scholarly journals D-dimer Levels as Novel Biomarker Predictor for All-cause In-hospital Mortality Risk in COVID-19 Patients

2021 ◽  
Vol 2 (4) ◽  
pp. 14-19
Author(s):  
Nisa Amnifolia Niazta ◽  
Muchammad Dzikrul Haq Karimullah ◽  
William Sulistyono Putra ◽  
Norma Khairun Nisa ◽  
Phamella Esty Nuraini ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Mortality Data ◽  
Inhospital Mortality ◽  
Rt Pcr ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Degrees Of Severity ◽  
D Dimer

Background : Coronavirus disease 2019 (COVID-19) has affected people all around the world in varying degrees of severity, causing death. The global case fatality rate (CFR) due to COVID-19 was 2.2 % as of January 1st, 2021. The CFR in the Kediri district is 7.7%, which is higher than the Nasional CFR of 3%. In COVID-19, we looked at high D-dimer as one of the predictors of in-hospital mortality. Objectives : The goal of this study was to find a link between D-dimer levels and all-cause in-hospital mortality in COVID-19 patients, as well as to define the best cut-off point. Methods : A single-center cross-sectional study was conducted. From March to December 2020, 185 COVID-19 patients treated at Kediri General Hospital who were confirmed positive by RT-PCR matched the eligibility criteria. The levels of D-dimer were divided into two groups: those above and those below the cutoff point. We 􏰏􏰚􏰏􏰦􏰗􏰱􏰋􏰕 􏰲 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊􏰌􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰢􏰣􏰤 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰧 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰸 􏰶􏰟􏰷􏰔􏰦􏰳 􏰏􏰚􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣 The primary endpoint was all-cause in-hospital mortality. Data were collected retrospectively and processed using SPSS version 25.0. Results : 􏰴􏰞􏰑􏰝􏰚􏰟 􏰜􏰓􏰌􏰐􏰝􏰊􏰏􏰦􏰝􏰱􏰏􏰊􏰝􏰓􏰚􏰳 􏰲􏰤 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰪􏰧􏰲􏰣􏰸􏰹􏰮 􏰎􏰋􏰑􏰋 􏰕􏰝􏰋􏰕􏰣 􏰺􏰦􏰋􏰻􏰏􏰊􏰋􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦 􏰎􏰏􏰌 􏰌􏰊􏰏􏰊􏰝􏰌􏰊􏰝􏰩􏰏􏰦􏰦􏰗 significant associated with all-cause inhospital mortality (adjusted odds ratio [OR] 3.46; 95% confidence interval [CI] = 1.41 – 8.49, p = 0.007), with a sensitivity of 82.1% and a specificity of 42.2% ( area under curve [AUC] = 0.628; 95% CI = 0.527 – 0.728; p = 0.012). Conclusion : Elevated D-dimer levels were associated with all-cause in-hospital mortality. In our study, the 􏰓􏰐􏰊􏰝􏰔􏰏􏰦 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰻􏰏􏰦􏰞􏰋 􏰎􏰏􏰌 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣

scholarly journals Mortality among Hospitalized Dengue Patients with Comorbidities in Mexico, Brazil, and Colombia

2021 ◽  
Author(s):  
Alejandro E. Macias ◽  
Guilherme L. Werneck ◽  
Raúl Castro ◽  
Cesar Mascareñas ◽  
Laurent Coudeville ◽  
...  
Keyword(s):  
Heart Disease ◽  
Relative Risk ◽  
Hospital Mortality ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Severe Dengue ◽  
Sectional Study ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Increased Risk

