Pneumonia and in-hospital mortality after renal transplantation

Introduction/Objective. Pneumonias remain one of the most frequent reasons for morbidity and mortality in the group of kidney recipients. The objective of the study was to define the factors associated with a higher risk for in-hospital mortality from pneumonia after renal transplantations. Methods. A total of 124 patients with kidney transplants hospitalized with pneumonia for the period of nine years were studied. Different noninvasive and invasive diagnostic tests were used. Results. Forty-one of the patients died as a result of pneumonia or related complications during their hospital stay. The factors associated with the increased risk for in-hospital mortality were as follows: the development of pneumonia during the early postoperative period (during the first month after surgery) (HR = 2.027; p = 0.025) or between the first and sixth month after surgery (HR = 2.303; p = 0.026), dyspnoea (HR = 2.184; p = 0.007) and hypoxemia (HR = 2.261; p = 0.003). The presence of bilateral infiltrates (HR = 2.482; p = 0.001), failure of initial antibiotic therapy (HR = 3.548; p < 0.001), intubation and mechanical ventilation (HR = 4.635; p < 0.001) also increased the risk for the fatal outcome. Conclusion. Knowing the prognostic factors associated with the increased risk for in-hospital fatal outcome from pneumonia after renal transplantation makes it possible to differentiate the high-risk group of renal recipients who require early etiological diagnosis and strict control of the condition, in order to reduce the mortality from pulmonary infections in the group.

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Age differences in mortality in patients undergoing surgery for infective endocarditis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2021 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Ostergaard ◽

M.H Smerup ◽

K Iversen ◽

A.D Jensen ◽

A Dahl ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Hospital Mortality ◽

Hazard Analysis ◽

Age Groups ◽

Prosthetic Heart Valve ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Factors Associated ◽

Increased Risk

Abstract Background Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival, but the intercept between benefit and harm is hard to balance and may be closely related to age. Purpose To examine the in-hospital and 90-day mortality in patients undergoing surgery for IE and to identify differences between age groups and type of valvular intervention. Methods By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment in the period from 2000 to 2017. The study population was grouped in patients <60 years, 60–75 years, and ≥75 years of age. High-risk subgroups by age and surgical valve intervention (mitral vs aortic vs mitral+aortic) during IE admission were examined. Kaplan Meier estimates was used to identify 90-day mortality by age groups and multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results We included 1,767 patients with IE undergoing surgery, 735 patients <60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients >75 years (36.1% female). The proportion of patients with IE undergoing surgery was 35.3%, 26.9%, and 9.1% for patients <60 years, 60–75 years, and >75 years, respectively. For patients with IE undergoing surgery, the in-hospital mortality was 6.4%, 13.6%, and 20.3% for patients <60 years, 60–75 years, and ≥75 years of age, respectively and mortality at 90 days were 7.5%, 13.9%, and 22.3%, respectively. Factors associated with an increased risk 90-day mortality were: mitral valve surgery and a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, patients 60–75 years and >75 years as compared with patients aged <60 years, prosthetic heart valve prior to IE admission, and diabetes, Figure. Patients >75 years undergoing a combination of mitral and aortic valve surgery had an in-hospital mortality of 36.3%. Conclusion In patients undergoing surgery for IE, a stepwise increase in 90-day mortality was seen for age groups, highest among patients >75 years with a 90-day mortality of more than 20%. Patients undergoing mitral and combined mitral and aortic valve surgery as compared to isolated aortic valve surgery were associated with a higher mortality. These findings may be of importance for the management strategy of patients with IE. Mortality risk Funding Acknowledgement Type of funding source: None

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Exposure To ABO Compatible But Non-Group Identical Blood and In-Hospital Mortality

Blood ◽

10.1182/blood.v122.21.3651.3651 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3651-3651

Author(s):

Richard J Cook ◽

Nancy Heddle ◽

Ker-Ai Lee ◽

Yang Liu ◽

Rebecca Barty, MLT ◽

...

