scholarly journals Comorbidities Associated with Complicated Hospital Course and Death in COVID-19 Patients: A Retrospective Study from Iran

2021 ◽  
Author(s):  
Nader Tavakoli ◽  
Nahid Hashemi-Madani ◽  
Mojtaba Malek ◽  
Zahra Emami ◽  
Alireza Khajavi ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Adverse Outcomes ◽  
Invasive Ventilation ◽  
Limited Data ◽  
Risk Of Death ◽  
End Point ◽  
Academic Hospitals ◽  
Patients With Diabetes ◽  
Duration Of Hospitalization ◽  
The Impact

Abstract Objective There are limited data regarding the impact of comorbidities on hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran. Methods We evaluated the risk of serious adverse outcomes in 1368 Iranian COVID-19 patients, admitted to five academic hospitals in Tehran between February-June 2020. The composite end-points were defined as admission to an intensive care unit, invasive ventilation, or death. The Cox proportional survival model determined the potential comorbidities associated with death. Results Overall, 576 patients (42.3%) reached the composite end-point (280 death). Adjusted for age, sex, duration of hospitalization, and the presence of the other comorbidities, patients with diabetes (RR=1.25, 95%CI; 1.08-1.44), heart failure (RR=1.45, 95%CI; 1.10-1.91), chronic kidney disease (RR=1.32, 95%CI; 1.04-1.67), malignancy (RR=1.79, 95%CI; 1.41-2.28), and lung diseases (RR=1.53, 95%CI; 1.27-1.84) were more likely to reach the composite end-point than those without the very comorbidity. Moreover, patients aged less than 65 years had a greater risk of death in the presence of two (HR=2.68, 95%CI; 1.46-4.95, p=0.002) or more (HR=3.47, 95%CI; 1.69-7.12, p=0.001) comorbidities, compared to those without any comorbidity. Conclusion To conclude, having two or more comorbidities in patients less than 65 years is associated with a greater risk of death during hospitalization.

scholarly journals P6419Machine learning in critical care: the role of diabetes and age in acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Cenko ◽  
M Van Der Schaar ◽  
J Yoon ◽  
Z Vasiljevic ◽  
S Kedev ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Secondary Endpoint ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
The Impact

Abstract Background Patients with diabetes and non-ST elevation acute coronary syndrome (NSTE-ACS) have an increased risk of mortality and adverse outcomes following percutaneous coronary intervention (PCI). Purpose We aimed to investigate the impact of early, within 24 hours PCI compared with only routine medical treatment on clinical outcomes in a large international cohort of patients with NSTE-ACS and diabetes. Methods We identified 1,250 patients with diabetes and NSTE-ACS from a registry-based population between October 2010 and April 2016. The primary endpoint was 30-day all-cause mortality. The secondary endpoint was the composite outcome of 30-day all-cause mortality and left ventricular dysfunction (ejection fraction <40%). We undertook analyses to explore the heterogeneity of treatment effects using meta-classification (MC) algorithms followed by propensity score matching and inverse-probability-of-treatment weighting (IPTW) from a landmark of 24 hours from hospitalization. Results Of 1,250 NSTE-ACS first-day survivors with diabetes (median age 67 years; 59%, men), 470 (37.6%) received early PCI and 780 routine medical treatment. The overall 30-day all-cause mortality rates were higher in the routine medical treatment than the early PCI group (6.3% vs. 2.5%). The prediction results of the MC algorithms accounted for only one interaction term that was statistically significant: age ≥65 years. After propensity-matched analysis as well as IPTW, early PCI was associated with reduced 30-day all-cause mortality in the older age (OR: 0.35; 95% CI: 0.14 to 0.92 and 0.43; 95% CI: 0.21 to 0.86, respectively), whereas younger age had no association with the primary endpoint. Similar results were also obtained for the secondary endpoint. Conclusions Among patients with diabetes hospitalized for NSTE-ACS, an early, within 24 hours, PCI strategy is associated with reduced odds of 30-day mortality only for patients aged 65 years or over. MC algorithms provide accurate identification of treatment effect modifiers.

