scholarly journals Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

2021 ◽  
Author(s):  
Liangkai Chen ◽  
Wenwu Sun ◽  
Yanli Liu ◽  
Lijuan Zhang ◽  
Yanling Lv ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Early Phase ◽  
Fasting Glucose ◽  
Control Strategies ◽  
Case Series ◽  
Severe Pneumonia ◽  
Adverse Outcomes ◽  
Glucose Levels ◽  
Increased Risk ◽  
Prolonged Hospital

<a><b>OBJECTIVE—</b></a><a></a><a><b> </b></a><a></a><a>To investigate the association of in-hospital early-phase glycemic control with adverse outcomes among inpatients with coronavirus disease 2019 (COVID-19) in Wuhan, China.</a><b></b> <p><b>RESEARCH DESIGN AND METHODS—</b><a></a><a> The study is a large case series and data were obtained regarding consecutive patients hospitalized with COVID-19 in the Central Hospital of Wuhan between January 2 and February 15, 2020. All patients with definite outcomes (death or discharge) were included. Demographic, clinical, treatment, and laboratory information were extracted from electronic medical records. We collected daily fasting glucose data from standard morning fasting blood biochemistry to determine glycemic status and fluctuation (calculated as the square root of the variance of daily fasting glucose levels) during the first week of hospitalization.</a></p> <p><b>RESULTS— </b>A total of 548 patients were included in the study (median age 57 years; =298 [54%] women; <i>n</i>=99 diabetes [18%]), 215 suffered acute respiratory distress syndrome (ARDS), 489 survived, and 59 died. <a></a><a></a><a></a><a>Patients who had higher mean levels of glucose during their first week of hospitalization were older and more likely to have a comorbidity</a> and abnormal laboratory markers, prolonged hospital stays, increased expenses, and greater risks of severe pneumonia, ARDS, and death. <a></a><a>Compared with patients with the lowest quartile of glycemic fluctuation</a>, those had the highest quartile of fluctuation magnitude had an increased risk of ARDS (risk ratio 1.97 [95% CI: 1.01, 4.04]) and mortality (hazard ratio 2.73 [95% CI: 1.06, 7.73]).</p> <b>CONCLUSIONS—<a></a><a></a><a></a><a> </a></b>These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization.

scholarly journals Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

2021 ◽  
Author(s):  
Liangkai Chen ◽  
Wenwu Sun ◽  
Yanli Liu ◽  
Lijuan Zhang ◽  
Yanling Lv ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Early Phase ◽  
Fasting Glucose ◽  
Control Strategies ◽  
Case Series ◽  
Severe Pneumonia ◽  
Adverse Outcomes ◽  
Glucose Levels ◽  
Increased Risk ◽  
Prolonged Hospital

<a><b>OBJECTIVE—</b></a><a></a><a><b> </b></a><a></a><a>To investigate the association of in-hospital early-phase glycemic control with adverse outcomes among inpatients with coronavirus disease 2019 (COVID-19) in Wuhan, China.</a><b></b> <p><b>RESEARCH DESIGN AND METHODS—</b><a></a><a> The study is a large case series and data were obtained regarding consecutive patients hospitalized with COVID-19 in the Central Hospital of Wuhan between January 2 and February 15, 2020. All patients with definite outcomes (death or discharge) were included. Demographic, clinical, treatment, and laboratory information were extracted from electronic medical records. We collected daily fasting glucose data from standard morning fasting blood biochemistry to determine glycemic status and fluctuation (calculated as the square root of the variance of daily fasting glucose levels) during the first week of hospitalization.</a></p> <p><b>RESULTS— </b>A total of 548 patients were included in the study (median age 57 years; =298 [54%] women; <i>n</i>=99 diabetes [18%]), 215 suffered acute respiratory distress syndrome (ARDS), 489 survived, and 59 died. <a></a><a></a><a></a><a>Patients who had higher mean levels of glucose during their first week of hospitalization were older and more likely to have a comorbidity</a> and abnormal laboratory markers, prolonged hospital stays, increased expenses, and greater risks of severe pneumonia, ARDS, and death. <a></a><a>Compared with patients with the lowest quartile of glycemic fluctuation</a>, those had the highest quartile of fluctuation magnitude had an increased risk of ARDS (risk ratio 1.97 [95% CI: 1.01, 4.04]) and mortality (hazard ratio 2.73 [95% CI: 1.06, 7.73]).</p> <b>CONCLUSIONS—<a></a><a></a><a></a><a> </a></b>These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization.

