scholarly journals Prognostic Accuracy of the Modified CHA2DS2-VASc Score in COVID-19 Patients Admitted to the Emergency Department Due to Clinical Worsening

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Beatriz Valente Silva ◽  
Rui Plácido ◽  
Cláudia Jorge ◽  
Carlos Mendonça ◽  
Maria Luísa Urbano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Rank Test ◽  
Short Term ◽  
Prognostic Accuracy ◽  
Log Rank Test ◽  
Short Term Mortality ◽  
Risk Categories ◽  
Clinical Worsening

Introduction: Risk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department.Material and Methods: Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (≥ 4 points).Results: We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA2DS2-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA2DS2-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation.Discussion: This is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department.Conclusion: The M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.

scholarly journals An Investigation of Risk Factors Affecting Short Term Mortality of Patients Referring to the Hospital Emergency Department

2020 ◽  
Author(s):  
Elham Peyravi ◽  
Hadid Hamrah ◽  
Mohammad Sadegh Masoudi ◽  
Milad Ahmadi Marzaleh ◽  
Mahmoudreza Peyravi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Emergency Department ◽  
Systolic Blood Pressure ◽  
Fars Province ◽  
Hospital Emergency ◽  
Short Term ◽  
Factors Affecting ◽  
Emergency Department Overcrowding ◽  
Short Term Mortality

Abstract Background and Objective: One of the causes of short-term mortality in patients is the lower quality of services provided by hospital emergency departments. Given the particular importance of the hospital emergency system and the presence of numerous problems, as well as short term mortality rates in hospitals, this study aimed to investigate the risk factors affecting short term mortality of patients presenting to the Emergency Department at Nemazi Hospital in Shiraz, Fars province in 2019.Methods: This is a retrospective study with a case control-analytical design. The sample size was 768 subjects. In the present study, the emergency department overcrowding was measured by the NEDOCS (National Emergency Department Overcrowding Scale) criterion. The severity of the disease was also evaluated based on the level of the triage of patients through the Emergency Severity Index (ESI) system and vital signs.Results: With each year increase in age, the chance of short-term mortality increases by 0.8%. People with O2 sat% <90% are 7.3 times more likely to experience short term mortality in an emergency department compared to people with O2 sat%> 90%. A significant relationship was noted between short term mortality and SBP (systolic blood pressure) in the hospital's emergency department. It was also found out that as the triage score increases, short term mortality decreases significantly. As hospital stay increases, the chance of the patients' mortality decreases by 0.5%.Conclusion: The percentage of arterial blood oxygen saturation, systolic blood pressure, respiration rate per minute, triage score, the way the patient arrives at the hospital, working shifts, hospitalization duration, age, and comorbidities were regarded as the risk factors for short term mortality. Therefore, promoting professional knowledge and skills of nurses and physicians in the hospitals' emergency department and up-to-dating and reviewing emergency protocols as well as similar research can greatly help reduce short term mortality in the hospital's emergency department.

scholarly journals Modified CHA2DS2-VASc can predict mortality in COVID-19 patients admitted to the emergency department

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B V Silva ◽  
C Jorge ◽  
C Mendonca ◽  
M L Urbano ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Prognostic Value ◽  
Risk Groups ◽  
Discriminative Power ◽  
Short Term ◽  
Logrank Test ◽  
Kaplan Meier ◽  
Short Term Mortality ◽  
Score Risk

Abstract Introduction CHA2DS2-VASc score is used to determine the thromboembolic risk, but its prognostic value has been demonstrated in several cardiovascular (CV) diseases. Except for female gender, many CV risk factors comprising this score are recognized as risk factors for mortality in COVID-19. Cetinak G. et al demonstrated the ability of modified CHA2DS2-VASc (M-CHA2DS2-VASc) to predict mortality in COVID-19, which is based on changing gender criteria from female to male. Purpose To evaluate the prognostic value of a M-CHA2DS2-VASc score to predict pulmonary embolism (PE) and mortality in pts with COVID-19 admitted at the emergency department (ED). Methods Retrospective study of pts admitted to the ED between June 2020-January 2021, who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. Pts were stratified into 3 M-CHA2DS2-VASc risk groups: lower (0–1), intermediate (2–3) and high risk (≥4). Kruskal-Wallis and X-square test were used to compare score risk groups. Logistic regression was used to determine predictors of PE and mortality. ROC curve was performed to evaluate the discriminative power of the score. Results We included 300 pts: median age 71 years, 59% male. Hypertension (59%) chronic kidney disease (CKD, 33%), dyslipidemia (32%) and diabetes (28%) were the most common comorbidities. PE was diagnosed in 46 pts (15%). We found no difference in PE incidence according to M-CHA2DS2-VASc groups (p=0.531) and it showed no predictive value for PE (OR: 1.050, p=0.596). The AUC of M-CHA2DS2-VASc was 0.52, suggesting no discriminative power to predict PE. Regarding mortality, M-CHA2DS2-VASc score was higher in non-survivors COVID-19 pts than in survivors [4 (IQR 3–5) vs 2 (1–4), respectively, p&lt;0.001]. A multivariate logistic regression analysis was performed for mortality based on M-CHA2DS2-VASC, troponin, CKD and smoking history, and only M-CHA2DS2-VASc was identified as an independent predictor of mortality (OR: 1.406, p=0.007). Kaplan-Meier showed that M-CHA2DS2-VASc score was associated with mortality: the survival rate was 92%, 80% and 63% in the lower, intermediate and higher M-CHA2DS2VASc score risk group (logrank test p&lt;0.001; Fig. A). Most of the pts in the cohort were hospitalized (83%), but 21 pts (17%) discharged from the ED. Among these pts, 33% (n=17) had low risk, 37% (n=19) intermediate risk and 29% (n=15) high risk for mortality according to the M-CHA2DS2VASc score. The Kaplan-Meier individual survival analysis for hospitalized patients (Fig. B) and for those discharged from the ED (Fig. C) showed that M-CHA2DS2-VASc score had a good discriminative ability to predict short-term mortality for both groups (logrank test p&lt;0.001 and p=0.007, respectively). Conclusion Considering the lack of validated scores to predict mortality in COVID-19 pts, the M-CHA2DS2-VASc might be a simple tool to predict short-term mortality in these pts, irrespectively of the need for hospitalization or not. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