scholarly journals Comorbidity and outcomes in traumatic brain injury: protocol for a systematic review on functional status and risk of death

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018626 ◽  
Author(s):  
Tatyana Mollayeva ◽  
Chen Xiong ◽  
Sara Hanafy ◽  
Vincy Chan ◽  
Zheng Jing Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Status ◽  
Medical Information ◽  
Longitudinal Design ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Risk Of Death ◽  
The Impact

IntroductionReports on the association between comorbidity and functional status and risk of death in patients with traumatic brain injury (TBI) have been inconsistent; it is currently unknown which additional clinical entities (comorbidities) have an adverse influence on the evolution of outcomes across the lifespan of men and women with TBI. The current protocol outlines a strategy for a systematic review of the current evidence examining the impact of comorbidity on functional status and early-term and late-term mortality, taking into account known risk factors of these adverse outcomes (ie, demographic (age and sex) and injury-related characteristics).Methods and analysisA comprehensive search strategy for TBI prognosis, functional (cognitive and physical) status and mortality studies has been developed in collaboration with a medical information specialist of the large rehabilitation teaching hospital. All peer-reviewed English language studies with longitudinal design in adults with TBI of any severity, published from May 1997 to April 2017, found through Medline, Central, Embase, Scopus, PsycINFO and bibliographies of identified articles, will be considered eligible. Study quality will be assessed using published guidelines.Ethics and disseminationThe authors will publish findings from this review in a peer-reviewed scientific journal(s) and present the results at national and international conferences. This work aims to understand how comorbidity may contribute to adverse outcomes in TBI, to inform risk stratification of patients and guide the management of brain injury acutely and at the chronic stages postinjury on a population level.PROSPERO registration numberCRD42017070033.

scholarly journals Genomic context and TP53 allele frequency define clinical outcomes in TP53-mutated myelodysplastic syndromes

2020 ◽  
Vol 4 (3) ◽  
pp. 482-495 ◽  
Author(s):  
Guillermo Montalban-Bravo ◽  
Rashmi Kanagal-Shamanna ◽  
Christopher B. Benton ◽  
Caleb A. Class ◽  
Kelly S. Chien ◽  
...  
Keyword(s):  
Allele Frequency ◽  
Adverse Outcomes ◽  
Response To Therapy ◽  
International Prognostic Scoring System ◽  
Limited Data ◽  
Survival Times ◽  
Genomic Context ◽  
Clinicopathologic Characteristics ◽  
Tp53 Mutations ◽  
The Impact

Abstract TP53 mutations are associated with adverse outcomes and shorter response to hypomethylating agents (HMAs) in myelodysplastic syndrome (MDS). Limited data have evaluated the impact of the type, number, and patterns of TP53 mutations in response outcomes and prognosis of MDS. We evaluated the clinicopathologic characteristics, outcomes, and response to therapy of 261 patients with MDS and TP53 mutations. Median age was 68 years (range, 18-80 years). A total of 217 patients (83%) had a complex karyotype. TP53 mutations were detected at a median variant allele frequency (VAF) of 0.39 (range, 0.01-0.94). TP53 deletion was associated with lower overall response rate (ORR) (odds ratio, 0.3; P = .021), and lower TP53 VAF correlated with higher ORR to HMAs. Increase in TP53 VAF at the time of transformation was observed in 13 patients (61%), and previously undetectable mutations were observed in 15 patients (65%). TP53 VAF was associated with worse prognosis (hazard ratio, 1.02 per 1% VAF increase; 95% confidence interval, 1.01-1.03; P &lt; .001). Integration of TP53 VAF and karyotypic complexity identified prognostic subgroups within TP53-mutant MDS. We developed a multivariable model for overall survival that included the revised International Prognostic Scoring System (IPSS-R) categories and TP53 VAF. Total score for each patient was calculated as follows: VAF TP53 + 13 × IPSS-R blast score + 16 × IPSS-R cytogenetic score + 28 × IPSS-R hemoglobin score + 46 × IPSS-R platelet score. Use of this model identified 4 prognostic subgroups with median survival times of not reached, 42.2, 21.9, and 9.2 months. These data suggest that outcomes of patients with TP53-mutated MDS are heterogeneous and that transformation may be driven not only by TP53 but also by other factors.