Keyword(s):

Hospital Mortality ◽

Research Funding ◽

Cox Regression ◽

Type A ◽

Blood Type ◽

Hospital Death ◽

Trauma Patients ◽

Factors Associated ◽

Blood Types ◽

Increased Risk

Abstract Background Transfusions that are ABO compatible but not group identical (mismatched) are given for a variety of reasons including inventory availability, avoiding wastage from outdating, and clinical urgency. A recent observation at our centre suggested that patient outcome was different for those patients that received a transfusion of units with a compatible but mismatched ABO group compared to those receiving ABO group identical blood. Hence, we performed a retrospective hospital registry study to explore the association between mismatched blood and in-hospital mortality in transfused patients. Study Design Our patient/blood utilization database included 35,487 transfused hospitalized patients from 3 acute care academic centres from April 1, 2002 to October 31, 2011. Information on transfused RBCs included duration of storage (days) and ABO type. Patient data included: sex; age; hemoglobin; creatinine; diagnosis; interventions; ABO blood group and hospital discharge status. Factors associated with mismatched blood and in-hospital mortality were examined using generalized estimating equations to account for the potential serial dependence over multiple transfusions. The effect of exposure to ABO mismatched blood on in-hospital death was examined through Cox regression with time-dependent strata defined by: year of first admission; disease group; and the cumulative number of units transfused (≤ 7 days of storage; > 7 days but ≤ 28 days storage; and, >28 days of storage); and, controlling for available baseline and time-varying characteristics. Results 18,843 patients (blood groups A, B and AB), with complete covariates contributed to the analysis. Factors associated with transfusion of mismatched blood included: younger patient age (p<0.0001); lower hemoglobin (p<0.0001); higher creatinine (p<0.0001); intervention during hospitalization (OR=4.6, p<0.0001); and, patient ABO group whereby blood types A and B were much less likely to receive a mismatched unit compared to type AB patients (p<0.0001). There was a statistically significant interaction between patient blood type and the effect of receiving mismatched blood (p=0.034) with type A patients incurring a 79% higher risk of death (RR=1.79, 95% CI: 1.20, 2.67; p=0.0047); other patient blood types did not suggest increased risk. Similar results were observed when suspected trauma patients (≥ 6 units within 24 hours) were excluded from the analysis (Table 1). Conclusion Controlling for known potential confounders through Cox regression yielded evidence of increased risk of in-hospital mortality among blood type A patients receiving group O red cells. This association remained after suspected trauma patients were excluded from the analyses. Further study of the association observed in this study is warranted. Disclosures: Cook: CIHR: Research Funding. Heddle:CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Health Canada: Research Funding. Eikelboom:CIHR: Research Funding.

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Outcome of Acute Hypoxaemic Respiratory Failure. Insights from the Lung Safe Study

European Respiratory Journal ◽

10.1183/13993003.03317-2020 ◽

2020 ◽

pp. 2003317

Author(s):

Tài Pham ◽

Antonio Pesenti ◽

Giacomo Bellani ◽

Gordon Rubenfeld ◽

Eddy Fan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Hospital Mortality ◽

Distress Syndrome ◽

Pulmonary Involvement ◽

Positive End Expiratory Pressure ◽

Factors Associated ◽

Risk Of Death ◽

Increased Risk ◽

Current Incidence

BackgroundThe current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in intensive care unit are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with PaO2/FiO2 ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure (PEEP) of at least 5 cm H2O. ICU prevalence, causes of hypoxemia, hospital survival, factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared.Findings12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (8.2%, CHF). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1%versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality but similar adjusted mortality than ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only 2 quadrants involved.InterpretationMore than one third of the patients receiving mechanical ventilation have hypoxaemia and new infiltrates with an hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.

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Predictors of hypoxemia after general anesthesia in the early postoperative period in a hospital in Ethiopia: An observational study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2021.782 ◽

2021 ◽

Vol 16 ◽

Author(s):

Moges Gelaw Taye ◽

Amelework Molla ◽

Diriba Teshome ◽

Metages Hunie ◽

Simegnew Kibret ◽

...

Keyword(s):

Chronic Disease ◽

General Anesthesia ◽

Emergency Surgery ◽

Oxygen Therapy ◽

Early Postoperative Period ◽

Postoperative Hypoxemia ◽

Factors Associated ◽

Specialized Hospital ◽

Increased Risk ◽

Debre Tabor

Background: Early postoperative hypoxemia is a common problem after general anesthesia. The identification of factors associated with an increased occurrence of it might help healthcare professionals to hypoxemia risk patients, therefore this study aims to assess the incidence and factors associated with early postoperative hypoxemia among surgical procedures.Methods: A prospective cohort study design was conducted from February 1, 2020 to June 30, 2020, on a total of 424 patients who underwent surgery under general anesthesia in Debre Tabor Comprehensive Specialized Hospital. The data was collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association.Results: The incidence of early postoperative hypoxemia was 45.8%. Patients having a BMI of 25-29.9 kg/m2 and BMI of 30-39.9 kg/m2, patients having a chronic disease, current smokers, SPO2 reading before induction of less than 95%, emergency surgery, and the absence of oxygen therapy during the period of transfer and/or in the post anesthesia care unit were significantly associated with an increased risk of hypoxemia in the early postoperative period.Conclusions: The incidence of early postoperative hypoxemia was high in Debre Tabor Comprehensive Specialized Hospital. Obese patients, patients having a chronic disease, current smokers, and lower oxygen saturations before induction, emergency surgery, and the absence of oxygen therapy were the main predictors of an increased occurrence of early postoperative hypoxemia

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COVID-19 in-hospital mortality in South Africa: the intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting

10.1101/2020.12.21.20248409 ◽

2020 ◽

Author(s):

WAASILA JASSAT ◽

Cheryl Cohen ◽

Maureen Masha ◽

Susan Goldstein ◽

Tendesayi Kufa-Chakezha ◽

...