Dengue patients with comorbidities may be at higher risk of death. In this cross-sectional study, healthcare databases from Mexico (2008–2014), Brazil (2008–2015), and Colombia (2009–2017) were used to identify hospitalized dengue cases and their comorbidities. Case fatality rates (CFRs), relative risk, and odds ratios (OR) for in-hospital mortality were determined. Overall, 678,836 hospitalized dengue cases were identified: 68,194 from Mexico, 532,821 from Brazil, and 77,821 from Colombia. Of these, 35%, 5%, and 18% were severe dengue, respectively. Severe dengue and age ≥ 46 years were associated with increased risk of in-hospital mortality. Comorbidities were identified in 8%, 1%, and 4% of cases in Mexico, Brazil, and Colombia, respectively. Comorbidities increased hospitalized dengue CFRs 3- to 17-fold; CFRs were higher with comorbidities regardless of dengue severity or age. The odds of in-hospital mortality were significantly higher in those with pulmonary disorders (11.6 [95% CI 7.4–18.2], 12.7 [95% CI 9.3–17.5], and 8.0 [95% CI 4.9–13.1] in Mexico, Brazil, and Colombia, respectively), ischemic heart disease (23.0 [95% CI 6.6–79.6], 5.9 [95% CI 1.4–24.6], and 7.0 [95% CI 1.9–25.5]), and renal disease/failure (8.3 [95% CI 4.8–14.2], 8.0 [95% CI 4.5–14.4], and 9.3 [95% CI 3.1–28.0]) across the three countries; the odds of in-hospital mortality from dengue with comorbidities was at least equivalent or higher than severe dengue alone (4.5 [95% CI 3.4–6.1], 9.6 [95% CI 8.6–10.6], and 9.0 [95% CI 6.8–12.0). In conclusion, the risk of death because of dengue increases with comorbidities independently of age and/or disease severity.

scholarly journals Predictors of In-hospital Mortality In Patients With RT-PCR Confirmed Lassa Fever Infection Treated At A National Treatment Center, South West Nigeria

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Olatunde LO ◽  
Owhin S.O ◽  
Momoh A.J ◽  
Adebayo T.T. ◽  
Babatunde E ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Setting ◽  
Case Fatality ◽  
Lassa Fever ◽  
Standards Of Care ◽  
Inhospital Mortality ◽  
Rt Pcr ◽  
Case Record ◽  
Study Results ◽  
Elevated Creatinine

Background: Lassa fever (LF) infection is one of the viral hemorrhagic fever diseases found mainly in Sub-Saharan West Africa, including Nigeria. The case fatality rate is 60% among patients with Lassa fever complicated by AKI in one center study in Nigeria. Clinical and laboratory parameter has been documented as predictors of mortality among confirmed Lassa fever infected patients. Therefore, we decided to conduct similar study in our hospital to determine predictors of inhospital mortality among Lassa fever infected patients. Aim: This study was designed to determine the in-hospital clinical and laboratory predictors of outcome among RT-PCR (Real Time- Polymerase Chain Reaction) diagnosed Lassa fever patients. Methodology: This was a descriptive retrospective study involving the assessment of records of confirmed LF infected patients that were managed at the center from December 2019 to December 2020. 147 medical case record files of patients were retrieved for this study. Results: We found in our hospital setting, altered sensorium (p=0.001), seizures (p=0.001), bleeding diathesis (p=0.001), oliguria (p=0.001), elevated urea (p=0.001), elevated creatinine (p=0.001), hypoalbuminaemia (P=0.001), elevated SGOT (P=0.008) as significant predictors on in-hospital mortality. Conclusion: This study has helped us to identify the clinical parameters such as bleeding, central nervous system affectation, oliguria, tachycardia, tachypnea, hypoxaemia and laboratory parameters such as, elevated urea, elevated creatinine, hypoalbuminaemia as predictors of in-hospital mortality in RT-PCR confirmed Lassa fever patients. We believe early recognition of derangements of these parameters and with prompt intervention shall help to improve standards of care and outcome.