Relationship Between Left Atrial Strain and Malnutrition Scores in Diabetic Patients

2021 ◽  
Author(s):  
Flora Özkalaycı ◽  
Ali Karagoz ◽  
Işıl Kutlutürk Karagöz ◽  
Süleyman Çağan Efe ◽  
Erdem Türkyılmaz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Left Atrial ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Diabetic Patients ◽  
Left Atrial Strain ◽  
Patients With Diabetes ◽  
Atrial Strain ◽  
The Impact ◽  
Conut Score

Objectives: Malnutrition is a serious public health problem that is associated with adverse outcomes in a broad range of disease including cardiovascular disease and diabetes mellitus. Malnutrition is demonstrated to be accompanying to several disease, yet there is a lack of evidence on the impact of malnutrition on cardiac functions in patients with diabetic patients with diabetic retinopathy. Herewith our primary goal was to evaluate the relation between any degree malnutrition with left atrial strain in relevant patient group. Patients and Methods: Patients with diabetes mellitus with retinopathy, who were referred to the outpatient cardiology clinic were assessed. Those who had sinus rhythm, had no findings of significant valvular heart disease and coronary artery disease underwent to 2-dimensional speckle tracking echocardiography and assessed for malnutrition in their prior examinations were included to the study. Hundred and seventy patients met the inclusion criteria. Malnutrition scores such as CONUT score, NRI, and PNI were used to evaluate nutrition condition of the patients. Results: Thirty percent of all diabetic patients were demonstrated to have malnutrition according to the CONUT score. Left atrial conduit strain was demonstrated to decrease [ß: -7.5 (CI 95%, -10.7, -4.3 p<0.001)], Left atrial reservoir strain was demonstrated to increase [ß: 2.48(CI 95%,0.83- 4.13 p<0.03)] and Left atrial contractile strain was demonstrated to decrease [ß: -4.21(CI 95%, -2.21, -6.01 p<0.001)] in the presence of any degree malnutrition. Conclusion: In this study we have demonstrated that malnutrition is an important entity in patients with diabetes mellitus and also has a significant impact on Left atrial strain.

scholarly journals Impact of comorbidities on clinical prognosis in 1280 patients with different types of COVID-19

2020 ◽  
Vol 69 (1) ◽  
pp. 75-85
Author(s):  
Huilin Fang ◽  
Qiaomei Liu ◽  
Maomao Xi ◽  
Di Xiong ◽  
Jing He ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Prolonged Treatment ◽  
Cure Rate ◽  
Clinical Prognosis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Different Types ◽  
Patients With Diabetes ◽  
Critical Patients ◽  
The Impact

The study aimed to compare the clinical characteristics and outcomes of patients with different types (ordinary, severe, and critical) of COVID-19. A total of 1280 patients diagnosed with COVID-19 were retrospectively studied, including 793 ordinary patients, 363 severe patients and 124 critical patients. The impact of comorbidities on prognosis in ordinary, severe, and critical patients were compared and analyzed. The most common comorbidities were hypertension (33.0%), followed by diabetes (14.4%). The length of hospital stay and time from the onset to discharge were significantly longer in ordinary patients with comorbidities compared with those without comorbidities. Critical patients with comorbidities had significantly lower cure rate (19.3% vs 38.9%, p<0.05) and significantly higher mortality rate (53.4% vs 33.3%, p<0.05) compared with those without comorbidities. The time from onset to discharge was significantly longer in ordinary patients with hypertension compared with those without hypertension. The mortality rate of critical patients with diabetes was higher than that of patients without diabetes (71.4% vs 42.7%, p<0.05). Men had a significantly increased risk of death than women (OR=4.395, 95% CI 1.896 to 10.185, p<0.05); patients with diabetes had higher risk of death (OR=3.542, 95% CI 1.167 to 10.750, p<0.05). Comorbidities prolonged treatment time in ordinary patients, increased the mortality rate and reduced the cure rate of critical patients; hypertension and diabetes may be important factors affecting the clinical course and prognosis of ordinary and critical patients, respectively.