Keyword(s):

South Africa ◽

Infectious Diseases ◽

Hospital Mortality ◽

Surveillance System ◽

Hospital Admissions ◽

Communicable Diseases ◽

Middle Income ◽

Non Communicable Diseases ◽

Factors Associated ◽

Increased Risk

Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis (TB) are unclear, particularly in low- and middle-income countries (LMIC) in Africa. We investigated this interaction using a nationally representative hospital surveillance system in South Africa. Methods: A national surveillance system for laboratory-confirmed COVID-19 hospital admissions (DATCOV) was established. Using DATCOV data, we describe the demographic characteristics, clinical features, and in-hospital mortality among individuals admitted to public and private hospitals with COVID-19 during 5 March to 11 August 2020. Multivariable logistic regression models were used to compare individuals who were HIV-infected and HIV-uninfected and determine the factors associated with in-hospital mortality. Findings: Hospital admissions peaked at 1,560 admissions per day, in late July. Among the 41,877 individuals admitted with laboratory-confirmed COVID-19, 7,662 (18.3%) died. Comorbidities were documented in 27,555 (65.8%) individuals, most commonly observed were hypertension (36.8%), diabetes (29.6%), obesity (19.7%), and HIV (8.7%); TB was reported in 0.7% of individuals. Increased risk of in-hospital mortality was associated with HIV and TB, as well as other described risk factors for COVID-19, such as increasing age, male sex, non-White race (Black, mixed and Indian race), chronic underlying conditions particularly hypertension, diabetes and obesity. In addition, HIV-infected individuals with immunosuppression had increased risk of mortality (adjusted odds ratio 2.2; 95% confidence interval 1.6-3.1). Among HIV-infected individuals, the prevalence of other comorbidities associated with severe COVID-19 outcomes was 39.9%. The effect of multiple comorbidities on mortality was similar in HIV-infected and -uninfected individuals. Interpretation: These data provide a better understanding of the interaction of non-communicable diseases, chronic infectious diseases like HIV and TB and COVID-19. Increasing age and presence of chronic underlying comorbidities (particularly hypertension and diabetes) are important additional factors associated with COVID-19 mortality in a middle-income African setting and are common among HIV-infected individuals. HIV- and TB-infected individuals, particularly those with additional comorbidities, would benefit from COVID-19 prevention and treatment programmes.

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National COVID-19 Hospital Admissions and Mortality among Healthcare Workers in South Africa, 2020-2021

10.21203/rs.3.rs-637985/v2 ◽

2021 ◽

Author(s):

Nonhlanhla Tlotleng ◽

Waasila Jassat ◽

Cheryl Cohen ◽

Felix Made ◽

Tahira Kootbodien ◽

...

Keyword(s):

