scholarly journals SARS CoV-2 Genomic Characteristics and Clinical Impact of SARS-CoV-2 Viral Diversity in Critically Ill COVID-19 Patients: A Prospective Multicenter Cohort Study

2022 ◽  
Author(s):  
Slim Fourati ◽  
Etienne Audureau ◽  
Romain Arrestier ◽  
Stéphane Marot ◽  
Claire Dubois ◽  
...  
Keyword(s):  
Cohort Study ◽  
Severe Disease ◽  
Supplemental Oxygen ◽  
Multicenter Cohort Study ◽  
Ventilator Support ◽  
Synonymous Mutations ◽  
Risk Of Mortality ◽  
Mutational Pattern ◽  
Paris Area ◽  
Observational Cohort

Abstract Background: SARS-CoV-2 variant of concern (VOC) α spread worldwide, including in France, at the beginning of 2021. This variant was suggested to be associated with a higher risk of mortality than other variants. Little information is available in the subset of patients with severe disease admitted in the intensive care unit (ICU). We aimed to characterize the genetic diversity of SARS-CoV-2 variants isolated from patients with severe COVID-19 in order to unravel the relationships between specific viral mutations/mutational patterns and clinical outcomes.Methods: Prospective multicentre observational cohort study. Patients aged ≥18 years admitted in 11 ICUs from Great Paris area hospitals between October 1, 2020, and May 30, 2021 (before the introduction of VOC δ (B.617.2) in France) for acute respiratory failure (SpO2≤90% and need for supplemental oxygen or ventilator support) were included. SARS-CoV-2 infection, determined by RT-PCR testing. The primary clinical endpoint was day-28 mortality. Full-length SARS-CoV-2 genomes were sequenced by means of next-generation sequencing (Illumina COVIDSeq).Results: 413 patients were included, 183 (44.3%) had been infected with pre-existing variants, 197 (47.7%) with variant α (B.1.1.7), and 33 (8.0%) with other variants. Patients infected with pre-existing variants were significantly older (64.9±11.9 vs 60.5±11.8 years; p=0.0005); they had significantly more frequent COPD (11.5% (n=21/183) vs 4.1% (n=8/197); p=0.009), and higher SOFA score (4 [3-8] vs 3 [2-4]; 0.0002). Day-28 mortality was not different between patients infected with pre-existing, α (B.1.1.7) or other variants (31.1% (n=57/183) vs 26.2% (n=51/197) vs 30.3% (n=10/33), respectively; p=0.550). There was no association between day-28 mortality with a specific variant or the presence of specific mutations in SARS CoV-2 genome, including 17 mutations selected in the spike protein and all 1017 non-synonymous mutations detected throughout the entire viral genome.Conclusions: At ICU admission, patients infected with pre-existing variants had a different clinical presentation from those infected with variant α (B.1.1.7) and other variants later in the course of the pandemic, but mortality did not differ between these groups. There was no association between a specific variant or SARS CoV-2 genome mutational pattern and day-28 mortality.

scholarly journals Oral Bacteriotherapy in Patients With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 7 ◽  
Author(s):  
Giancarlo Ceccarelli ◽  
Cristian Borrazzo ◽  
Claudia Pinacchio ◽  
Letizia Santinelli ◽  
Giuseppe Pietro Innocenti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intestinal Epithelial ◽  
Risk Of Mortality ◽  
Crude Mortality ◽  
Increased Risk ◽  
Observational Cohort ◽  
Prospective Trials ◽  
Independent Variable ◽  
Retrospective Observational Cohort Study ◽  
Length Of Hospitalization

Background: Mounting evidence suggests SARS-CoV-2 may impact on host microbiota and gut inflammation, infecting intestinal epithelial cells. This possible link and its implications can be investigated by observing the effects of modulation of the microbial flora in patients with COVID-19. The aim of this study was to compare the rate of mortality, the need of ICU hospitalization and the length of hospitalization in patients with severe COVID-19 pneumonia who received the best available therapy (BAT) vs. patients treated with BAT and supplemented with oral bacteriotherapy.Methods: This retrospective, observational cohort study included 200 adults with severe COVID-19 pneumonia. All patients received therapeutic regimens including low molecular weight heparin plus one or more between hydroxychloroquine, azithromycin, antivirals, and Tocilizumab. Oral bacteriotherapy was used as complementary treatment.Results: Out of the 200 patients, 112 received BAT without oral bacteriotherapy, and 88 BAT with oral bacteriotherapy. Crude mortality was 22%. Eleven percent died in the group of patients treated with BAT plus oral bacteriotherapy vs. 30% subjects in the group of patients managed only with BAT (p < 0.001). By multivariate analysis, the age >65 years, CRP >41.8 mg/L, Platelets <150.000 mmc, and cardiovascular events were associated with the increased risk of mortality. Oral bacteriotherapy was an independent variable associated with a reduced risk for death. Despite large prospective trials are needed, this study highlights a possible role for oral bacteriotherapy in the management of patients hospitalized for COVID-19 pneumonia.

