scholarly journals Factors Related to Survival in Intensive Care Unit Patients with Covid-19: A study from a Single Center in Brazil.

2021 ◽  
Author(s):  
Rodrigo Sardenberg ◽  
Gabriel Antonio Roberto ◽  
Catarina Marchon Silva ◽  
Andrea Santos Galvão ◽  
Daniela Jesus Meireles Ribeiro Pinho ◽  
...  
Keyword(s):  
Protective Factor ◽  
Univariate Analysis ◽  
Advanced Age ◽  
Chronic Obstructive ◽  
Original Research ◽  
Single Center ◽  
Obstructive Pulmonary Disease ◽  
Statistical Inferences ◽  
Nasal Catheter ◽  
High Fatality Rate

Abstract Introduction: The aim of this study is to the present an original research which describes the outcome in 268 ICU consecutive patients in a single center, as well analyzing the effects of viral infection on preexisting medical conditions such as hypertension, diabetes, obesity, chronic obstructive pulmonary disease, and how these factors affected survival and hospital stay.Material and methods: We retrospectively analyzed patients included in this study who were admitted to ICU between March 18th 2020 until August 30th 2020. All patients were analyzed under the same protocol at Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. Several factors were considered, such as: age, gender, symptoms before hospitalization, comorbidities, vasopressors use, radiological findings and use of high flow nasal catheter. The results were presented using the hazard ratio and its respective 95% confidence intervals. For statistical inferences, p <0.05 was adopted for all analysis.Results: The median age was 72 years, 64,2 years (53-74) for patients who were discharged, and 79.9 years (71.4-88.4) for those deceased (p<0.001). The most common comorbidities associated were: systemic arterial hypertension, diabetes, thyroid disease, cardiovascular and kidney disease. The univariate analysis showed the following factors as predictors of survival: myalgia (p=0.001), cerebrovascular disease (p=0.002), COPD (p=0.003), dementia (p=0.000), the need for mechanical ventilation (p=0.000), dialysis (0.000), vasopressors use (0.000), SAPS3 (0.000), lymphopenia (p=0.004), elevated D-dimer (P=0.011), time in ICU before tracheostomy (p=0.002), and performing a tracheostomy (p=0.000). The independent predictors of mortality were: advanced age (p=0.003); the non-use of vasopressor in the ICU was protective factor (p=0.001); tracheostomy performed in ICU was a mortality predictor (p=0.002).Discussion: COVID-19 affects more older adults and there is also a high fatality rate in this subset of patients. Acute respiratory distress syndrome (ARDS) is the primary cause of death in and around < 5% of patients were reported as experiencing bacterial/fungal coinfection at admission. Our findings support the observations of earlier studies, which found a high percentage of hospitalized patients of advanced age with preexisting conditions, hypertension being the most common.Conclusion: In our analysis, age, the need for vasopressors medications patients who underwent tracheostomy and underlying comorbidities, such as systemic coronary disease, heart failure, neoplasia, COPD, were found to be significantly associated with COVID-19 severity.

Appendicitis in Diabetics: Predictors of Complications and Their Incidence

2016 ◽  
Vol 82 (8) ◽  
pp. 753-758 ◽  
Author(s):  
Lindsay Bach ◽  
Andrew Donovan ◽  
Whitney Loggins ◽  
Stephanie Thompson ◽  
Bryan Richmond
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
General Surgeon ◽  
Management Approach ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cell Counts ◽  
Chi Squared

Appendicitis is the most common surgical emergency encountered by the general surgeon. Literature has demonstrated that diabetics may manifest atypical signs of infection, often clouding the diagnostic picture. We conducted a 3-year retrospective analysis of adults with appendicitis to determine differences in presentation, diagnosis, treatment, and outcomes for diabetic versus nondiabetic patients. Demographics, symptoms, imaging, procedure(s), complications, and length of stay (LOS) were obtained via chart review. Factors were compared between patients with and without diabetes using chi-squared test, t test, or Mann-Whitney U test (significance at P ≤ 0.05). Multivariate regression analysis identified variables predicting longer LOS or perforation at diagnosis. Overall, 339 patients met inclusion criteria [303 were nondiabetic (ND), 36 were diabetic (D)]. On univariate analysis, diabetics were more likely to have other comorbid illnesses: obesity ( P < 0.001), chronic kidney disease ( P = 0.003), hypertension ( P < 0.001), coronary artery disease ( P < 0.001), peripheral vascular disease (PVD, P = 0.31), and chronic obstructive pulmonary disease ( P = 0.002). Diabetics presented with lower white blood cell counts (mean 14.2 ND, 11.9 D, P = 0.02), and were more likely to present with perforation (18.5% ND, 38.9% D, P = 0.008). LOS was longer in diabetics (1.0 day for ND, 3.0 day for D, P < 0.001). Complications were more frequent in diabetics (19.4% D vs 8.6% ND), which trended toward but failed to reach significance ( P = 0.066). On multivariate analysis, however, old age was the only characteristic associated with perforation [odds ratio: 1.05 (1.02–1.06), P < 0.001], whereas diabetes, chronic obstructive pulmonary disease, and older age predicted longer LOS ( P ≤ 0.001). Diabetics present a more complicated clinical picture having significantly more comorbidities and a trend toward postoperative complications necessitating a higher index of suspicion to detection complications. Further study is needed to evaluate the optimal diagnostic and management approach in this challenging population.

