scholarly journals Characterization of Confirmed and Suspected COVID-19 Pneumonia Patients in a Retrospective Cohort Study in Wuhan

2020 ◽  
Author(s):  
Maomao Xi ◽  
Dan Cui ◽  
Qiaomei Liu ◽  
Lili Li ◽  
Yilin Yin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Disease ◽  
Mortality Risk ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Ground Glass Opacity ◽  
Ground Glass ◽  
Medical Attention ◽  
Cox Regression Analysis

Abstract Background: A methodical comparison of confirmed and suspected COVID-19 patients has not been previously reported. Therefore, we thoroughly analyzed the demographic and clinical characteristics between these groups to identify mortality risk factors.Methods: A retrospective cohort of 1,276 hospitalized COVID-19 pneumonia patients at Tongren Hospital (Wuhan, China; January 27 to March 3, 2020) was studied. Cox regression analyses were performed to evaluate multiple mortality risk factors. Results: Both cohorts of confirmed (n=797) and suspected (n=479) patients exhibited typical demographic, clinical, and radiological characteristics. Treatment methods were consistent and both groups shared similarities in many demographic and clinical characteristics: age (≥65, 45.9% vs 41.8%, P=0.378) and lung disease (12.5% vs 14.6%, P=0.293). However, confirmed patients exhibited more severe disease manifestations than those in suspected patients: a higher incidence of fever (65.4% vs 58.0%, P<0.01), lower lymphocyte count (1.12×109/L vs 1.22×109/L, P=0.022), higher C-reactive protein (CRP) (11.60 mg/L vs 7.61mg/L, P=0.021), and more severe radiographic manifestations (lung infection incidence, 3.8% vs 3.0%, P=0.014; ground-glass opacity lesion incidence, 2.3% vs 2.0%, P=0.033). The dynamic profiles of lymphocytes, monocytes, D-dimer, and CRP, clearly delineated confirmed patients from suspected patients exhibiting critical illness. Cox regression analysis demonstrated that lung disease (adjusted hazard ratio 8.972, 95% CI: 3.782-21.283), cardiovascular disease (3.083, 1.347-7.059), neutrophil count (1.189, 1.081-1.307), age (1.068, 1.027-1.110), and ground-glass opacity lesions (1.039, 95% 1.013-1.065), were the main risk factors for mortality in confirmed patients; lung disease (14.725, 2.187-99.147), age (1.076, 1.004-1.153), and CRP level (1.012, 95% CI 1.004-1.020) were the primary factors in suspected patients.Conclusions: Suspected patients with serious illness should seek medical attention to reduce mortality. Multiple factors must be assessed to determine the mortality risk and the appropriate treatment.

scholarly journals Risk of pneumothorax in pneumoconiosis patients in Taiwan: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e054098
Author(s):  
Jo-Hui Pan ◽  
Chih-Hung Cheng ◽  
Chao-Ling Wang ◽  
Chia-Yen Dai ◽  
Chau-Chyun Sheu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Cumulative Incidence ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Secondary Outcome ◽  
Matched Cohort ◽  
Cox Regression Analysis ◽  
Control Subjects

ObjectivesThis study was conducted to explore the association between pneumoconiosis and pneumothorax.DesignRetrospective cohort study.SettingNationwide population-based study using the Taiwan National Health Insurance Database.ParticipantsA total of 2333 pneumoconiosis patients were identified (1935 patients for propensity score (PS)-matched cohort) and matched to 23 330 control subjects by age and sex (7740 subjects for PS-matched cohort).Primary and secondary outcome measuresThe incidence and the cumulative incidence of pneumothorax.ResultsBoth incidence and the cumulative incidence of pneumothorax were significantly higher in the pneumoconiosis patients as compared with the control subjects (p<0.0001). For multivariable Cox regression analysis adjusted for age, sex, residency, income level and other comorbidities, patients with pneumoconiosis exhibited a significantly higher risk of pneumothorax than those without pneumoconiosis (HR 3.05, 95% CI 2.18 to 4.28, p<0.0001). The male sex, heart disease, peripheral vascular disease, chronic pulmonary disease and connective tissue disease were risk factors for developing pneumothorax in pneumoconiosis patients.ConclusionsOur study revealed a higher risk of pneumothorax in pneumoconiosis patients and suggested potential risk factors in these patients. Clinicians should be aware about the risk of pneumothorax in pneumoconiosis patients.