scholarly journals Title: Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

2020 ◽  
Author(s):  
Jack W Goodall ◽  
Thomas A N Reed ◽  
Maddalena Ardissino ◽  
Paul Bassett ◽  
Ashley M Whittington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Severe Disease ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Reactive Protein ◽  
Global Pandemic ◽  
Northwick Park Hospital ◽  
Observational Cohort

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalized patients is critical as the pandemic progresses. This observational cohort study aimed to characterize the independent associations between the clinical outcomes of hospitalized patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, United Kingdom between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Score <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

scholarly journals Coronavirus Disease 2019 in Solid Organ Transplant: A Multicenter Cohort Study

2020 ◽  
Author(s):  
Olivia S Kates ◽  
Brandy M Haydel ◽  
Sander S Florman ◽  
Meenakshi M Rana ◽  
Zohra S Chaudhry ◽  
...  
Keyword(s):  
Cohort Study ◽  
Severe Disease ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Chest Imaging ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Abnormal Chest

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. Methods We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results Four hundred eighty-two SOT recipients from &gt;50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46–57), median time post-transplant was 5 years (IQR 2–10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age &gt;65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7–5.5, P &lt; .001], congestive heart failure [aOR 3.2, 95% CI 1.4–7.0, P = .004], chronic lung disease [aOR 2.5, 95% CI 1.2–5.2, P = .018], obesity [aOR 1.9, 95% CI 1.0–3.4, P = .039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1–3.5, P = .033], abnormal chest imaging [aOR 2.9, 95% CI 1.1–7.5, P = .027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.

scholarly journals Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

2020 ◽  
Vol 148 ◽  
Author(s):  
J. W. Goodall ◽  
T. A. N. Reed ◽  
M. Ardissino ◽  
P. Bassett ◽  
A. M. Whittington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Severe Disease ◽  
Cox Proportional Hazards ◽  
Reactive Protein ◽  
Global Pandemic ◽  
Northwick Park Hospital ◽  
Hospitalised Patients ◽  
Observational Cohort

Abstract COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalised patients is critical as the pandemic progresses. This observational cohort study aimed to characterise the independent associations between the clinical outcomes of hospitalised patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, UK between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Scale <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

Oseltamivir Resistance in Severe Influenza A(H1N1)pdm09 Pneumonia and Acute Respiratory Distress Syndrome: A French Multicenter Observational Cohort Study

2019 ◽  
Vol 71 (4) ◽  
pp. 1089-1091 ◽  
Author(s):  
Sylvie Behillil ◽  
Faten May ◽  
Slim Fourati ◽  
Charles-Edouard Luyt ◽  
Thomas Chicheportiche ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Influenza A ◽  
Distress Syndrome ◽  
Multicenter Cohort Study ◽  
Oseltamivir Resistance ◽  
Influenza A H1n1 ◽  
Observational Cohort

Abstract In a multicenter cohort study including 22 oseltamivir-treated patients with influenza A(H1N1)pdm09 acute respiratory distress syndrome, prevalence of the H275Y substitution in the neuraminidase, responsible for highly reduced sensitivity to oseltamivir, was 23%. Patients infected with the H275Y mutant virus had higher day 28 mortality than others (80% vs 12%; P = .011).

scholarly journals Readmission destination and risk of mortality after major surgery: an observational cohort study