Social class based on occupation is associated with hospitalization for A(H1N1)pdm09 infection. Comparison between hospitalized and ambulatory cases

2015 ◽  
Vol 144 (4) ◽  
pp. 732-740 ◽  
Author(s):  
J. PUJOL ◽  
P. GODOY ◽  
N. SOLDEVILA ◽  
J. CASTILLA ◽  
F. GONZÁLEZ-CANDELAS ◽  
...  
Keyword(s):  
Social Class ◽  
Influenza Vaccination ◽  
Protective Factor ◽  
Conditional Logistic Regression ◽  
Corticosteroid Treatment ◽  
Chronic Obstructive ◽  
Occupational Class ◽  
Obstructive Pulmonary Disease ◽  
Conditional Logistic Regression Analysis ◽  
Occupational Social Class

SUMMARYThis study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009–2010 and 2010–2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74–1·27], but an association (aOR 1·53, 95% CI 1·01–2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23–0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza.

scholarly journals Physical, Psychological, and Social Factors Associated with Exacerbation-Related Hospitalization in Patients with COPD

2020 ◽  
Vol 9 (3) ◽  
pp. 636
Author(s):  
Mieke R.C. Crutsen ◽  
Spencer J. Keene ◽  
Daisy J.A. Janssen Nienke Nakken ◽  
Miriam T. Groenen ◽  
Sander M.J. van Kuijk ◽  
...  
Keyword(s):  
Goodness Of Fit ◽  
Univariate Analysis ◽  
Gain Control ◽  
Chronic Obstructive ◽  
Goodness Of Fit Test ◽  
Timed Up And Go ◽  
Obstructive Pulmonary Disease ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

Background and objective: Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. Methods: Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. Results: During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD%correct)) (<60% (OR = 1.00); 60%–75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. Conclusion: A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD%correct allows clinicians to predict the probability of an eCOPD-related hospitalization.

scholarly journals The Impact of COPD in Trends of Urinary Tract Infection Hospitalizations in Spain, 2001–2018: A Population-Based Study Using Administrative Data

2020 ◽  
Vol 9 (12) ◽  
pp. 3979
Author(s):  
Javier de Miguel-Diez ◽  
Romana Albaladejo-Vicente ◽  
Domingo Palacios-Ceña ◽  
David Carabantes-Alarcon ◽  
José Javier Zamorano-Leon ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
Population Based ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Tract Infections ◽  
The Impact ◽  
Over Time

(1) Background: To examine trends in incidence and outcomes of urinary tract infections (UTIs) among men and women with or without chronic obstructive pulmonary disease (COPD), and to identify the predictors for in-hospital mortality (IHM). (2) Methods: We included patients (aged ≥40 years) who were hospitalized with UTIs between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 748,458 UTI hospitalizations, 6.53% with COPD. The UTIs incidence increased over time. It was 1.55 times higher among men COPD patients than among non-COPD men (incidence rate ratio (IRR) 1.55; 95% CI 1.53–1.56). The opposite happened in women with COPD compared to non-COPD women (IRR 0.30; 95% CI 0.28–0.32). IHM was higher in men with COPD than non-COPD men (5.58% vs. 4.47%; p < 0.001) and the same happened in women (5.62% vs. 4.92%; p < 0.001). The risk of dying increased with age and comorbidity, but the urinary catheter was a protective factor among men (OR 0.75; 95% CI 0.64–0.89). Multivariable analysis showed a significant reduction in the IHM over time for men and women with COPD. Suffering from COPD only increased the risk of IHM among men (OR 1.07; 95% CI 1.01–1.13). (4) Conclusions: The incidence of UTIs increased over time. Suffering COPD increased the risk of IHM among men, but not among women.

scholarly journals Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

2020 ◽  
Vol 7 (1) ◽  
pp. e000535
Author(s):  
Yuanyuan Wang ◽  
Jens H Bos ◽  
H Marike Boezen ◽  
Jan-Willem C Alffenaar ◽  
J F M van Boven ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Treatment Failure ◽  
Pulmonary Disease ◽  
Reference Group ◽  
Advanced Age ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
Oral Corticosteroids

IntroductionAlthough bacteria contribute significantly to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), the added value of antibiotics remains controversial, especially in outpatient settings. Age may affect antibiotic effectiveness, but real-world evidence is lacking. We aimed to assess the influence of age on the effectiveness of doxycycline for AECOPD.MethodsA retrospective cohort study among outpatients with the first recorded AECOPD treated with oral corticosteroids was conducted using a large pharmacy dispensing database. The primary outcome was treatment failure within 15–31 days after treatment start. Secondary outcome was time to second exacerbation. All analyses were stratified by age groups.ResultsWe identified 6300 outpatients with the first AECOPD. 2261 (36%) received doxycycline and 4039 (64%) did not receive any antibiotic (reference group). Overall, there was no difference in treatment failure (adjusted OR: 0.97, 95% CI: 0.84 to 1.12) between two groups. Similarly, no difference in treatment failure was observed in younger groups. However, in patients with advanced age (≥75 years), treatment failure was significantly reduced by doxycycline compared with reference (16% vs 20%, adjusted OR: 0.77, 95% CI: 0.62 to 0.97). Overall, median time to second exacerbation was 169 days (95% CI: 158 to 182 days) in doxycycline group compared with 180 days (95% CI: 169 to 191 days) in reference group (adjusted HR: 1.06, 95% CI: 0.99 to 1.12). Although in older patients there was a trend within 3 months towards longer time of next exacerbation by doxycycline, it did not achieve statistical significance.ConclusionsOur findings showed short-term treatment benefit of doxycycline added to oral corticosteroids for chronic obstructive pulmonary disease patients with advanced age. This value remains unclear for persons aged under 75 years in current primary care. Long-term preventive benefits of doxycycline for the next exacerbation were not observed, irrespective of age.

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