scholarly journals Severe COVID-19 and Diabetes: A Retrospective Cohort Study from Three London Teaching Hospitals

2020 ◽  
Author(s):  
Chioma Izzi-Engbeaya ◽  
Walter Distaso ◽  
Anjali Amin ◽  
Wei Yang ◽  
Oluwagbemiga Idowu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
High Risk Patient ◽  
Male Gender ◽  
Adverse Outcomes ◽  
Clinical Frailty Scale ◽  
Risk Of Death ◽  
Antiplatelet Medication ◽  
Patients With Diabetes

Patients with diabetes mellitus admitted to hospital with COVID-19 caused by infection with the novel coronavirus (SARS-CoV-2) have poorer outcomes. However, the drivers for this are not fully elucidated. We performed a retrospective cohort study, including detailed pre-hospital and presenting clinical and biochemical factors of 889 patients diagnosed with COVID-19 in three constituent hospitals of a large London NHS Trust. 62% of patients with severe COVID-19 were of non-White ethnic backgrounds and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death or admission to the intensive care unit (ICU) within 30 days of diagnosis. Male gender, advancing age and the Clinical Frailty Scale, an established measure of multimorbidity, independently predicted poor outcomes on multivariate analysis. Diabetes did not confer an independent risk for adverse outcomes in COVID-19, although patients with diabetes and ischaemic heart disease were at particular risk. Additional risk factors which significantly and independently associated with poorer outcomes in patients with diabetes were age, male gender and lower platelet count. Antiplatelet medication was associated with a lower risk of death/ICU admission and should be evaluated in randomised clinical trials amongst high risk patient groups.

scholarly journals Effect and impact of mechanical ventilation in myotonic dystrophy type 1: a prospective cohort study

Thorax ◽  
2018 ◽  
Vol 73 (11) ◽  
pp. 1075-1078 ◽  
Author(s):  
Ghilas Boussaïd ◽  
Hélène Prigent ◽  
Pascal Laforet ◽  
Jean-Claude Raphaël ◽  
Djillali Annane ◽  
...  
Keyword(s):  
Myotonic Dystrophy ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Myotonic Dystrophy Type 1 ◽  
Myotonic Dystrophy Type ◽  
Invasive Ventilation ◽  
Risk Of Death ◽  
Home Ventilation ◽  
The Impact

Few studies have assessed the impact of home ventilation in patients with myotonic dystrophy type 1 (DM1) and no specific recommendations are available. We assessed the survival associated with category of home ventilation adherence of patients with DM1 followed up at a home ventilation unit using a Cox proportional hazards model. 218 patients were included; those who refused or delayed their acceptance of non-invasive ventilation were at higher risk for severe events (invasive ventilation or death) (P=0.03). Risk of death was associated with orthopnoea (HR 2.37; 95% CI 1.17 to 4.80; P<0.02) and adherence category (100 to 90% vs >75%: HR 3.26; 95% CI 1.32 to 8.04; P<0.03). Failure to use home ventilation as prescribed may be associated with increased mortality in patients with DM1.