Association Between Physician Caseload and Patient Outcome for Sepsis Treatment

2009 ◽  
Vol 30 (6) ◽  
pp. 556-562 ◽  
Author(s):  
Chao-Hung Chen ◽  
Yi-Hua Chen ◽  
Hsiu-Chen Lin ◽  
Herng-Ching Lin
Keyword(s):  
Hospital Mortality ◽  
Estimating Equation ◽  
Cross Sectional Study ◽  
Inhospital Mortality ◽  
Research Database ◽  
Cross Sectional ◽  
Pooled Data ◽  
Taiwan National Health Insurance ◽  
The Difference ◽  
Very High

Objective.The purpose of this study was to investigate whether physicians with larger sepsis caseloads provide better outcomes, defined as lower in-hospital mortality rates, for patients with sepsis.Design.Retrospective cross-sectional study.Method.This study used pooled data from the 2002-2004 Taiwan National Health Insurance Research Database. A total of 48,336 patients hospitalized with a principal diagnosis of septicemia were selected and assigned to 1 of 4 caseload groups on the basis of their treating physician's sepsis caseload during the 3 years reflected in the pooled data (low caseload, less than 39 cases; medium caseload, 39–88 cases; high caseload, 89–176 cases; and very high caseload, more than 176 cases). Generalized estimating equation models were used for analysis.Results.Receipt of treatment from physicians in the very high, high, and medium caseload groups decreased patients' odds of inhospital mortality by 49% (95% confidence interval [CI], 0.41-0.67; P < .001 ), 40% (95% CI, 0.53-0.68; P < .001 ), and 18% (95% CI, 0.73-0.92; P < .001), respectively, compared with the odds for patients treated by low-caseload physicians. These findings persisted after partitioning out systematic physician-specific and hospital-specific variation and isolating the effects of most hospital, physician, and patient confounders.Conclusion.Patients treated by physicians who had a larger sepsis caseload had a substantially lower in-hospital mortality rate than did patients treated by physicians in the other caseload groups, and the difference was statistically significant. This result supports the “practice makes perfect” hypothesis.

scholarly journals COVID-19 among patients with pre-existing renal impairment: experience in a tertiary care hospital of Bangladesh

2020 ◽  
pp. 23-28
Author(s):  
Muhammad Abdur Rahim ◽  
Tabassum Samad ◽  
Ishrat Jahan ◽  
Md Mashud Alam ◽  
Talha Sami Ul Haque ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Fatality ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Electrolyte Imbalance ◽  
Care Hospital ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Increased Risk ◽  
Polymerase Chain

Background: Patients with chronic kidney disease (CKD) are at increased risk for infection because of immunosuppressed state. CKD is an independent risk factor for poor outcome in coronavirus disease 2019 (COVID-19). This study was designed to describe clinical and laboratory parameters of COVID-19 patients with preexisting CKD. Methods: This cross-sectional study was conducted in the Department of Nephrology, BIRDEM General Hospital from July to December 2020. Hospitalized adult patients with CKD not yet on dialysis, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR), irrespective of symptoms were included in this study. RT-PCR negative cases were excluded. Results: Total patients were 40 (mean age 58.3 years, 52.5% male). Common comorbidities were diabetes mellitus (92.5%), hypertension (67.5%) and ischaemic heart disease (27.5%). Fever, cough, shortness of breath, headache and fatigue were common presenting features. Nearly one-fifth had no COVID-related symptoms. Lymphopenia and high inflammatory markers (ESR, CRP) were common. Sixteen patients were complicated by acute kidney injury, four patients required haemodialysis and 23 had electrolyte imbalance. Most cases were mild to moderate; most were transferred to COVID-dedicated hospitals or discharged with home isolation protocols. Three patients required intensive care unit shifting and two patients died. Conclusion: Most CKD patients had comorbid conditions. Clinical presentation was typical in most cases. Case fatality rate was higher than Bangladeshi statistics. Birdem Med J 2020; 10, COVID Supplement: 23-28

scholarly journals A cross-sectional study of knife injuries at a London major trauma centre

