapy or oral AT combinations). During the study period, 22,220 individuals were included (mean (SD) age 68 (12) years). The cumulative incidence of oral AT combinations at 5 years was 27.8% (95% confidence interval (CI) 26.8–28.9). Overall, 64% of any oral AT combinations did not comply with guidelines. The cumulative incidence of major bleeding and death in the whole cohort at 5 years was 4.1% (95% CI 3.7–4.6) and 10.8% (95% CI 10.1–11.6), respectively. Risk of major bleeding increased among individuals with oral AT combinations versus oral AT monotherapy at study entry (subdistribution hazard ratio sHR: 2.16 (1.01–4.63)); with no difference in terms of death. The use of oral AT combinations among oral AT users is frequent, often inappropriately prescribed, and associated with an increased risk of major bleeding.

scholarly journals Combined Anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalized COVID-19 patients: a propensity matched cohort study

2021 ◽  
Author(s):  
Kamal Matli ◽  
Nibal Chamoun ◽  
Aya Fares ◽  
Victor Zibara ◽  
Soad Al-Osta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Cox Regression Analysis ◽  
Icu Admission ◽  
Therapeutic Anticoagulation ◽  
Significant Difference ◽  
Prophylactic Anticoagulation ◽  
Improved Outcome

Background: COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. Methods: A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, ICU admission, or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. Results: 242 patients were included in the study and divided into 4 subgroups: therapeutic anticoagulation (TAC), prophylactic anticoagulation + antiplatelet (PACAP), therapeutic anticoagulation + antiplatelet (TACAP), and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable cox regression analysis and propensity matching were done and showed when compared to PAC, TACAP and TAC were associated with less in-hospital all cause mortality with an adjusted hazard ratio (aHR) of 0.113 (95% confidence interval (CI) 0.028-0.449) and 0.126 (95% CI, 0.028-0.528) respectively. The number needed to treat (NNT) in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI, 0.014-0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission, or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. Conclusion: The use of combined anticoagulant and antiplatelet agents or therapeutic anticoagulation alone in hospitalized COVID-19 patients was associated with a better outcome in comparison to prophylactic anticoagulation alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomized controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using therapeutic anticoagulation in the management of patients with COVID-19 infection.

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