2021 ◽  
Author(s):  
Aiham Qdaisat ◽  
Sai-Ching Yeung ◽  
Cristhiam M Rojas Hernandez ◽  
Pavani Samudrala ◽  
Mona Kamal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Platelet Count ◽  
Cancer Patients ◽  
Intracranial Hemorrhage ◽  
Statistical Significance ◽  
Mortality Rates ◽  
Short Term ◽  
Short Term Mortality ◽  
Low Platelet Count

Abstract Introduction: Intracranial hemorrhage is a devastating complication of cancer and its treatment.Objective: To evaluate the characteristic, risk factors and clinical outcomes in cancer patients with intracranial hemorrhage presenting to the emergency department. Methods: We collected a decade of retrospective data on all patients with the diagnosis of ICH who visited The University of Texas MD Anderson Cancer Center emergency department. Logistic regression analyses were used to determine the association between clinical variables and various outcomes.Results: 704 confirmed acute ICH cases were identified. Of these, 576 (81.8%) were spontaneous. In-hospital, 7-day, and 30-day mortality rates were 15.1%, 11.4%, and 25.6%, respectively. Hypertension was most predictive of prolonged hospital stay ( [OR]=4.77, 95% [CI]=1.30-22.70, P=0.045) and intensive care unit admission (OR=1.52, 95% CI=1.09-2.12, P=0.013). Low platelet count was associated with both in-hospital mortality (OR=0.96, 95% CI=0.94-0.99, P=0.008) and 30-day mortality (OR=0.98, 95% CI=0.96-1.00, P=0.016). Radiologic findings especially herniation and hydrocephalus, were strong predictors of short-term mortality. Patients with intratumor bleeding had substantially lower short-term mortality rates, but this did not reach statistical significance.Conclusions: Intracranial hemorrhage remains an uncommon complication in cancer patients. The risk factors most helpful in predicting outcomes were hypertension, low platelet count, and hydrocephalus or herniation on imaging.

Bioinformatics Analysis of The Expression of ATP Binding Cassette Transporters and The Screening of Regulatory Genes in PTEN/PI3K/Akt/mTOR Signaling Pathway in The Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Tingdan Zheng ◽  
Wuqi Song ◽  
Aiying Yang
Keyword(s):  
Gene Expression ◽  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Bioinformatics Analysis ◽  
Wilcoxon Test ◽  
Rank Test ◽  
Short Term ◽  
Term Survival ◽  
Log Rank Test ◽  
Short Term Survival

Abstract Objective Here we performed the Bioinformatics analysis on the data from The Cancer Genome Atlas (TCGA), in order to find the correlation between the expression of ATP Binding Cassette (ABC) Transporters’ genes and hepatocellular carcinoma (HCC) prognosis; Methods Transcriptome profiles and clinical data of HCC were obtained from TCGA database. Package edgeR was used to analyze differential gene expression. Patients were divided into low-ABC expression and high-ABC expression groups based on the median expression level of ABC genes in cancer. The overall survival and short-term survival (n= 341) of the two groups was analyzed using the log-rank test and Wilcoxon test; Results We found that ABC gene expression was correlated with the expression of PIK3C2B (p<0.001, ABCC1: r=0.27; ABCC10: r=0.57; ABCC4: r=0.20; ABCC5: r=0.28; ABCB9: r=0.17; ABCD1: r=0.21). All patients with low-ABC expression showed significantly increased overall survival. Significantly decreased overall survival (Log-rank test: p<0.05, Wilcoxon test: p<0.05) was found in patients with high expression of ABCC1 (HR=1.58), ABCD1 (HR=1.45), ABCC4 (HR=1.56), and ABCC5 (HR=1.64), while decreased short-term survival (Log-rank test: p>0.05, Wilcoxon test: p<0.05) was correlated with the increased expression of ABCC10 (HR=1.29), PIK3C2B (HR=1.29) and ABCB9 (HR=1.23); Conclusions Our findings indicate that the specific ABC gene expression correlates with the prognosis of HCC. Therefore, ABC expression profile could be a potential indicator for HCC patients.

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