2014 ◽  
Vol 96 (1) ◽  
pp. 23-26 ◽  
Author(s):  
JR Pallett ◽  
E Sutherland ◽  
E Glucksman ◽  
M Tunnicliff ◽  
JW Keep
Keyword(s):  
Major Trauma ◽  
Case Fatality ◽  
Trauma Team ◽  
Cross Sectional Study ◽  
Trauma Centre ◽  
Mortality Data ◽  
Contributory Factor ◽  
Cross Sectional ◽  
Major Trauma Centre ◽  
Knife Injury

INTRODUCTION No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. METHODS A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. RESULTS A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team’s caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16–24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. CONCLUSIONS Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.

scholarly journals Evaluation of SARS-CoV-2 antigen-based rapid diagnostic kits in Pakistan: formulation of COVID-19 national testing strategy

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Umar Saeed ◽  
Sara Rizwan Uppal ◽  
Zahra Zahid Piracha ◽  
Azhar Rasheed ◽  
Zubair Aftab ◽  
...  
Keyword(s):  
Gold Standard ◽  
Injection Drug Users ◽  
Drug Users ◽  
Diagnostic Testing ◽  
False Negative ◽  
Cross Sectional Study ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Negative Results

AbstractRapid diagnosis of SARS-CoV-2 during pandemic enables timely treatment and prevention of COVID-19. Evaluating the accuracy and reliability of rapid diagnostic testing kits is crucial for surveillance and diagnosis of SARS-CoV-2 infections in general population, injection drug users, multi-transfused populations, healthcare workers, prisoners, barbers and other high risk populations. The aim of this study was to evaluate performance and effectiveness of nasopharyngeal swab (NSP) and saliva based rapid antigen detection testing kits in comparison with USFDA approved triple target gold standard real-time polymerase chain reaction. A cross-sectional study was conducted on 33,000 COVID-19 suspected patients. From RT-PCR positive patients, nasopharyngeal swab (NSP) and saliva samples were obtained for evaluation of rapid COVID-19 testing kits (RDT). 100/33,000 (0.3%) of specimens were RT-PCR positive for SARS-CoV-2. Among RT-PCR positive, 62% were males, 34% were females, and 4% were children. The NSP-RDT (Lepu Medical China) analysis revealed 53% reactivity among males, 58% reactivity among females, and 25% reactivity among children. However saliva based RDT (Lepu Medical China) analysis showed 21% reactivity among males and 23% among females, and no reactivity in children. False negative results were significantly more pronounced in saliva based RDT as compared to NSP-RDT. The sensitivity of these NSP-RDT and saliva based RDT were 52% and 21% respectively. The RDTs evaluated in this study showed limited sensitivities in comparison to gold standard RT-PCR, indicating that there is a dire need in Pakistan for development of suitable testing to improve accurate COVID-19 diagnosis in line with national demands.

scholarly journals Prevalence of SARS-CoV-2 Infection at the University of Barcelona during the Third COVID-19 Pandemic Wave in Spain

2021 ◽  
Vol 18 (12) ◽  
pp. 6526
Author(s):  
Sebastián Videla ◽  
Aurema Otero ◽  
Sara Martí ◽  
M. Ángeles Domínguez ◽  
Nuria Fabrellas ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Venous Blood ◽  
Herd Immunity ◽  
Cross Sectional Study ◽  
Rt Pcr ◽  
Igg Antibody ◽  
Cross Sectional ◽  
Total Prevalence ◽  
The University ◽  
The Impact