The Lancet ◽  
2015 ◽  
Vol 386 (9996) ◽  
pp. 884-895 ◽  
Author(s):  
Benjamin S Brooke ◽  
Philip P Goodney ◽  
Larry W Kraiss ◽  
Daniel J Gottlieb ◽  
Matthew H Samore ◽  
...  
Keyword(s):  
Cohort Study ◽  
Observational Cohort Study ◽  
Major Surgery ◽  
Risk Of Mortality ◽  
Observational Cohort

scholarly journals Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1031
Author(s):  
Andrea Cona ◽  
Alessandro Tavelli ◽  
Andrea Renzelli ◽  
Benedetta Varisco ◽  
Francesca Bai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Bloodstream Infections ◽  
Corticosteroid Treatment ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Incidence Risk ◽  
Observational Cohort ◽  
Healthcare Associated ◽  
Hospital Acquired

With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI.

scholarly journals Laparoscopic Petersen’s Hernia Reduction Was Associated With A Better Clinical Course Than Open Reduction After Gastrectomy: A Multicenter Observational Cohort Study

2020 ◽  
Author(s):  
Jae-Seok Min ◽  
Kyung Won Seo ◽  
Sangho Jeong ◽  
Ki Hyun Kim ◽  
Ji-ho Park ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Course ◽  
Recovery Period ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Multicenter Cohort Study ◽  
Ph Reduction ◽  
Observational Cohort ◽  
Petersen’S Hernia

Abstract Background The aim of this multicenter cohort study was to compare the clinical courses between open and laparoscopic Petersen’s hernia (PH) reduction.Materials and method We retrospectively collected the clinical data of patients who underwent PH repair surgery after gastrectomy for gastric cancer from 2015-2018. Forty patients underwent PH reduction operations that were performed by six expert surgeons at four hospitals. Among the 40 patients, 15 underwent laparoscopic PH reduction (LPH), and 25 underwent open PH reduction (OPH), including 4 patients who underwent LPH but required conversion to OPH.Results We compared the clinical factors between the LPH and OPH groups. In the clinical course, we found no differences in operation times or intraoperative bowel injury, morbidity, or mortality rates between the two groups (p>0.05). However, the number of days on a soft fluid diet (OPH vs. LPH; 5.8 vs. 3.7 days, p=0.03) and length of hospital stay (12.6 vs. 8.2 days, p=0.04) were significantly less in the LPH group than the OPH group. Regarding postoperative complications, the OPH group had a case of pneumonia and sepsis with multi-organ failure, which resulted in mortality. In the LPH group, one patient experienced recurrence and required reoperation for PH.Conclusion Laparoscopic PH reduction was associated with a faster postoperative recovery period than open PH reduction, with a similar incidence of complications. The laparoscopic approach should be considered an appropriate strategy for PH reduction.

scholarly journals Prediction Models for the Clinical Severity of Patients With COVID-19 in Korea: Retrospective Multicenter Cohort Study (Preprint)

2020 ◽  
Author(s):  
Bumjo Oh ◽  
Suhyun Hwangbo ◽  
Taeyeong Jung ◽  
Kyungha Min ◽  
Chanhee Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Prediction Models ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Clinical Severity ◽  
Limited Information ◽  
Multicenter Cohort Study ◽  
Web Based ◽  
Multicenter Cohort

BACKGROUND Limited information is available about the present characteristics and dynamic clinical changes that occur in patients with COVID-19 during the early phase of the illness. OBJECTIVE This study aimed to develop and validate machine learning models based on clinical features to assess the risk of severe disease and triage for COVID-19 patients upon hospital admission. METHODS This retrospective multicenter cohort study included patients with COVID-19 who were released from quarantine until April 30, 2020, in Korea. A total of 5628 patients were included in the training and testing cohorts to train and validate the models that predict clinical severity and the duration of hospitalization, and the clinical severity score was defined at four levels: mild, moderate, severe, and critical. RESULTS Out of a total of 5601 patients, 4455 (79.5%), 330 (5.9%), 512 (9.1%), and 301 (5.4%) were included in the mild, moderate, severe, and critical levels, respectively. As risk factors for predicting critical patients, we selected older age, shortness of breath, a high white blood cell count, low hemoglobin levels, a low lymphocyte count, and a low platelet count. We developed 3 prediction models to classify clinical severity levels. For example, the prediction model with 6 variables yielded a predictive power of &gt;0.93 for the area under the receiver operating characteristic curve. We developed a web-based nomogram, using these models. CONCLUSIONS Our prediction models, along with the web-based nomogram, are expected to be useful for the assessment of the onset of severe and critical illness among patients with COVID-19 and triage patients upon hospital admission.

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