South Africa ◽

Hospital Mortality ◽

Healthcare Workers ◽

Hospital Admissions ◽

Kidney Diseases ◽

Public Hospitals ◽

Control Measures ◽

Infection Prevention And Control ◽

Factors Associated ◽

Increased Risk

Abstract Background: Healthcare workers (HCWs) in close contact with SARS-CoV-2-infected patients have an increased risk of infection compared to non-HCWs, but little is known about the clinical course and risks for mortality amongst HCWs in South Africa. In this study, we compared characteristics of hospitalised HCWs with non-HCWs with COVID-19 and assessed factors associated with COVID-19 mortality among HCWs.Methods: Data from 5 March 2020 to 30 April 2021 was obtained from DATCOV, the national surveillance programme monitoring COVID-19 admissions in private and public hospitals across South Africa. A logistic regression model was used to determine factors associated with COVID-19 HCW admissions and mortality. Results: There were a total 169,678 confirmed COVID-19 admissions reported on DATCOV, of which 6,364 (3.8%) were HCWs. Compared to non-HCWs, HCWs were less likely to be male [aOR 0.3, 95%CI (0.3-0.4)], and more likely to be younger, white or other race, have pre-existing obesity and asthma, and be admitted in the private sector, in Eastern Cape, Gauteng, Kwa-Zulu Natal, Limpopo, Northern Cape and North West provinces. Pre-wave 1 [aOR 3.0; 95%CI 2.4-3.7)], wave 1 [aOR 2.1; 95%CI (1.8-2.5)] and post-wave 1 [aOR 1.3; 95%CI (1.0-1.7)] were associated with increase in HCW admissions compared to wave 2. There was an increased risk for in-hospital mortality among HCWs in the older age group (40-49 [aOR 3.8; 95%CI (1.6-8.80)]; 50-59 [aOR 4.7; 95%CI (2.0-10.9)] and 60-65 years [aOR 9.8; 95%CI (4.2-23.0)] compared to HCWs less than 40 years, with comorbidities such as hypertension, diabetes, chronic kidney diseases, malignancy and TB. Mortality was decreased for HCWs who were coloured [aOR 0.5; 95%CI (0.3-0.8)], admitted in the public sector [aOR 0.7; 95%CI (0.5-0.9)] in pre-wave 1 [aOR 0.6; 95%CI (0.3-0.9)] compared to wave one period. Conclusion: In-hospital mortality in HCWs was associated with age, race, wave period, presence of comorbidites and sector. Policies should be put in place to remove older HCWs with comorbidities from direct patient care. Optimal management of comorbid conditions is advised and improvement of infection prevention and control measures in healthcare settings for those that come into direct contact with infected patients.

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Characteristics and outcomes of hospitalized adult COVID-19 patients in Georgia

10.1101/2020.10.23.20218255 ◽

2020 ◽

Author(s):

Tengiz Tsertsvadze ◽

Marina Ezugbaia ◽

Marina Endeladze ◽

Levani Ratiani ◽

Neli Javakhishvili ◽

...

Keyword(s):

Regression Analysis ◽

Platelet Count ◽

Hospital Mortality ◽

Health Sector ◽

Multivariate Regression Analysis ◽

Factors Associated ◽

Increased Risk ◽

Co Morbidity ◽

Low Platelet Count ◽

D Dimer

AbstractObjectiveDescribe presenting characteristics of hospitalized patients and explore factors associated with in-hospital mortality during the first wave of pandemic in Georgia.MethodsThis retrospective study included 582 adult patients admitted to 9 dedicated COVID-19 hospitals as of July 30, 2020 (72% of all hospitalizations). Data were abstracted from medical charts. Factors associated with mortality were evaluated in multivariable Poisson regression analysis.ResultsAmong 582 adults included in this analysis 14.9% were 65+ years old, 49.1% were women, 59.3% had uni- or bi-lateral lung involvement on chest computed tomography, 27.1% had any co-morbidity, 13.2% patients had lymphopenia, 4.1% had neutophilosis, 4.8% had low platelet count, 37.6% had d-dimer levels of >0.5 mcg/l. Overall mortality was 2.1% (12/582). After excluding mild infections, mortality among patients with moderate-to-critical disease was 3.0% (12/399), while among patients with severe-to-critical disease mortality was 12.7% (8/63). Baseline characteristics associated with increased risk of mortality in multivariate regression analysis included: age ≥65 years (RR: 10.38, 95% CI: 1.30-82.75), presence of any chronic co-morbidity (RR: 20.71, 95% CI: 1.58-270.99), lymphopenia (RR: 4.76, 95% CI: 1.52-14.93), neutrophilosis (RR: 7.22, 95% CI: 1.27-41.12), low platelet count (RR: 6.92, 95% CI: 1.18-40.54), elevated d-dimer (RR: 4.45, 95% CI: 1.48-13.35), elevated AST (RR: 6.33, 95% CI: 1.18-33.98).ConclusionIn-hospital mortality during the first wave of pandemic in Georgia was low. We identified several risk factors (older age, co-morbidities and laboratory abnormalities) associated with poor outcome that should provide guidance for planning health sector response as pandemic continues to evolve.

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Assessing the Necessity of Routine Crossmatching for Blood Transfusion in Renal Transplantation

Progress in Transplantation ◽

10.1177/1526924820958117 ◽

2020 ◽

Vol 30 (4) ◽

pp. 360-364

Author(s):

Douglas Cheung ◽

Luke Reynolds ◽

Melin Peng ◽

Jason Lee ◽

Robert Stewart ◽

...

