scholarly journals Risk Factors Associated with Disease Severity and Clinical Outcomes for COVID-19 in Wuhan, China

2021 ◽  
Author(s):  
Yun Liu ◽  
Hao Wu ◽  
Bei Zhu ◽  
Yi Yang ◽  
Peng Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Severe Disease ◽  
Adverse Outcomes ◽  
Regression Methods ◽  
Risk Of Death ◽  
Severe Group ◽  
Hospital Deaths ◽  
New Type ◽  
Severity Of The Disease

Abstract Background: A new type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China. However, the risk factors and characteristics related to the severity of the disease and its outcomes need to be further explored.Methods: In this retrospective study, we evaluated COVID-19 patients with severe disease and those who were critically ill, as diagnosed at Jinyintan Hospital (Wuhan, China). The demographic information, clinical characteristics, complications, and laboratory results for the patients were evaluated. Multivariate logistic regression methods were used to analyze risk factors related to hospital deaths.Results: The 235 COVID-19 patients included were divided into a severe group of 183 (78%) and a critical group of 52 (22%). Of these patients, 185 (79%) were discharged, and 50 (21%) died during hospitalization. In multivariate logistic analyses, age (OR=1.07, 95% CI 1.02-1.14, P=0.009), critical disease (OR=48.23, 95% CI 10.91-323.13, P<0.001), low lymphocyte counts (OR=15.48, 95% CI 1.98-176.49, P=0.015), elevated interleukin 6 (IL-6) (OR=9.11, 95% CI 1.69-67.75, P=0.017), and elevated aspartate aminotransferase (AST) (OR=8.46, 95% CI 2.16-42.60, P=0.004) were independent risk factors for adverse outcomes.Conclusions: The results show that advanced age (> 64 years), critical illness, low lymphocyte levels, and elevated IL-6 and AST were factors for the risk of death for COVID-19 patients who had severe disease and those who were critically ill.

scholarly journals Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

2015 ◽  
Vol 12 (2) ◽  
pp. 117-120
Author(s):  
P Thapa ◽  
PK Chakraborty ◽  
JB Khattri ◽  
K Ramesh ◽  
P Sharma
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Significant Proportion ◽  
Adverse Outcomes ◽  
Tube Placement ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting.Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients.Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal.Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877).Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients.Kathmandu University Medical Journal Vol.12(2) 2014: 117-120

The Frequency and Clinical Significance of Thrombocytopenia Complicating Critical Illness: A Systematic Review

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4664-4664
Author(s):  
Philip LY Hui ◽  
Deborah J Cook ◽  
Wendy Lim ◽  
Graeme Fraser ◽  
Donald M. Arnold
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Conflicts Of Interest ◽  
Risk Of Death ◽  
Incidence Risk ◽  
Computer Library ◽  
Poor Outcomes

Abstract Abstract 4664 Background: The epidemiology of thrombocytopenia in critically ill patients has not been well characterized. The objective of this study was to systematically review the prevalence, incidence, risk factors for, and consequences of thrombocytopenia among critically ill patients. Methods: We searched MEDLINE, EMBASE, the Cochrane Registry for controlled trials (until May 2010), and the Online Computer Library as well as bibliographies of relevant studies to identify investigations designed to examine the frequency, risk factors and/or outcomes associated with thrombocytopenia among patients admitted to the intensive care unit (ICU). We selected studies, abstracted data and assessed methodological quality in duplicate, independently. Heterogeneity of design and analysis precluded statistical pooling of results. Results: We identified 23 studies (12 prospective) enrolling 6,568 patients from medical, surgical, mixed, cardiac or trauma ICUs. Prevalent thrombocytopenia (on ICU admission) occurred in 8.3 – 67.6% of patients; incident thrombocytopenia (developing during the course of the ICU stay) occurred in 13.0 – 44.1% patients. High illness severity, organ dysfunction, sepsis and renal failure were common risk factors. Only 1 study using multivariate analysis examined whether thrombocytopenia was associated with major bleeding but found no association. Six out of 8 studies using multivariate analysis found that thrombocytopenia increased the risk of death. Conclusion: The frequency of thrombocytopenia during critical illness varies widely based on case mix and definition. Thrombocytopenia appears to increase the risk of death after adjustment for confounding factors. The association between thrombocytopenia and bleeding in the ICU has not been adequately examined. Although thrombocytopenia was associated with poor outcomes in most studies, randomized trials of platelet transfusions or other interventions aimed at increasing the platelet count are needed to determine whether improvement of thrombocytopenia can modify these risks. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Development and validation of a prognostic model for COVID-19: a population-based cohort study in Iceland

