Risk of mortality following discharge from Critical Care

ABSTRACTObjectivesCritical care provides specialist treatment for patients with life-threatening illnesses and injuries. Outcomes data are fundamental to identify where resources need to be focused to provide safer care; we can determine long term survival after critical care and identify the risk factors of mortality by linking the critical care data with a mortality register, thereby building on previous survival reporting which is constrained to mortality within the admission. The objective is to identify the factors that increase the risk of mortality following discharge from critical care.ApproachAnonymised critical care data reported from 1st April 2006 are held within the Secure Anonymised Information Linkage (SAIL) databank and will be linked with ONS mortality data, inpatients data and the Welsh Demographic Service dataset. Details of patient care during the critical care admission such as duration of level 2/3 support, the organs supported and discharge details such as the time of day, along with patient demographics such as age, sex and socioeconomic factors are available for analysis. Adult Welsh patients alive at the discharge date and with a discharge date from critical care on or before 31.12.2013 will be followed up until 31.12.2014, outward migration or death. ResultsSurvival analysis techniques will be used to determine the risk of death at certain time points after discharge from critical care and to identify the risk factors associated with mortality. ConclusionDetermining the factors associated with mortality will allow patients at highest risk of death to be identified. If these risk factors are modifiable, then preventive interventions can be introduced to reduce the number of avoidable deaths.

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Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland: a national electronic healthcare record linkage cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023853 ◽

2018 ◽

Vol 8 (12) ◽

pp. e023853 ◽

Cited By ~ 1

Author(s):

Chiara Ventre ◽

Sian Nowell ◽

Catriona Graham ◽

Doug Kidd ◽

Christos Skouras ◽

...

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Critical Care ◽

Cohort Study ◽

General Population ◽

Record Linkage ◽

Factors Associated ◽

Critical Care Admission ◽

New Onset

IntroductionSevere acute pancreatitis (AP) requiring critical care admission (ccAP) impacts negatively on long-term survival.ObjectiveTo document organ-specific new morbidity and identify risk factors associated with premature mortality after an episode of ccAP.DesignCohort study.SettingElectronic healthcare registries in Scotland.ParticipantsThe ccAP cohort included 1471 patients admitted to critical care with AP between 1 January 2008 and 31 December 2010 followed up until 31 December 2014. The population cohort included 3450 individuals from the general population of Scotland frequency-matched for age, sex and social deprivation.MethodsRecord linkage of routinely collected electronic health data with population matching.Primary and secondary outcome measuresPatient demographics, comorbidity (Charlson Comorbidity Index), acute physiology, organ support and other critical care data were linked to records of mortality (death certificate data) and new-onset morbidity. Kaplan-Meier and Cox regression analyses were used to identify risk factors associated with mortality.Results310 patients with AP died during the index admission. Outcomes were not ascertained for five patients, and the deprivation quintile was not known for six patients. 340 of 1150 patients in the resulting postdischarge ccAP cohort died during the follow-up period. Greater comorbidity measured by the Charlson score, prior to ccAP, negatively influenced survival in the hospital and after discharge. The odds of developing new-onset diabetes mellitus after ccAP compared with the general population were 10.70 (95% CI 5.74 to 19.94). A new diagnosis of myocardial infarction, stroke, heart failure, liver disease, peptic ulcer, renal failure, cancer, peripheral vascular disease and lung disease was more frequent in the ccAP cohort than in the general population.ConclusionsThe persistent deleterious impact of severe AP on long-term outcome and survival is multifactorial in origin, influenced by pre-existing patient characteristics and acute episode features. Further mechanistic and epidemiological investigation is warranted.

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A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

Frontiers in Immunology ◽

10.3389/fimmu.2021.744696 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mark J. Ponsford ◽

Tom J. C. Ward ◽

Simon M. Stoneham ◽

Clare M. Dallimore ◽

Davina Sham ◽

...