Keyword(s):

Renal Transplantation ◽

Primary Outcome ◽

Deceased Donor ◽

Female Gender ◽

Early Postoperative Period ◽

Packed Red Blood Cells ◽

Preoperative Hemoglobin ◽

Conflicting Evidence ◽

Economic Climate ◽

Increased Risk

Introduction: Routine crossmatch of packed red blood cells (pRBCs) is completed preoperatively at many centers despite conflicting evidence on the incidence of blood transfusions with renal transplantation. In the current economic climate, resource adjudication should be judicious and medically appropriate. The objective of this study was to determine the incidence, timing, and predictors of early postoperative pRBC transfusion in patients undergoing renal transplantation. Methods: A retrospective review of all patients undergoing renal transplantation at our institution from January 2013 to May 2016 was performed. Demographic, biochemical, and clinical parameters were recorded. The primary outcome was early postoperative transfusion, defined as an intraoperative transfusion or within 2 days of surgery. Multivariable logistic regression was performed to identify associations with early postoperative transfusion. Results: We identified 428 patients during the study period (average age 55 years, 60% male, 30% obese, 67% deceased donor, and 43% preoperative antithrombotic use). Forty (9.3%) patients required early postoperative transfusion (mean: 2.8 pRBCs/transfusion) and most did not require blood urgently. Only 20 (4.7%) patients required a transfusion intraoperatively or on the same day of surgery. Lower preoperative hemoglobin (per g/L unit: odds ratio [OR]: 0.943), female gender (OR: 2.752), and preoperative antithrombotic use (OR 2.369) were associated with a need for early postoperative transfusion. Conclusion: Transfusion in the early postoperative period following renal transplantation was less than 10%, suggesting that routine crossmatch may not be necessary for all patients. Preoperative hemoglobin, female gender, and preoperative antithrombotic use were associated with increased risk and may be useful to risk-stratify patients who require crossmatch.

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National COVID-19 Hospital Admissions and Mortality Among Healthcare Workers in South Africa, 2020-2021

10.21203/rs.3.rs-637985/v1 ◽

2021 ◽

Author(s):

Nonhlanhla Tlotleng ◽

Waasila Jassat ◽

Cheryl Cohen ◽

Felix Made ◽

Tahira Kootbodien ◽

...

Keyword(s):

South Africa ◽

Hospital Mortality ◽

Healthcare Workers ◽

Hospital Admissions ◽

Kidney Diseases ◽

Public Hospitals ◽

Control Measures ◽

Infection Prevention And Control ◽

Factors Associated ◽

Increased Risk

Abstract Background: Healthcare workers (HCWs) in close contact with SARS-CoV-2-infected patients have an increased risk of infection compared to non-HCWs, but little is known about the clinical course and risks for mortality amongst HCWs in South Africa. In this study, we compared characteristics of hospitalised HCWs with non-HCWs with COVID-19 and assessed factors associated with COVID-19 mortality among HCWs. Methods: Data from 5 March 2020 to 30 April 2021 was obtained from DATCOV, the national surveillance programme monitoring COVID-19 admissions in private and public hospitals across South Africa. A logistic regression model was used to determine factors associated with COVID-19 HCW admissions and mortality.Results: There were a total 169,678 confirmed COVID-19 admissions reported on DATCOV, of which 6,364 (3.8%) were HCWs. Compared to non-HCWs, HCWs were less likely to be male [aOR 0.3, 95%CI (0.3-0.4)], and more likely to be younger, white or other race, have pre-existing obesity and asthma, and be admitted in the private sector, in Eastern Cape, Gauteng, Kwa-Zulu Natal, Limpopo, Northern Cape and North West provinces. Pre-wave 1 [aOR 3.0; 95%CI 2.4-3.7)], wave 1 [aOR 2.1; 95%CI (1.8-2.5)] and post-wave 1 [aOR 1.3; 95%CI (1.0-1.7)] were associated with increase in HCW admissions compared to wave 2. There was an increased risk for in-hospital mortality among HCWs in the older age group (40-49 [aOR 3.8; 95%CI (1.6-8.80)]; 50-59 [aOR 4.7; 95%CI (2.0-10.9)] and 60-65 years [aOR 9.8; 95%CI (4.2-23.0)] compared to HCWs less than 40 years, with comorbidities such as hypertension, diabetes, chronic kidney diseases, malignancy and TB. Mortality was decreased for HCWs who were coloured [aOR 0.5; 95%CI (0.3-0.8)], admitted in the public sector [aOR 0.7; 95%CI (0.5-0.9)] in pre-wave 1 [aOR 0.6; 95%CI (0.3-0.9)] compared to wave one period. Conclusion: In-hospital mortality in HCWs was associated with age, race, wave period, presence of comorbidites and sector. Policies should be put in place to remove older HCWs with comorbidities from direct patient care. Optimal management of comorbid conditions is advised and improvement of infection prevention and control measures in healthcare settings for those that come into direct contact with infected patients.

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