2021 ◽  
Author(s):  
Elias Eythorsson ◽  
Valgerdur Bjarnadottir ◽  
Hrafnhildur Linnet Runolfsdottir ◽  
Dadi Helgason ◽  
Ragnar Freyr Ingvarsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Model ◽  
Outpatient Visit ◽  
Severe Disease ◽  
Population Based ◽  
Adverse Outcomes ◽  
Clinical Severity ◽  
Ordinal Scale ◽  
Chronic Obstructive ◽  
C Statistic

Background: The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 at the time of diagnosis and determine risk factors for severe disease. Methods: All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview with those diagnosed before May 1, 2020 and validated in those diagnosed between May 1 and December 31, 2020. Outcomes were defined on an ordinal scale; no need for escalation of care during follow-up, need for outpatient visit, hospitalization, and admission to intensive care unit (ICU) or death. Risk factors were summarized as odds ratios (OR) adjusted for confounders identified by a directed acyclic graph. Results: The prognostic model was derived from and validated in 1,625 and 3,131 individuals, respectively. In total, 375 (7.9%) only required outpatient visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. Discrimination and calibration were excellent for outpatient visit or worse (C-statistic 0.75, calibration intercept 0.04 and slope 0.93) and hospitalization or worse (C-statistic 0.81, calibration intercept 0.16 and slope 1.03). Age was the strongest risk factor for adverse outcomes with OR of 75- compared to 45- year-olds, ranging from 5.29-17.3. Higher BMI consistently increased the risk and chronic obstructive pulmonary disease and chronic kidney disease correlated with worse outcomes. Conclusion: Our prognostic model can accurately predict the outcome of SARS-CoV-2 infection using information that is available at the time of diagnosis.

scholarly journals COVID-19 severity: Studying the clinical and demographic risk factors for adverse outcomes

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255999
Author(s):  
Naila Shoaib ◽  
Naila Noureen ◽  
Rimsha Munir ◽  
Farhad Ali Shah ◽  
Noshaba Ishtiaq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Strong Association ◽  
Adverse Outcomes ◽  
Vulnerable Groups ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Severity Of The Disease ◽  
Demographic Risk ◽  
Demographic Risk Factors

Background The primary goal of the presented cross-sectional observational study was to determine the clinical and demographic risk factors for adverse coronavirus disease 2019 (COVID-19) outcomes in the Pakistani population. Methods We examined the individuals (n = 6331) that consulted two private diagnostic centers in Lahore, Pakistan, for COVID-19 testing between May 1, 2020, and November 30, 2020. The attending nurse collected clinical and demographic information. A confirmed case of COVID-19 was defined as having a positive result through real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. Results RT-PCR testing was positive in 1094 cases. Out of which, 5.2% had severe, and 20.8% had mild symptoms. We observed a strong association of COVID-19 severity with the number and type of comorbidities. The severity of the disease intensified as the number of comorbidities increased. The most vulnerable groups for the poor outcome are patients with diabetes and hypertension. Increasing age was also associated with PCR positivity and the severity of the disease. Conclusions Most cases of COVID-19 included in this study developed mild symptoms or were asymptomatic. Risk factors for adverse outcomes included older age and the simultaneous presence of comorbidities.

scholarly journals Clinical characteristics of COVID-19 patients in Latvia under low incidence in Spring 2020

2020 ◽  
Author(s):  
Ludmila Viksna ◽  
Oksana Kolesova ◽  
Aleksandrs Kolesovs ◽  
Ieva Vanaga ◽  
Seda Arutjunana ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Troponin T ◽  
Severe Disease ◽  
University Hospital ◽  
Disease Course ◽  
Blood Tests ◽  
Prothrombin Index ◽  
Severe Group ◽  
Low Incidence ◽  
Severity Of The Disease

ABSTRACTBackgroundCOVID-19 is a new infectious disease with severe disease course and high mortality in some groups. Blood tests on admission to the hospital can be useful for stratification of patients and timely correction. Our study investigated the clinical features of COVID-19 patients in Latvia and differences in blood tests in groups with different disease severity.MethodsThe retrospective study included 100 patients hospitalized in Riga East Clinical University Hospital in Spring 2020. The severity of the disease course was classified by the presence of pneumonia and its combination with respiratory failure. We have assessed blood cells’ count, hemoglobin, hematocrit, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alanine aminotransferase, lactate dehydrogenase (LDH), troponin T, electrolytes, creatinine, glomerular filtration rate (GFR), D-dimer, prothrombin time, prothrombin index, oxygen saturation, and temperature on admission to the hospital.ResultsPatients were from 18 to 99 (57±18 years, 57% males). Comorbidities were found in 74% of patients. The mild, moderate, and severe groups included 35, 44, and 16 patients, respectively. In the severe group, the mortality rate was 50%. The progression to severe COVID-19 was associated positively with temperature, ESR, CRP, creatinine, LDH, and troponin T and negatively associated with oxygen saturation, eosinophils, and GFR on admission to the hospital.ConclusionsCOVID-19 severity associates with lower renal function and a higher level of inflammation and tissue damage. Eosinophils, CRP, ESR, LDH, troponin T, creatinine, and GFR are blood indicators for monitoring patients’ condition.