Using a Nurse-Led Telehealth Intervention to Improve Fasting Glucose Levels in Patients With Uncontrolled Type 2 Diabetes Undergoing a Surgical Intervention

2018 ◽  
Vol 11 (2) ◽  
pp. 126-131
Author(s):  
Christine Mott ◽  
Kendra Barker ◽  
Renee Schwertfeger ◽  
Jennifer Mallow
Keyword(s):  
Glycemic Control ◽  
Clinical Significance ◽  
Diabetes Education ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Telephone Intervention ◽  
Glucose Levels ◽  
Uncontrolled Diabetes ◽  
Significant Difference ◽  
Telehealth Intervention

Background: Uncontrolled diabetes during the perioperative period can result in a variety of adverse postoperative outcomes. Objective: Evaluate a nurse-led telehealth preoperative intervention to improve glycemic control. Methods: Provide telehealth diabetes education prior to surgery and evaluate time spent and pre-/post-glucose levels. Between-group differences were used to assess glycemic control. Results: There was no significant difference in scores for those who received the telephone intervention (M = 167.71, SD = 59.9) and those who did not receive the intervention (M = 171.44, SD = 54.9; t (44) = 0.220, p = .82, two-tailed). The magnitude of the differences in the means was very small (Cohen’s d = 0.03). There was a reduction in pre- and post-glucose levels for both groups. Conclusions: Although the findings were not statistically significant, there may be some clinical significance. Implications for Nursing: The clinical significance has implications for nursing due to participants choosing to delay surgery and potentially preventing adverse outcomes.

scholarly journals Influence ofHelicobacter pyloriInfection on Metabolic Syndrome in Old Chinese People

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Wen Yang ◽  
Cunfu Xuan
Keyword(s):  
Metabolic Syndrome ◽  
Fasting Glucose ◽  
Binary Logistic Regression Analysis ◽  
Rapid Urease Test ◽  
Chinese People ◽  
Old Chinese ◽  
Glucose Levels ◽  
Increased Risk ◽  
Urease Test ◽  
H Pylori

Background. H. pyloriinfection is one of the most common chronic infectious inflammatory diseases worldwide and is also a risk factor for atherosclerosis. Patients with metabolic syndrome are known to be at increased risk for atherosclerosis. The aim of our study was to assess the effects ofH. pyloriinfection on serum lipids, body mass index (BMI), and metabolic syndrome in old Chinese people.Material and Method.A total of 191 (133 males and 58 females, aged73.19±11.03years) people who had gastroscopy examination in our hospital were divided intoH. pylori-positive group (n=80) andH. pylori-negative group (n=111).H. pyloriinfection was diagnosed by rapid urease test.Results.Patients withH. pyloriinfection had higher BMI and fasting glucose levels and incidence of metabolic syndrome (p<0.01). It was found that BMI (p<0.01, OR 74.469),H. pyloriinfection (p<0.01, OR 5.427), total cholesterol (p<0.01, OR 15.544), and diabetes mellitus (p<0.01, OR 23.957) were significantly associated with the risk of metabolic syndrome by binary logistic regression analysis.Conclusions.Patients withH. pyloriinfection had higher BMI and fasting glucose levels and had incidence of metabolic syndrome.

scholarly journals COVID-19 OUTCOMES IN PREGNANCY: A REVIEW OF 275 SCREENED STUDIES

2021 ◽  
Author(s):  
Rupalakshmi Vijayan ◽  
Hanna Moon ◽  
Jasmine Joseph ◽  
Madiha Zaidi ◽  
Chhaya Kamwal ◽  
...  
Keyword(s):  
Literature Review ◽  
Pregnant Women ◽  
Direct Evidence ◽  
Case Series ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
World Health ◽  
Increased Risk ◽  
Immunological Changes ◽  
In Pregnancy