scholarly journals Serial CT analysis in idiopathic pulmonary fibrosis: comparison of visual features that determine patient outcome

Thorax ◽  
2020 ◽  
Vol 75 (8) ◽  
pp. 648-654 ◽  
Author(s):  
Joseph Jacob ◽  
Leon Aksman ◽  
Nesrin Mogulkoc ◽  
Alex J Procter ◽  
Bahareh Gholipour ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Clinical Importance ◽  
Ground Glass Opacity ◽  
Mortality Prediction ◽  
Ground Glass ◽  
Traction Bronchiectasis

AimsPatients with idiopathic pulmonary fibrosis (IPF) receiving antifibrotic medication and patients with non-IPF fibrosing lung disease often demonstrate rates of annualised forced vital capacity (FVC) decline within the range of measurement variation (5.0%–9.9%). We examined whether change in visual CT variables could help confirm whether marginal FVC declines represented genuine clinical deterioration rather than measurement noise.MethodsIn two IPF cohorts (cohort 1: n=103, cohort 2: n=108), separate pairs of radiologists scored paired volumetric CTs (acquired between 6 and 24 months from baseline). Change in interstitial lung disease, honeycombing, reticulation, ground-glass opacity extents and traction bronchiectasis severity was evaluated using a 5-point scale, with mortality prediction analysed using univariable and multivariable Cox regression analyses. Both IPF populations were then combined to determine whether change in CT variables could predict mortality in patients with marginal FVC declines.ResultsOn univariate analysis, change in all CT variables except ground-glass opacity predicted mortality in both cohorts. On multivariate analysis adjusted for patient age, gender, antifibrotic use and baseline disease severity (diffusing capacity for carbon monoxide), change in traction bronchiectasis severity predicted mortality independent of FVC decline. Change in traction bronchiectasis severity demonstrated good interobserver agreement among both scorer pairs. Across all study patients with marginal FVC declines, change in traction bronchiectasis severity independently predicted mortality and identified more patients with deterioration than change in honeycombing extent.ConclusionsChange in traction bronchiectasis severity is a measure of disease progression that could be used to help resolve the clinical importance of marginal FVC declines.

scholarly journals Staphylococcus Aureus Bacteriuria as a Predictor of In-Hospital Mortality in Patients with Staphylococcus Aureus Bacteremia. Results of a Retrospective Cohort Study

2020 ◽  
Vol 9 (2) ◽  
pp. 508 ◽  
Author(s):  
Tobias Siegfried Kramer ◽  
Beate Schlosser ◽  
Désirée Gruhl ◽  
Michael Behnke ◽  
Frank Schwab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
University Hospital ◽  
Hospital Death ◽  
Cox Regression Analysis

Staphylococcus aureus bloodstream infection (SA-BSI) is an infection with increasing morbidity and mortality. Concomitant Staphylococcus aureus bacteriuria (SABU) frequently occurs in patients with SA-BSI. It is considered as either a sign of exacerbation of SA-BSI or a primary source in terms of urosepsis. The clinical implications are still under investigation. In this study, we investigated the role of SABU in patients with SA-BSI and its effect on the patients’ mortality. We performed a retrospective cohort study that included all patients in our university hospital (Charité Universitätsmedizin Berlin) between 1 January 2014 and 31 March 2017. We included all patients with positive blood cultures for Staphylococcus aureus who had a urine culture 48 h before or after the first positive blood culture. We identified cases while using the microbiology database and collected additional demographic and clinical parameters, retrospectively, from patient files and charts. We conducted univariate analyses and multivariable Cox regression analysis to evaluate the risk factors for in-hospital mortality. 202 patients met the eligibility criteria. Overall, 55 patients (27.5%) died during their hospital stay. Cox regression showed SABU (OR 2.3), Pitt Bacteremia Score (OR 1.2), as well as moderate to severe liver disease (OR 2.1) to be independent risk factors for in-hospital mortality. Our data indicates that SABU in patients with concurrent SA-BSI is a prognostic marker for in-hospital death. Further studies are needed for evaluating implications for therapeutic optimization.