Abstract 14982: Impact of Health Literacy on Long-Term Outcomes in Patients with Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Miyuki Tsuchihashi-Makaya ◽  
Shiho Matsuoka ◽  
Takahiro Kayane ◽  
Masako Koizumi ◽  
Michiyo Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Depressive Symptoms ◽  
Health Literacy ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
World Health ◽  
Risk Of Death ◽  
The Impact

Introduction: Health literacy (HL) is an important concept for patient education and disease management of heart failure (HF). It has been demonstrated that HL is associated with clinical outcomes including death and readmission. Although previous research on HL has predominantly focused on functional HL (the ability to “read and write”), the World Health Organization advocates evaluation of comprehensive HL, including the ability to access information (communicative HL) and critically evaluate information (critical HL). However, the impact of these three HL components on long-term adverse outcomes in patients with HF has never been fully investigated. Methods: We conducted a prospective observational study to examine the associations between HL level and risk of death or readmission in 234 patients (mean age, 67.8 years; male, 62%). HL, including subscales of functional, communicative, and critical HL, was assessed using the HF specific HL scale, which has been reported to be valid and reliable in patients with HF. Sociodemographic, clinical, and depressive symptoms were also assessed. Mortality and hospitalization data were obtained during a 2 year follow-up (median duration, 707 days). Results: Among all patients, 19.7% exhibited a low HL score. In each subscale, 19.7%, 23.1%, and 23.9% of patients exhibited low functional, low communicative, and low critical HL, respectively. Patients with low HL were older and living alone. In multivariate Cox regression, low critical HL was independently associated with higher readmission exacerbated HF after controlling for demographic and clinical characteristics, HF severity, depressive symptoms at baseline (unadjusted rate, 23.2% vs. 9.1%; adjusted hazard ratio, 3.89 [95% CI, 1.24–12.21]; P=0.02). However, there was no association between all types of HL and mortality, and between functional and communicative HL and readmission due to HF. Conclusions: Critical HL is an independent risk factor for HF readmission in patients with HF. To improve clinical outcomes in patients with HF, effective interventions should be developed to improve patient skills for critically analyzing information and making decisions.

scholarly journals Intensive Home Hemodialysis Results in Regression of Left Ventricular Hypertrophy and Better Clinical Outcomes

2016 ◽  
Vol 44 (4) ◽  
pp. 300-307 ◽  
Author(s):  
Emilie Trinh ◽  
Christopher T. Chan
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Clinical Outcomes ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Baseline Risk ◽  
Home Hemodialysis ◽  
Risk Of Death ◽  
End Point ◽  
The Impact ◽  
Intensive Hemodialysis

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for mortality and cardiovascular events in patients with end-stage renal disease. Studies have shown that frequent hemodialysis leads to LVH regression, but the impact of left ventricular mass (LVM) regression on clinical outcomes remains unknown. Methods: This observational cohort study assessed the impact of LVH regression on the composite outcome of time to all-cause mortality, technique failure or cardiovascular hospitalization in patients on home hemodialysis. LVH regression was defined as either a reduction of more than 10% in LVM in patients with LVH at baseline or prevention of LVH in those without LVH at baseline. Risk factors associated with progression of LVM were also examined. Results: We studied 144 intensive hemodialysis patients between 1999 and 2012 with a mean follow-up of 4.7 years. Eighty-seven patients (60.4%) had LVH regression or prevention and 57 patients (39.6%) had LVH progression. In a multivariate analysis, smoking (OR 2.78, 95% CI 1.06-7.36) and presence of LVH at baseline (OR 2.21, 95% CI 1.06-4.59) were significant predictors for LVM progression. Sixteen patients (18.4%) in the regressor group and 19 patients (33.3%) in the progressor group developed the composite end point. When adjusted for age and diabetes, regression was significantly associated with a decreased risk (hazards ratio (HR) 0.42, 95% CI 0.21-0.84) for the composite end point. Regression was also significantly associated with a decreased risk of death in the adjusted analysis (HR 0.20, 95% CI 0.06-0.67). Conclusions: Regression of LVH with intensive hemodialysis is associated with favorable clinical outcomes.

scholarly journals Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

2021 ◽  
Author(s):  
◽  
Mustafa Alsahab ◽  
Lucy Beishon ◽  
Bryony Brown ◽  
Elinor Burn ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Care Needs ◽  
Multi Centre Study ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ordinal Logistic Regression Analysis ◽  
The Impact

Abstract Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (&gt;80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

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