Keyword(s):

Systematic Review ◽

Critical Care ◽

Relative Risk ◽

Meta Analysis ◽

Case Definition ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

Critical Care Admission ◽

Community Acquired Infection

BackgroundLittle is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection.MethodsWe systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition.Results21 studies were included in the primary MA, describing 8,251 admissions across 8 countries during the first wave, comprising 1513 probable or definite nosocomial COVID-19, and 6738 community-acquired cases. Across all studies, the risk of mortality was 1.3 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.005 to 1.683). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61).ConclusionsAdults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups.Systematic Review RegistrationPROSPERO CRD42021249023

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Multivalve Infective Endocarditis In Intravenous Drug Using Patients: An Epidemiological Study

QJM ◽

10.1093/qjmed/hcab225 ◽

2021 ◽

Author(s):

Isa Khan ◽

Elizabeth Brookes ◽

Nima Yaftian ◽

Andrew Wilson ◽

Jonathan Darby ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Social Issues ◽

High Rate ◽

Intravenous Drug ◽

Term Survival ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk

Abstract Background Infective endocarditis (IE) remains a life-threatening condition. Intravenous drug use (IVDU) adds to the clinical challenge associated with IE due to clinical aberrations caused by the social issues associated with this population. Aim To improve survival this study aimed to characterise the contemporary IVDU associated IE population seen at our tertiary hospital, determine their long-term outcomes, and find risk factors associated with mortality. Design Retrospective observational cohort study. Methods 79 patients accounting for 89 presentations were treated for IVDU associated IE at St Vincent’s Hospital Melbourne (SVHM) between 1999 and 2015. Patients were followed up until death or January 2021. The primary outcome was all-cause mortality and Kaplan-Meier survival analysis was used to calculate long-term survival estimates. Cox proportional hazards analysis was used to examine risk factors for mortality. Results The IVDU population treated at SVHM had a high rate of multivalvular IE, at 18.98%. Multivariate analysis revealed that multivalvular IE is significantly associated with an increased risk of mortality in a dose-dependent relationship (two valves affected: HR = 4.73, P = 0.006, three valves affected: HR = 14.19, P = 0.014). The IVDU population has survival estimates of 83.78% (95%CI: 73.21-90.45%) at 1-year and 64.98% (95%CI: 50.94-75.92%) at 15-years. Conclusion IVDU patients have high rates of multivalvular endocarditis, which is associated with increased risk of mortality and difficult to identify on echocardiography. Clinicians should be suspicious of multivalve involvement in the IVDU population and decisions related to medical management/intervention should be made with the understanding that these patients are at a higher risk of death.

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A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

10.1101/2021.07.10.21260306 ◽

2021 ◽

Author(s):

Mark J Ponsfonrd ◽

Tom JC Ward ◽

Simon Stoneham ◽

Clare M Dallimore ◽

Davina Sham ◽

...

Keyword(s):

Systematic Review ◽

Critical Care ◽

Relative Risk ◽

Meta Analysis ◽

Case Definition ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

Critical Care Admission ◽

Community Acquired Infection

Background: Little is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection. Methods: We systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition. Results: 21 studies were included in the primary MA, describing 8,246 admissions across 8 countries during the first wave, comprising 1517 probable or definite nosocomial COVID-19, and 6729 community-acquired cases. Across all studies, the risk of mortality was 1.31 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.01 to 1.70). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61). Conclusions: Adults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy, and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups. Systematic review registration: PROSPERO CRD42021249023

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Understanding Terminal Decline in Cognition and Risk of Death

European Psychologist ◽

10.1027/1016-9040.11.3.164 ◽

2006 ◽

Vol 11 (3) ◽

pp. 164-171 ◽

Cited By ~ 16

Author(s):

Patrick Rabbitt ◽

Mary Lunn ◽

Danny Wong

Keyword(s):

Risk Factors ◽

Longitudinal Study ◽

Test Scores ◽

Intelligence Test ◽

Practice Effects ◽

Risk Of Death ◽

Risk Of Mortality ◽

Impending Death ◽

Intelligence Test Scores ◽

Reduced Risk

There is new empirical evidence that the effects of impending death on cognition have been miscalculated because of neglect of the incidence of dropout and of practice gains during longitudinal studies. When these are taken into consideration, amounts and rates of cognitive declines preceding death and dropout are seen to be almost identical, and participants aged 49 to 93 years who neither dropout nor die show little or no decline during a 20-year longitudinal study. Practice effects are theoretically informative. Positive gains are greater for young and more intelligent participants and at all levels of intelligence and durations of practice; declines in scores of 10% or more between successive quadrennial test sessions are risk factors for mortality. Higher baseline intelligence test scores are also associated with reduced risk of mortality, even when demographics and socioeconomic advantage have been taken into consideration.