In December 2019, a novel strain of severe acute respiratory syndrome (SARS-CoV-2), was declared as a cause of respiratory illness, called coronavirus 2019 (COVID-19), characterized by fever and cough. In diagnostic imaging, the afflicted population showed pathognomonic findings of pneumonia. What started out as an epidemic in China, rapidly spread across geographical locations with a significant daily increase in the number of affected cases. According to the World Health Organization (WHO) reports, the range of worldwide mortality is 3 to 4%. Maternal adaptations and immunological changes predispose pregnant women to a prolonged and severe form of pneumonia, which results in higher rates of maternal, fetal, and neonatal morbidity and mortality. There is limited data about the consequences of COVID-19 in pregnancy, thereby limiting the prevention, counseling, and management of these patients. The objective of this literature review is to explore pregnancy and perinatal outcomes of COVID-19, complications, morbidity, and mortality in this sub-population. We conducted a literature review pertaining to COVID-19 and pregnancy in databases such as: PubMed, Google Scholar, and Science Direct. The studies we chose to focus on were systematic reviews, meta-analysis, case series, and case reports. Twenty four articles were reviewed regarding COVID-19 and pregnancy, complications and their outcomes. Due to immunological changes during pregnancy as evidenced by the flaring of auto-immune diseases; pregnant women may be at an increased risk for infection. Women (19.7%) who had underlying comorbidities such as gestational DM, HTN, hypothyroidism, and autoimmune disease, COPD, or HBV infection were considered high risk. The most common maternal outcomes were premature rupture of membranes (PROM) and pre-eclampsia. Asthma was the most common comorbidity associated with maternal mortality. The most common neonatal complications were fetal distress leading to NICU admissions and preterm birth <37 weeks. The most common laboratory changes were elevated CRP and lymphocytopenia. Most patients underwent C-section due to their underlying comorbidities. Pregnant and lactating women did not shed viral particles through their vaginal mucus and milk, as evidenced by negative nucleic-acid tests of these secretions. Neonatal infections as demonstrated by positive RT-PCR were rare, but direct evidence supporting intrauterine transmission was not confirmed. Direct evidence indicating vertical transmission of COVID-19 is not available, but risk for transmission cannot be ruled out. Pregnant women should be closely monitored due to increased risk of adverse outcomes.

scholarly journals Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Zongjie Shi ◽  
Shunyuan Guo ◽  
Jie Pan ◽  
Chao Xu ◽  
Yu Geng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Fasting Glucose ◽  
Independent Predictor ◽  
Secondary Outcome ◽  
Vessel Occlusion ◽  
Glucose Levels ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage

Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment.Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses.Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment.Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.

scholarly journals Coronary Artery Bypass Grafting Complicated by Post-operative Coronavirus Infection -- Two Similar Presentations with Dissimilar Outcomes

2021 ◽  
Author(s):  
Siddharth Pahwa ◽  
Harideep Samanapally ◽  
Mike O. Udoh ◽  
Jiapeng Huang ◽  
Mark Slaughter
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Surgical Procedures ◽  
Artery Bypass ◽  
Case Series ◽  
Adverse Outcomes ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Increased Risk

Patients diagnosed with COVID-19 infection undergoing surgical procedures have been reported to have increased post-operative complications and mortality. These findings are important when considering cardiac surgical procedures, specifically coronary artery bypass grafting (CABG). This case series describes the clinical course following a CABG procedure in two patients that went on to develop COVID-19 infection post-operatively, having previously tested negative. We aim to illustrate the similarities in clinical presentation, but differences in eventual outcomes for both patients and hypothesize the reasons for the differences. Patients with comorbidities such as advanced age, diabetes mellitus, obesity, hypertension, and COPD are possibly at increased risk of adverse outcomes should they contract the infection, and special care should be taken in this population. Early institution of VV-ECMO may be beneficial, but further studies are needed in this matter.

COVID-19 AND PNEUMOTHORAX: A CASE SERIES

2021 ◽  
pp. 8-10
Author(s):  
Boopathi Shankar ◽  
Meenakshi Narasimhan ◽  
Naveen Vennilavan
Keyword(s):  
Independent Risk Factor ◽  
Case Series ◽  
Severe Pneumonia ◽  
Prolonged Hospital Stay ◽  
Appropriate Treatment ◽  
Male Preponderance ◽  
Hospital Stays ◽  
The Mean ◽  
Prolonged Hospital ◽  
Made In

Covid19 causing variant of pulmonary symptoms and complications, in this case series we reported about the observations made in 9 cases of COVID 19 associated with pneumothorax. Pneumothorax was predominantly seen in severe pneumonia patients with the mean age of 44.613.6 years, with male preponderance. Pneumothorax presented in different scenarios, 3 (33.3%) admitted with presentation of pneumothorax, 4 (44.4%) developed during the course of the illness and 2 (22.2%) after mechanical ventilation. The mean duration of hospital stays prolonged in all cases. Out of 9 cases, 3 were managed conservatively and 6 by intercostal chest tube drainage. Mortality was observed to be 55.5% among 9 patients. Pneumothorax acts as an independent risk factor for severe covid19 infection in worsening oxygen status, prolonged hospital stay leading to morbid outcomes. So early diagnosis, appropriate treatment modality and optimized ventilatory strategies can limit the morbidity and mortality in COVID19 patients with pneumothorax.