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in December 2019 and still is a major global health challenge. Lockdown measures and social distancing sparked a global shift towards online learning, which deeply impacted universities’ daily life, and the University of Barcelona (UB) was not an exception. Accordingly, we aimed to determine the impact of the SARS-CoV-2 pandemic at the UB. To that end, we performed a cross-sectional study on a sample of 2784 UB members (n = 52,529). Participants answered a brief, ad hoc, online epidemiological questionnaire and provided a nasal swab for reverse transcription polymerase chain reaction (RT-PCR) SARS-CoV-2 analysis and a venous blood sample for SARS-CoV-2 IgG antibody assay. Total prevalence of SARS-CoV-2 infection (positive RT-PCR or positive IgG) was 14.9% (95%CI 13.3 to 17.0%). Forty-four participants (1.6%, 95%CI: 1.2–2.1%) were positive for SARS-CoV-2 RT-PCR. IgG against SARS-CoV-2 was observed in 12.8% (95%CI: 11.6–14.1%) of participants. Overall, while waiting for population vaccination and/or increased herd immunity, we should concentrate on identifying and isolating new cases and their contacts.

scholarly journals Processes of care and outcomes for homeless patients hospitalised for cardiovascular conditions at safety-net versus non-safety-net hospitals: cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046959
Author(s):  
Atsushi Miyawaki ◽  
Dhruv Khullar ◽  
Yusuke Tsugawa
Keyword(s):  
Hospital Mortality ◽  
Health Outcomes ◽  
Care Delivery ◽  
Bypass Graft ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Homeless Adults ◽  
To Receive

ObjectivesEvidence suggests that homeless patients experience worse quality of care and poorer health outcomes across a range of medical conditions. It remains unclear, however, whether differences in care delivery at safety-net versus non-safety-net hospitals explain these disparities. We aimed to investigate whether homeless versus non-homeless adults hospitalised for cardiovascular conditions (acute myocardial infarction (AMI) and stroke) experience differences in care delivery and health outcomes at safety-net versus non-safety-net hospitals.DesignCross-sectional study.SettingData including all hospital admissions in four states (Florida, Massachusetts, Maryland, and New York) in 2014.ParticipantsWe analysed 167 105 adults aged 18 years or older hospitalised for cardiovascular conditions (age mean=64.5 years; 75 361 (45.1%) women; 2123 (1.3%) homeless hospitalisations) discharged from 348 hospitals.Outcome measuresRisk-adjusted diagnostic and therapeutic procedure and in-hospital mortality, after adjusting for patient characteristics and state and quarter fixed effects.ResultsAt safety-net hospitals, homeless adults hospitalised for AMI were less likely to receive coronary angiogram (adjusted OR (aOR), 0.42; 95% CI, 0.36 to 0.50; p<0.001), percutaneous coronary intervention (aOR, 0.52; 95% CI, 0.44 to 0.62; p<0.001) and coronary artery bypass graft (aOR, 0.43; 95% CI, 0.26 to 0.71; p<0.01) compared with non-homeless adults. Homeless patients treated for strokes at safety-net hospitals were less likely to receive cerebral arteriography (aOR, 0.23; 95% CI, 0.16 to 0.34; p<0.001), but were as likely to receive thrombolysis therapy. At non-safety-net hospitals, we found no evidence that the probability of receiving these procedures differed between homeless and non-homeless adults hospitalised for AMI or stroke. Finally, there were no differences in in-hospital mortality rates for homeless versus non-homeless patients at either safety-net or non-safety-net hospitals.ConclusionDisparities in receipt of diagnostic and therapeutic procedures for homeless patients with cardiovascular conditions were observed only at safety-net hospitals. However, we found no evidence that these differences influenced in-hospital mortality markedly.

scholarly journals Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043721
Author(s):  
Donald Richardson ◽  
Muhammad Faisal ◽  
Massimo Fiori ◽  
Kevin Beatson ◽  
Mohammed Mohammed
Keyword(s):  
Hospital Mortality ◽  
Early Warning ◽  
Absolute Risk ◽  
Cross Sectional Study ◽  
Early Warning Score ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Baseline Mortality ◽  
Acute Hospitals ◽  
National Early Warning Score

ObjectivesAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.DesignA retrospective cross-sectional study.SettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).ConclusionsThe index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.

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