The Impact of Routine Pulse Oximetry Use on Outcomes in COVID-19-Infected Patients at Increased Risk of Severe Disease: A Retrospective Cohort Analysis

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

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Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

10.21203/rs.3.rs-100124/v1 ◽

2020 ◽

Author(s):

Benedict Morath ◽

Andreas Meid ◽

Johannes Rickmann ◽

Jasmin Soethoff ◽

Markus Verch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Kidney Function ◽

Hydroxyethyl Starch ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Kidney Injury ◽

Retrospective Cohort Analysis ◽

The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

British Journal of General Practice ◽

10.3399/bjgp20x709385 ◽

2020 ◽

Vol 70 (695) ◽

pp. e399-e405

Author(s):

Rachel Denholm ◽

Richard Morris ◽

Sarah Purdy ◽

Rupert Payne

Keyword(s):

Hospital Admission ◽

Retrospective Cohort ◽

Hospital Admissions ◽

Cohort Analysis ◽

Post Discharge ◽

Emergency Hospital ◽

Obstetrics And Gynaecology ◽

Emergency Hospital Admission ◽

Retrospective Cohort Analysis ◽

The Impact

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

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A low initial serum sodium level is associated with an increased risk of overcorrection in patients with chronic profound hyponatremia: a retrospective cohort analysis

BMC Nephrology ◽

10.1186/s12882-017-0732-1 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Sae Aratani ◽

Masahiko Hara ◽

Masahiko Nagahama ◽

Fumika Taki ◽

Miyuki Futatsuyama ◽

...

Keyword(s):

Serum Sodium ◽

Retrospective Cohort ◽

Sodium Level ◽

Serum Sodium Level ◽

Cohort Analysis ◽

Retrospective Cohort Analysis ◽

Increased Risk

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Sex and gender differences in testing, hospital admission, clinical presentation, and drivers of severe outcomes from COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab448 ◽

2021 ◽

Author(s):

Eileen P Scully ◽

Grant Schumock ◽

Martina Fu ◽

Guido Massaccesi ◽

John Muschelli ◽

...

Keyword(s):

Health Behaviors ◽

Inflammatory Markers ◽

Inflammatory Marker ◽

Severe Disease ◽

Cohort Analysis ◽

Sex And Gender ◽

Sex Effect ◽

Increased Risk ◽

Male Sex ◽

The Impact

Abstract Background Males experience increased severity of illness and mortality from SARS-CoV-2 compared to females but the mechanisms of male susceptibility are unclear. Methods We performed a retrospective cohort analysis of SARS-CoV-2 testing and admission data at 5 hospitals in the Maryland/Washington DC area. Using age-stratified logistic regression models we quantified the impact of male sex on the risk of the composite outcome of severe disease or death (WHO score 5-8), and tested the impact of demographics, comorbidities, health behaviors, and laboratory inflammatory markers on the sex effect. Results Among 213,175 SARS-CoV-2 tests, despite similar positivity rates, males in age strata between 18 and 74 years were more frequently hospitalized. For the 2,626 hospitalized individuals, clinical inflammatory markers (IL-6, CRP, ferritin, absolute lymphocyte count and neutrophil:lymphocyte ratio) were more favorable for females than males (p< 0.001). Among 18-49 year-olds, male sex carried a higher risk of severe outcomes; both early (odds ratio (OR) 3.01, 95%CI 1.75,5.18) and at peak illness during hospitalization (OR 2.58, 95%CI 1.78,3.74). Despite multiple differences in demographics, presentation features, comorbidities and health behaviors, these variables did not change the association of male sex with severe disease. Only clinical inflammatory marker values modified the sex effect, reducing the OR for severe outcomes in males ages 18-49 years to 1.81 (95%CI 1.00,3.26) early and 1.39 (95%CI 0.93,2.08) at peak illness. Conclusions Higher inflammatory laboratory test values were associated with increased risk of severe COVID-19 for males. A sex-specific inflammatory response to SARS-CoV-2 infection may underlie the sex differences in outcomes.

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