scholarly journals Predictive Value of MR-proADM in the Risk Stratification of COVID-19 Patients Assessed at the Triage of the Emergency Department

2021 ◽  
Author(s):  
Marilena Minieri ◽  
Vito N. Di Lecce ◽  
Maria Stella Lia ◽  
Massimo Maurici ◽  
Francesca Leonardis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Predictive Value ◽  
Invasive Mechanical Ventilation ◽  
Discriminative Performance ◽  
Cox Regression Analysis ◽  
Laboratory Biomarkers

Abstract Background In the last two pandemic years, the Emergency Departments (ED) have been overrun with COVID-19 suspicious patients, creating a pressing need to optimize resources through risk stratification for those patients. For this reason, the assessment of prognostic tools and biomarkers have been necessary. Some dataon the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullim (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage in order to help the emergency physician in the decision-making process. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients by predicting who could need intensive care and ventilation. Methods Data from 321 consecutive patients admitted to the triage of the emergency department with a COVID-19 infection were analyzed. Epidemiological, demographic, clinical, laboratory, and outcome data were assessed. C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), d-dimer and MR-proADM blood levels were also evaluated. Results All the biomarkers evaluated showed significant increased values at admission in the emergency department in non-survivorsvs survivors as well in ventilated as compared to non-ventilated patients. Moreover, all the biomarkers analyzed showed animportant role in predicting mortality, need of invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) in patients admitted at the emergency department with COVID-19 infection as analyzed by the univariate Cox regression analysis. Pooling together both clinical and laboratory variables in a multivariate analysis, all biomarkers, except for PCT, seem to play a significant role in the mortality risk stratification at admission in the emergency department. Similarly, an increase of MR-proADM level at ED admission resulted independently associated with a threefold times higher risk of IMV. LDH showed a smaller but still significant power. CRP only showed a significant predictive value for the need of NIMV. In patients COVID-19 positive, MR-proADM assessed at the admission in the triage showed a good discriminative performance both for in-hospital mortality (AUC 0,85) and for prediction of IMV (AUC 0,81), whereas it was less effective for NIMV prediction (AUC 0,71). ROC curves and AUC resulted significantly greater for MR-proADM as compared to other laboratory biomarkers for the primary endpoint, i.e. in-hospital mortality, with the exception of CRP. Conclusion This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the emergency department.

Impact of cancer on emergency department outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18618-e18618
Author(s):  
Alexander S. Qian ◽  
Edmund M. Qiao ◽  
Vinit Nalawade ◽  
Rohith S. Voora ◽  
Nikhil V. Kotha ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Inpatient Admission ◽  
Cancer Site ◽  
Patients With Cancer ◽  
Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

scholarly journals Association between the level of plasma B-type natriuretic peptide and in-hospital mortality in patients with acute exacerbation of COPD without a history of coronary ischemic heart disease: a retrospective study

2021 ◽  
Author(s):  
Jiyun Cui ◽  
Jie Liu ◽  
Jing Wang ◽  
Meng Lv ◽  
Chunyan Xing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Ischemic Heart Disease ◽  
Natriuretic Peptide ◽  
Invasive Mechanical Ventilation ◽  
Ischemic Heart ◽  
Composite Outcome ◽  
History Of ◽  
Secondary Outcomes

Abstract Background: Previous studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.Methods: In this retrospective cohort study, patients who were diagnosed with AECOPD using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9 codes) between January 2017 and December 2019. All data were obtained from electronic patient files and medical data intelligence platform of Jinan Central Hospital. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.Results: A total of 300 patients were included in this study. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.45 (95% CI, 1.20-1.75), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic <60 mmHg and age > 65 years), arterial partial pressure of O2(PaO2), the adjusted HRs of the primary and secondary outcomes were 3.65 (95% CI, 2.54-5.26) and 1.43 (95% CI, 1.14-1.97), respectively. The results of subgroup analysis by age, sex, and lung function were robust. This study was retrospective, so there was no clinical trial registration.Conclusions: The plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation.

scholarly journals Dynamic Changes of the Neutrophil-to-Lymphocyte Ratio, Systemic Inflammation Index, and Derived Neutrophil-to-Lymphocyte Ratio Independently Predict Invasive Mechanical Ventilation Need and Death in Critically Ill COVID-19 Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1656
Author(s):  
Emanuel Moisa ◽  
Dan Corneci ◽  
Silvius Negoita ◽  
Cristina Raluca Filimon ◽  
Andreea Serbu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Systemic Inflammation ◽  
Predictive Value ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Dynamic Changes ◽  
Hematological Indices ◽  
Lymphocyte Ratio

Background: Hematological indices can predict disease severity, progression, and death in patients with coronavirus disease-19 (COVID-19). Objectives: To study the predictive value of the dynamic changes (first 48 h after ICU admission) of the following ratios: neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), systemic inflammation index (SII), and derived neutrophil-to-lymphocyte (dNLR) for invasive mechanical ventilation (IMV) need and death in critically ill COVID-19 patients. Methods: Observational, retrospective, and multicentric analysis on 272 patients with severe or critical COVID-19 from two tertiary centers. Hematological indices were adjusted for confounders through multivariate analysis using Cox regression. Results: Patients comprised 186 males and 86 females with no difference across groups (p > 0.05). ΔNLR > 2 had the best independent predictive value for IMV need (HR = 5.05 (95% CI, 3.06–8.33, p < 0.0001)), followed by ΔSII > 340 (HR = 3.56, 95% CI 2.21–5.74, p < 0.0001) and ΔdNLR > 1 (HR = 2.61, 95% CI 1.7–4.01, p < 0.0001). Death was also best predicted by an NLR > 11 (HR = 2.25, 95% CI: 1.31–3.86, p = 0.003) followed by dNLR > 6.93 (HR = 1.89, 95% CI: 1.2–2.98, p = 0.005) and SII > 3700 (HR = 1.68, 95% CI: 1.13–2.49, p = 0.01). Conclusions: Dynamic changes of NLR, SII, and dNLR independently predict IMV need and death in critically ill COVID-19 patients.

Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Nayab Nadeem ◽  
Rehan Saeed ◽  
Donald Haas ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Odds Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI

Angiology ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Adnan Kaya ◽  
Muhammed Keskin ◽  
Mustafa Adem Tatlisu ◽  
Osman Kayapinar
Keyword(s):  
Regression Analysis ◽  
Ventricular Arrhythmia ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Ventricular Arrhythmias ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Normal Ranges ◽  
Long Term Mortality

We evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges.

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