scholarly journals Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rui Zhong ◽  
Shali Tan ◽  
Yan Peng ◽  
Huan Xu ◽  
Xin Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Regression Analysis ◽  
Clinical Characteristics ◽  
Pancreatic Necrosis ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Western China ◽  
Occurrence Rate ◽  
Cox Regression Analysis

Abstract Background The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%). The etiology of pancreatitis in children was markedly different from that in adults (p < 0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p = 0.018) and occurrence rate of pancreatic necrosis (p = 0.041), SIRS (p = 0.021), acute peripancreatic fluid collection (p = 0.014). Univariate and Multivariate Cox regression analysis showed that female (p = 0.020; OR 3.821; 95% CI 1.231–11.861), hypertriglyceridemia (p = 0.045; OR 3.111; 95% CI 1.024–9.447), pancreatic necrosis (p = 0.023; OR 5.768; 95% CI 1.278–26.034) were the independent risk factors of ARP. Hypertriglyceridemia AP had the highest risk of recurrence compared to other etiology (p = 0.035). Conclusion Biliary and idiopathic disease were the major etiologies of AP in children. Children have simpler conditions than adults. Female, hypertriglyceridemia, and pancreatic necrosis were associated with the onset of ARP.

scholarly journals Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

2020 ◽  
Author(s):  
Rui Zhong ◽  
Shali Tan ◽  
Yan Peng ◽  
Huan Xu ◽  
Xin Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Regression Analysis ◽  
Clinical Characteristics ◽  
Pancreatic Necrosis ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Adult Patients ◽  
Cox Regression Analysis ◽  
Risk Of Recurrence

Abstract Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%), trauma (16.2%). There was a significant difference in the constituent ratio of etiology between pediatric patients and adult patients (p<0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p=0.012) and occurrence rate of pancreatic necrosis (p=0.02). During the follow-up time (34.2±20.8 months), 19 children (14.6%) developed into ARP. Multivariate Cox regression analysis showed that female (p=0.025; OR=3.632; 95%confidence interval(CI) 1.179-11.188), hyperlipidemia (p=0.022; OR=3.480; 95%CI 1.201-10.085), pancreatic necrosis (p=0.001; OR=8.815; 95%CI 2.446-31.774) were the independent risk factors of ARP. The risk of recurrence was significantly different in each etiology group. Hyperlipidemic AP had the highest risk of recurrence over time, while viral and drug-induced AP had the lowest risk of recurrence (p=0.035).Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Compared to adults, children tend to have milder disease conditions and a better prognosis. Female, hyperlipidemia, and first AP attack with pancreatic necrosis were associated with the increased risk of ARP.

scholarly journals Clinical Characteristics and Risk Factors of Mortality Among Severe COVID-19 Patients

2021 ◽  
Author(s):  
Reham Mohamed Elmorshedy ◽  
Maha Mohamed El-kholy ◽  
Alaa Eldin AbdelMoniem ◽  
Shimaa Abbas Hassan ◽  
Samiaa Hamdy Sadek
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Ground Glass Opacity ◽  
Older Age ◽  
Ground Glass ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
D Dimer

Abstract Background:The novel corona virus is attacking several millions of people worldwide, resulting in death of almost a million and a half-humans. The rational of the current study was to detect clinical characteristics of severe COVID- 19 patients, and assessment of risk factors for death.Methodology:This retrospective cohort study included all laboratory confirmed COVID-19 patients with severe disease admitted to critical care unit in June and July 2020. All recorded data were collected,which included clinincal, radiological, and laboratory data, in addition to the outcome and duration of ICU stay.Statistical analysis was performed for obtaining descriptive information, comparison between living and dead patients,in addition to regression analysis to identify risk factors for mortality.Results:One hundred and three patients were included in the current study;cough and fever were the most common clinical presentations, and bilateral ground glass opacity was the most common radiological presentation. Patients had elevated values of neutrophils, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), serum ferritin, CRP, and D-dimer, also had longer ICU stay ,with reduced values of lymphocytes, and PaO2/FIO2 ratio. Most of these variables were more exaggerated in dead patients compared to living ones. Older age, lower values of PaO2/FIO2 ratio, and higher values of neutrophils, NLR, and D-dimer were predictors for death.Conclusion: Cough, fever and bilateral ground glass opacity were the most common clinical and radiological presentation of severe COVID 19. Older age, lower value of PaO2/FIO2 ratio, and higher values of D- dimer, neutrophil and NLR were risk factors associated with increased risk of mortality.