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Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data

10.1101/2021.01.19.20241844 ◽

2021 ◽

Author(s):

Lisa Cummins ◽

Irene Ebyarimpa ◽

Nathan Cheetham ◽

Victoria Tzortziou Brown ◽

Katie Brennan ◽

...

Keyword(s):

Risk Factors ◽

Learning Disabilities ◽

Secondary Care ◽

Multivariate Logistic Regression Analysis ◽

Additional Patient ◽

Factors Associated ◽

Icu Admission ◽

Risk Of Death ◽

North East ◽

Increased Risk

AbstractBackgroundTo identify risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.MethodsMultivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020-30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and p-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.ResultsOver the study period 1,781 people were diagnosed with COVID-19, of whom 1,195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia in-creased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR=4.75, 95%CI=(1.91,11.84), p=0.001). Having three or four co-morbidities increased the risk of hospitalisation (OR=2.34,95%CI=(1.55,3.54),p<0.001;OR=2.40, 95%CI=(1.55,3.73), p<0.001 respectively) and death (OR=2.61, 95%CI=(1.59,4.28), p<0.001;OR=4.07, 95% CI= (2.48,6.69), p<0.001 respectively).ConclusionsWe confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.

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Risk factors associated with the severity of COVID-19 in a region of the Brazilian Amazon

Scientific Reports ◽

10.1038/s41598-021-00009-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniele Melo Sardinha ◽

Rosane do Socorro Pompeu de Loiola ◽

Ana Lúcia da Silva Ferreira ◽

Carmem Aliandra Freire de Sá ◽

Yan Corrêa Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Brazilian Amazon ◽

The State ◽

Metropolitan Region ◽

Epidemiological Surveillance ◽

Cross Sectional ◽

Factors Associated ◽

Risk Of Death ◽

Increased Risk ◽

Brazilian Amazon Region

AbstractThe Brazilian Northern region registered a high incidence of COVID-19 cases, particularly in the state of Pará. The present study investigated the risk factors associated with the severity of COVID-19 in a Brazilian Amazon region of 100,819 cases. An epidemiological, cross-sectional, analytical and demographic study, analyzing data on confirmed cases for COVID-19 available at the Brazilian Ministry of Health's surveillance platform, was conducted. Variables such as, municipalities of residence, age, gender, signs and symptoms, comorbidities were included and associated with COVID-19 cases and outcomes. The spatial distribution was performed using the ArcGIS program. A total of 100,819 cases were evaluated. Overall, patients had the mean age of 42.3 years, were female (51.2%) and with lethality reaching 4.79% of cases. Main symptoms included fever (66.5%), cough (61.9%) and sore throat (39.8%). Regarding comorbidities, most of the patients presented cardiovascular disease (5.1%) and diabetes (4.2%). Neurological disease increased risk of death by nearly 15 times, followed by obesity (5.16 times) and immunodeficiency (5.09 time). The municipalities with the highest incidence rate were Parauapebas, Canaã dos Carajás and Jacareacanga. Similarity between the Lower Amazon, Marajó and Southwest mesoregions of Pará state were observed concerning the highest morbidity rates. The obtained data demonstrated that the majority of cases occurred among young adults, females, with the classic influenza symptoms and chronic diseases. Finally, data suggest that the highest incidences were no longer in the metropolitan region of the state. The higher lethality rate than in Brazil may be associated with the greater impacts of the disease in this Amazonian population, or factors associated with fragile epidemiological surveillance in the notification of cases of cure.

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Ethnicity and other COVID-19 death risk factors in Mexico

Archives of Medical Science ◽

10.5114/aoms.2020.101443 ◽

2020 ◽

Author(s):

Erwin Chiquete ◽

Jesus Alegre-Díaz ◽

Ana Ochoa-Guzmán ◽

Liz Nicole Toapanta-Yanchapaxi ◽

Carlos González-Carballo ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards Model ◽

Invasive Mechanical Ventilation ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Chronic Obstructive ◽

Death Risk ◽

Factors Associated ◽

Risk Of Death

IntroductionPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19.Material and methodsWe analysed the Mexican Ministry of Health’s official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model.ResultsAs of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07–10.59%). The median time (interquartile range, IQR) from symptoms onset to death was nine days (5–13 days), and from hospital admission to death 4 days (2–8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IVM, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV).ConclusionsIn Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.