Glycemic Control in Neurocritically Ill Patients

2019 ◽  
pp. 241-245
Author(s):  
Carla P. Venegas-Borsellino ◽  
Michael A. Pizzi ◽  
Santiago Naranjo-Sierra
Keyword(s):  
Traumatic Brain Injury ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Glycemic Control ◽  
Adverse Outcomes ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Poor Outcomes

Hyperglycemia, hypoglycemia, and variable blood glucose levels are associated with poor outcomes in critically ill patients. Patients with acute brain injury are sensitive to changes in glycemic levels because brain metabolism depends on a continuous, reliable supply of glucose. Numerous studies have shown that even moderate hypoglycemia may cause pronounced neuroglycopenia. Conversely hyperglycemia, which is prevalent in neurocritically ill patients, has been related to adverse outcomes after traumatic brain injury, ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage.

scholarly journals Early Prognostic Indicators of Subsequent Hospitalization in Patients with Mild COVID-19

2021 ◽  
Vol 10 (8) ◽  
pp. 1562
Author(s):  
Alyssa Ylescupidez ◽  
Aaron Rips ◽  
Henry T. Bahnson ◽  
Cate Speake ◽  
Punam Verma ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Case Series ◽  
Area Under The Curve ◽  
Adverse Outcomes ◽  
Symptom Clusters ◽  
Prognostic Indicators ◽  
Close Monitoring ◽  
Increased Risk ◽  
Male Sex ◽  
Poor Outcomes

Comprehensive data on early prognostic indicators in patients with mild COVID-19 remains sparse. In this single center case series, we characterized the initial clinical presentation in 180 patients with mild COVID-19 and defined the earliest predictors of subsequent deterioration and need for hospitalization. Three broad patient phenotypes and four symptom clusters were characterized, differentiated by varying risk for adverse outcomes. Among 14 symptoms assessed, subjective shortness of breath (SOB) most strongly associated with adverse outcomes (odds ratio (OR) 21.3, 95% confidence interval (CI): 2.7–166.4; p < 0.0001). In combination, SOB and number of comorbidities were highly predictive of subsequent hospitalization (area under the curve (AUC) 92%). Additionally, initial lymphopenia (OR 21.0, 95% CI: 2.1–210.1; p = 0.002) and male sex (OR 3.5, 95% CI: 0.9–13.0; p = 0.05) were associated with increased risk of poor outcomes. Patients with known comorbidities, especially multiple, and those presenting with subjective SOB or lymphopenia should receive close monitoring and consideration for preemptive treatment, even when presenting with mild symptoms.

scholarly journals Epidemiological Risk Factors Associated with Death and Severe Disease in Patients Suffering From COVID-19: A Comprehensive Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Kunchok Dorjee ◽  
Hyunju Kim
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Severe Disease ◽  
Case Series ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Increased Risk ◽  
The Us

AbstractIntroductionProgression of COVID-19 to severe disease and death is insufficiently understood.ObjectiveSummarize the prevalence adverse outcomes, risk factors, and association of risk factors with adverse outcomes in COVID-19 patients.MethodsWe searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through May 22, 2020. Data were analyzed by fixed-effects meta-analysis, using Shore’s adjusted confidence intervals to address heterogeneity.ResultsForty-four studies comprising 20594 hospitalized patients met inclusion criteria; 12591 from the US-Europe and 7885 from China. Pooled prevalence of death [%(95% CI)] was 18% (15-22%). Of those that died, 76% were aged≥ 60 years, 68% were males, and 63%, 38%, and 29% had hypertension, diabetes and heart disease, respectively. The case fatality risk [%(95% CI)] were 62% (48-78) for heart disease, 51% (36-71) for COPD, and 42% (34-50) for age≥ 60 years and 49% (33-71) for chronic kidney disease (CKD). Summary relative risk (sRR) of death were higher for age≥ 60 years [sRR=3.8; 95% CI: 2.9-4.8; n=12 studies], males [1.3; 1.2-1.5; 17], smoking history [1.9; 1.1-3.3; n=6], COPD [2.0; 1.6-2.4; n=9], hypertension [1.8; 1.7-2.0; n=14], diabetes [1.5; 1.4-1.7; n=16], heart disease [2.0; 1.7-2.4; 16] and CKD [2.0; 1.3-3.1; 8]. The overall prevalence of hypertension (55%), diabetes (31%) and heart disease (16%) among COVODI-19 patients in the US were substantially higher than the general US population.ConclusionsPublic health screening for COVID-19 can be prioritized based on risk-groups. A higher prevalence of cardiovascular risk factors in COVID-19 patients can suggest increased risk of SARS-CoV-2 acquisition in the population.

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