scholarly journals Is Tocilizumab an effective therapy for Severe COVID-19: a retrospective cohort study

2020 ◽  
Author(s):  
Samreen Sarfaraz ◽  
Quratulain Shaikh ◽  
Sundus Iftikhar ◽  
Fivzia Farooq Herekar ◽  
Syed Ghazanfar Saleem ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Group Analysis ◽  
Length Of Hospital Stay ◽  
Median Length ◽  
X Ray ◽  
Chest X Ray ◽  
Baseline Characteristics ◽  
Critical Patients

Abstract ObjectivesTo compare the outcome of severe COVID-19 patients treated with Tocilizumab (TCZ). Methods: A retrospective cohort study comparing the clinical characteristics and outcomes of patients who received TCZ with those who did not, was conducted at The Indus Hospital, Karachi. A sub-group analysis was conducted on the TCZ group to identify predictors of mortality. Results 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p<0.05 and CRP 193 vs 133.9 mg/L, p<0.05. TCZ group showed severe bilateral chest x-ray findings (92% vs 31%, p<0.05) compared to non-TCZ. In the TCZ group 85.4% were admitted in ICU compared to 69.8% in non-TCZ group, p>0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stay, days of intubation, use of inotropic agents, use of invasive ventilation or in-hospital complications were not different between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p<0.05), ICU admission (100% vs 72%, p<0.05), need for mechanical ventilation (100% vs 13.6%, p<0.05) and higher incidence of in-hospital complications, p<0.05. ConclusionTCZ group had more critical patients and TCZ failed to demonstrate any mortality benefit in these patients. Non-survivors within the TCZ group were more critical compared to survivors and developed higher proportion of in hospital complications

scholarly journals The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Anneloes NJ Huijgens ◽  
Laurens J van Baardewijk ◽  
Carolina JPW Keijsers
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Lateral View ◽  
X Ray ◽  
Hospital Patients ◽  
Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

scholarly journals Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

CMAJ Open ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. E322-E329 ◽  
Author(s):  
Zachary Bouck ◽  
Graham Mecredy ◽  
Noah M. Ivers ◽  
Ciara Pendrith ◽  
Ben Fine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Low Risk ◽  
Health Examination ◽  
Periodic Health Examination ◽  
X Ray ◽  
Risk Patients ◽  
Chest X Ray

scholarly journals Incidence of Bloodstream Infections in Patients with COVID-19: A Retrospective Cohort Study of Risk Factors and Outcomes

2021 ◽  
Author(s):  
Claudia Villatoro Santos ◽  
Elisa Akagi Fukushima ◽  
Wei Zhao ◽  
Mamta Sharma ◽  
Dima Youssef ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Bloodstream Infections ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Male Sex

Abstract Objective: To describe the incidence, risk factors, and outcomes of bloodstream infections (BSIs) in patients with coronavirus disease 19 (COVID-19).Methods: This was a single-center retrospective cohort study of adults admitted for COVID-19 with BSIs. Data were collected by electronic medical record review. BSIs were defined as positive blood cultures (BCs) with a known pathogen in one or more BCs or the same commensal organism in two or more BCs. Results: Of 565 eligible patients, 290 (51.3%) had BCs done, with 39 (13.4%) having a positive result. In univariable analysis, male sex, black/African American race, admission from a facility, hemiplegia, altered mental status, and a higher Charlson Comorbidity Index were positively associated with a positive BC, whereas obesity and low systolic blood pressure (SBP) were negatively associated. Patients with positive BCs were more likely to have severe disease, be admitted to the Intensive Care Unit (ICU), require mechanical ventilation, have septic shock, and higher mortality. In multivariable logistic regression, factors that were independent predictors of a positive BC were male sex (OR=2.75, p=0.03), hypoalbuminemia (OR=3.3, p=0.01), ICU admission (OR=5.3, p<0.0001), SBP < 100 (OR=3.7, p=0.03) and having a procedure (OR=10.5, p<0.0001). Patients with an abnormal chest x-ray on admission were less likely to have a positive BC (OR=0.25, p=0.007). Conclusions: We found that independent predictors of BSIs in COVID-19 patients included male sex, abnormal chest x-ray, hypoalbuminemia, admission to ICU, low SBP, and having a procedure during hospital stay.

scholarly journals Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Emanuel Brunner ◽  
André Meichtry ◽  
Davy Vancampfort ◽  
Reinhard Imoberdorf ◽  
David Gisi ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Low Back Pain ◽  
Back Pain ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Negative Binomial ◽  
Length Of Hospital Stay ◽  
Binomial Model ◽  
Low Back

Abstract Background Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. Methods This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. Results We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). Conclusions Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

scholarly journals A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Kang Li ◽  
Chi Zhang ◽  
Ling Qin ◽  
Chaoran Zang ◽  
Ang Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Characteristic Curve ◽  
Length Of Hospital Stay ◽  
Cox Proportional Hazards ◽  
Brier Score ◽  
Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence   interval   CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

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