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Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management

Blood ◽

10.1182/blood-2011-11-327361 ◽

2012 ◽

Vol 120 (3) ◽

pp. 528-537 ◽

Cited By ~ 201

Author(s):

Karina Yazdanbakhsh ◽

Russell E. Ware ◽

France Noizat-Pirenne

Keyword(s):

Risk Factors ◽

Sickle Cell Disease ◽

Blood Cell ◽

Sickle Cell ◽

Red Blood Cell ◽

Cell Disease ◽

Factors Associated ◽

Life Threatening ◽

Red Blood Cell Transfusions ◽

Transfusion Reactions

Abstract Red blood cell transfusions have reduced morbidity and mortality for patients with sickle cell disease. Transfusions can lead to erythrocyte alloimmunization, however, with serious complications for the patient including life-threatening delayed hemolytic transfusion reactions and difficulty in finding compatible units, which can cause transfusion delays. In this review, we discuss the risk factors associated with alloimmunization with emphasis on possible mechanisms that can trigger delayed hemolytic transfusion reactions in sickle cell disease, and we describe the challenges in transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication.

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Abstract P058: Elevated Systolic Blood Pressure is Associated with Mortality in Faster, but Not Slower Walking Elderly Adults

Circulation ◽

10.1161/circ.125.suppl_10.ap058 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Michelle C Odden ◽

Carmen A Peralta ◽

Mary N Haan ◽

Kenneth E Covinsky

Keyword(s):

Blood Pressure ◽

At Risk ◽

High Blood Pressure ◽

Walking Speed ◽

Mortality Data ◽

P Value ◽

Elderly Adults ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk

Introduction: The association between high blood pressure (BP) and risk of death varies by age and appears to be attenuated in some elderly adults. Walking speed is an excellent measure of functional status and may identify which elders may be most at risk for the adverse consequences of hypertension. Hypothesis: We hypothesized that elevated BP would be associated with greater risk of mortality in faster walkers, but not in slower walkers. Methods: The study population included 2,340 persons ≥ 65 years, with measured BP, in the National Health and Nutrition Examination Survey (NHANES) waves 1999-2000 and 2001-2002. Mortality data was linked to death certificate data in the National Death Index. Walking speed was measured over a 20-foot walk; 243 (8%) did not complete the walk for various safety and logistical reasons. Participants with walking speed above the mean (2.7 ft/sec) were classified as faster walkers. Potential confouders included age, sex, race, survey year, lifestyle and physiologic factors, chronic health conditions, and antihypertensive use. Results: There were 589 deaths recorded through December 31 st , 2006. Among faster walkers, those with elevated systolic BP (≥140 mmHg) had a higher mortality rate compared to those with systolic BP <140 mmHg (236 vs. 161 per 100,000 person-years). Among slower walkers, mortality rates did not appear to differ by the presence of elevated systolic BP (586 vs. 563 per 100,000 person-years). This pattern remained after multivariable adjustment; there was an association between elevated systolic BP and mortality in faster, but not slower walkers (Table). Elevated diastolic BP was not independently associated with an increased risk of mortality. Conclusions: If confirmed in other studies, walking speed could be a simple measure to identify elderly adults who are most at risk for poor outcomes related to high blood pressure. Table Association of elevated blood pressure and mortality, stratified by walking speed Hazard Ratio (HR) of Death Faster Walking Speed >2.7 ft/sec (n = 1,279) Slower Walking Speed ≤ 2.7 ft/sec (n = 818) p-value for interaction HR (95% CI) p-value HR (95% CI) p-value Elevated Systolic BP (≥140 mmHg) 1.44 (1.04, 1.99) 0.03 1.08 (0.82, 1.42) 0.56 0.11 Elevated Diastolic BP (≥90 mmHg) 1.09 (0.52, 2.27) 0.82 0.65 (0.30, 1.45) 0.28 0.28 Funding (This research has received full or partial funding support from the American Heart Association, Western States Affiliate (California, Nevada&Utah))

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