scholarly journals Sepsis-associated Encephalopathy In ICU Admissions: Prevalence, Early Risk of Death, and its Early Prevent and Control

2020 ◽  
Author(s):  
Dao-Ming Tong ◽  
Shao-Dan Wang ◽  
Yuan-Wei Wang ◽  
Ying Wang ◽  
Yuan-Yuan Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Cox Regression ◽  
Abdominal Cavity ◽  
Early Prevention ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Early Risk ◽  
Early Risk Factors ◽  
And Control

Abstract Background: Sepsis-associated encephalopathy (SAE) is a common encephalopathy in ICU. We are to definite whether SAE present an high prevalence rate and early risk factors for death in ICU 48 hours, while to cognize its important of early prevention/ control.Methods: We retrospectively enrolled patients with acute critically ill from ICU (January, 2015 to January, 2017). All patients were selected from onset to ICU ≤3 hours. The prevalence and some early risk factors of death in SAE was estimated by using a continuous head and thorax /abdominal cavity CT scans. Results: 748 critically ill adults were analyzed. The prevalence of sepsis within initial 48 hours was 40.4% (302/748). The median time from infection to sepsis was 9 hours ( range, 1-48 ). The SAE (93.4%, 282/302) was diagnosed in sepsis patients, and most of them (96.8%) presented multiple organ dysfunction syndromes (MODS). While the fatality of SAE was in 32.0% at initial 48 hours and 69.1% at initial 14 days. Cox regression analysis, unused antibiotic within initial 3 hours (OR, 0.39; 95% CI, 0.22-0.89), severe inflammatory storm (OR, 0.70; 95% CI, 0.58- 0.94), lower GCS (OR, 2.7; 95% CI, 1.5-3.6), and MODS (OR, 0.37; 95% CI, 0.26-0.96) were early risk factors for death in SAE. Early risk factors for predicting SAE were related to severe inflammatory storm (OR, 3.10; 95% CI, 2.28-4.33), MODS (OR, 3.57; 95% CI, 2.73- 4.67), and unused antibiotics within initial 3 hours (OR, 0.25; 95% CI, 0.11-0.56).Conclusions: SAE in ICU is an high prevalent acute brain dysfunction and most with MODS. The early bad prognosis in SAE was related to the failure of early prevention and control.

Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection

2015 ◽  
Vol 36 (10) ◽  
pp. 1183-1189 ◽  
Author(s):  
Neika Vendetti ◽  
Theoklis Zaoutis ◽  
Susan E. Coffin ◽  
Julia Shaklee Sammons
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Severe Disease ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Median Number ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Death ◽  
Increased Risk

OBJECTIVEThe incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.METHODSA multicenter cohort of children with CDI, aged 1–18 years, was established among children hospitalized at 41 freestanding children’s hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.RESULTSWe identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2–13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7–20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40–3.77)], underlying malignancy [3.57 (2.36–5.40)], cardiovascular disease [2.06 (1.28–3.30)], hematologic/immunologic condition [1.89 (1.05–3.39)], gastric acid suppression [2.70 (1.43–5.08)], and presence of >1 severity of illness marker [3.88 (2.44–6.19)].CONCLUSIONPatients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.Infect Control Hosp Epidemiol 2015;36(10):1183–1189

scholarly journals Risk factors for mortality in hospitalized patients with COVID-19 at the start of the pandemic in Belgium: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Karlijn van Halem ◽  
Robin Bruyndonckx ◽  
Jeroen van der Hilst ◽  
Janneke Cox ◽  
Paulien Driesen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Case Fatality Rate ◽  
Clinical Characteristics ◽  
Severe Disease ◽  
Univariate Analysis ◽  
Case Fatality ◽  
Fatality Rate ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Belgium was among the first countries in Europe with confirmed coronavirus disease 2019 (COVID-19) cases. Since the first diagnosis on February 3rd, the epidemic has quickly evolved, with Belgium at the crossroads of Europe, being one of the hardest hit countries. Although risk factors for severe disease in COVID-19 patients have been described in Chinese and United States (US) cohorts, good quality studies reporting on clinical characteristics, risk factors and outcome of European COVID-19 patients are still scarce. Methods This study describes the clinical characteristics, complications and outcomes of 319 hospitalized COVID-19 patients, admitted to a tertiary care center at the start of the pandemic in Belgium, and aims to identify the main risk factors for in-hospital mortality in a European context using univariate and multivariate logistic regression analysis. Results Most patients were male (60%), the median age was 74 (IQR 61–83) and 20% of patients were admitted to the intensive care unit, of whom 63% needed invasive mechanical ventilation. The overall case fatality rate was 25%. The best predictors of in-hospital mortality in multivariate analysis were older age, and renal insufficiency, higher lactate dehydrogenase and thrombocytopenia. Patients admitted early in the epidemic had a higher mortality compared to patients admitted later in the epidemic. In univariate analysis, patients with obesity did have an overall increased risk of death, while overweight on the other hand showed a trend towards lower mortality. Conclusions Most patients hospitalized with COVID-19 during the first weeks of the epidemic in Belgium were admitted with severe disease and the overall case fatality rate was high. The identified risk factors for mortality are not easily amenable at short term, underscoring the lasting need of effective therapeutic and preventative measures.