scholarly journals C-reactive protein and thyroid-stimulating hormone levels as risk factors for hypothyroidism in patients with subacute thyroiditis

2021 ◽  
Author(s):  
Chenjia Tang ◽  
Yanting Dong ◽  
Lusi Lu ◽  
Nan Zhang
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Thyroid Stimulating Hormone ◽  
Subacute Thyroiditis ◽  
C Reactive Protein ◽  
Roc Curve Analysis ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Stimulating Hormone

Objective: This study was designed to explore the relationships between the clinical characteristics and outcomes of patients with subacute thyroiditis (SAT). Design: This is a single-center retrospective study. Patients: Eighty-nine patients with SAT who were hospitalized in the Sir Run Run Shaw Hospital in Zhejiang, China, from October 2014 to September 2020 were included. Methods: The Mann–Whitney U-test, chi-square test, and Cox regression analysis were conducted to identify the relationships between clinical characteristics and outcomes. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff levels of C-reactive protein (CRP) and thyroid-stimulating hormone (TSH). Results: The hypothyroidism and recurrence rates were 15.7% and 16.9%, respectively. CRP (≥72.0 mg/L), TSH (<0.02 mIU/L), and free triiodothyronine (fT3) (≥4.10 pg/mL) were associated with hypothyroidism. The cutoff level was 97.80 mg/L for CRP (area under the curve (AUC), 0.717, p= 0.014; sensitivity, 57.1%; specificity, 84.0%) and 0.10 mIU/L for TSH (AUC, 0.752, p = 0.004; sensitivity, 100%; specificity, 46.0%) by ROC curve analysis for hypothyroidism. The factors under study were not associated with recurrence. Conclusion: CRP and TSH were risk factors for hypothyroidism in SAT. Thyroid functions should be monitored closely to detect hypothyroidism early, especially in patients with CRP levels of more than 97.80 mg/L and TSH levels of less than 0.10 mIU/L.

LO21: One-year mortality of patients treated in the emergency department for an opioid overdose: a single-centre retrospective cohort study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S14
Author(s):  
A. Jiang ◽  
J. Godwin ◽  
J. Moe ◽  
J. Buxton ◽  
A. Crabtree ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Mortality Rate ◽  
Mortality Risk ◽  
Cox Regression ◽  
Opioid Overdose ◽  
Housing Status ◽  
Cox Regression Analysis ◽  
Index Visit ◽  
One Year

Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.

scholarly journals Clinical characteristics and risk factors for mortality in patients with COVID-19 and chronic obstructive pulmonary disease in Wuhan, China

2020 ◽  
Author(s):  
Hao Zeng ◽  
Weiwei Huang ◽  
Yujie Liu ◽  
Lan Dong ◽  
Qifan Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Multiple Organ ◽  
Chronic Obstructive ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Cox Regression Analysis ◽  
Copd Patients ◽  
Discharged Patients

Abstract Patients with COVID-19 and COPD are at high risks. However, the risk factors for mortality in COPD patients infected COVID-19 are limited. In this retrospective study, consecutive COPD cases infected COVID-19 in East District of People's Hospital of Wuhan University from Jan 11th 2020 to Mar 28th 2020 were included. Different outcomes were compared between dead and discharged patients. Cox regression analysis was performed to explore the risk factors for death. Totally, 52 cases were included (aged 64.0-79.0 years, 39 [75.0%] males). Common symptoms on admission were cough (43, 82.6%), fever (41, 78.8%) and expectoration (21, 40.3%). Thirty-eight (73.1%) patients were discharged, and 14 (26.9%) cases were dead which mainly caused by multiple organ failure (7, 50.0%) and respiratory failure (6, 42.9%). Multivariate analysis indicated that age > 70 years (HR, 7.859, 95% CI: 1.376, 44.875; P = 0.020) and count of lymphocyte ≤ 0.8×109/L (HR, 27.429, 95% CI: 3.336, 225.530; P = 0.002) were risk factors for death. The study showed that close monitoring of the risk indexes is important for early supportive care during the management of patients with COVID-19 and COPD.

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