scholarly journals Clinical features and outcomes of COVID-19 among people living with HIV in the United States: A multicenter study from a large global health research network (TriNetX)

2021 ◽  
Author(s):  
George A Yendewa ◽  
Jaime Abraham Perez ◽  
Kayla Schlick ◽  
Heather Tribout ◽  
Grace A McComsey
Keyword(s):  
Mechanical Ventilation ◽  
African American ◽  
Severe Disease ◽  
The United States ◽  
Adverse Outcomes ◽  
Older Age ◽  
Cd4 Count ◽  
Research Network ◽  
People Living With Hiv ◽  
Risk Of Death

Abstract Background HIV infection is a presumed risk factor for severe COVID-19, yet little is known about COVID-19 outcomes in people with HIV (PLW). Methods We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV negative controls aged ≥ 18 years who sought care in 44 healthcare centers in the US from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care (ICU) and ICU admissions), mechanical ventilation, severe disease (ICU admission or death) and 30-day mortality. Results Of 297,194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with &gt; 83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the two groups (2.9% vs 2.3%; p=0.123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, p&lt;0.001), ICU admissions (4.2% vs 2.3%, p&lt;0.001) and mechanical ventilation (2.4% vs 1.6%, p&lt;0.005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use and low CD4 count; whereas severe disease was predicted by older age [adjusted odds ratio (aOR) 8.33, 95% confidence interval (CI) (1.06, 50.00); p=0.044] and CD4 &lt;200 cells/mm 3 [aOR, 8.33, 95% CI (1.06, 50.00); p=0.044]. Conclusion PWH had higher rates of poor COVID-19 outcomes but were not more at risk of death than non-HIV infected counterparts. Older age and low CD4 count predicted adverse outcomes.

scholarly journals Specific Risk Factors for Fatal Outcome in Critically Ill COVID-19 Patients: Results from a European Multicenter Study

2021 ◽  
Vol 10 (17) ◽  
pp. 3855
Author(s):  
David Meintrup ◽  
Stefan Borgmann ◽  
Karlheinz Seidl ◽  
Melanie Stecher ◽  
Carolin E. M. Jakob ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Graphical Representation ◽  
Fatal Outcome ◽  
Statin Treatment ◽  
Lasso Regression ◽  
Data Set ◽  
Risk Of Death ◽  
Specific Risk ◽  
European Multicenter Study

(1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable selection, a multifactorial logistic regression model was fitted to the response variable survival. Specific risk factors and their odds ratios were derived. A nomogram was developed as a graphical representation of the model. (3) Results: 14 variables were identified as independent factors contributing to the risk of death for critically ill COVID-19 patients: age (OR 1.08, CI 1.06–1.10), cardiovascular disease (OR 1.64, CI 1.06–2.55), pulmonary disease (OR 1.87, CI 1.16–3.03), baseline Statin treatment (0.54, CI 0.33–0.87), oxygen saturation (unit = 1%, OR 0.94, CI 0.92–0.96), leukocytes (unit 1000/μL, OR 1.04, CI 1.01–1.07), lymphocytes (unit 100/μL, OR 0.96, CI 0.94–0.99), platelets (unit 100,000/μL, OR 0.70, CI 0.62–0.80), procalcitonin (unit ng/mL, OR 1.11, CI 1.05–1.18), kidney failure (OR 1.68, CI 1.05–2.70), congestive heart failure (OR 2.62, CI 1.11–6.21), severe liver failure (OR 4.93, CI 1.94–12.52), and a quick SOFA score of 3 (OR 1.78, CI 1.14–2.78). The nomogram graphically displays the importance of these 14 factors for mortality. (4) Conclusions: There are risk factors that are specific to the subpopulation of critically ill COVID-19 patients.

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