scholarly journals COVID-19 in Pediatric Inpatients: A Multi-Center Observational Study of Factors Associated with Negative Short-Term Outcomes

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 951
Author(s):  
Sara Rubenstein ◽  
Emily Grew ◽  
Katharine Clouser ◽  
Alexander Kwok ◽  
Aravindhan Veerapandiyan ◽  
...  

Most cases of COVID-19 in children and adolescents are mild or asymptomatic, but a small number of individuals may develop severe disease, requiring PICU admission and/or mechanical ventilation. We assessed the factors associated with negative short-term outcomes of COVID-19 in 82 pediatric patients at three hospitals within the United States during the spring and summer of 2020 using medical records, laboratory data, and imaging studies of all patients admitted with a positive RT-PCR test for SARS-CoV-2. We found that older patients were more likely to have an extended hospital stay, and those with high BMIs (over 25) were more likely to be admitted to the PICU during the early pandemic. In addition, older patients, those with high BMIs, and those with underlying medical conditions, were more likely to receive respiratory support. Given the association of age, BMI, and underlying medical conditions with more severe COVID-19, clinicians should keep these factors in mind when treating patients.

2021 ◽  
Vol 10 (16) ◽  
pp. 3521
Author(s):  
Charles Guesneau ◽  
Anne Sophie Boureau ◽  
Céline Bourigault ◽  
Gilles Berrut ◽  
Didier Lepelletier ◽  
...  

Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort design. All patients aged 75 years and over, with a diagnosis of influenza confirmed by a positive RT-PCR, were included. The primary endpoint was death within the 30 days after diagnosis. Results: 114 patients were included; 14 (12.3%) patients died within 30 days. In multivariate analysis these patients were older (OR: 1.37 95% CI (1.05, 1.79), p = 0.021), and had a lower ADL score (OR: 0.36 95% CI (0, 17; 0.75), p = 0.006), and a higher SOFA score (OR: 2.30 95% CI (1.07, 4.94), p = 0.03). Oseltamivir treatment, initiated within the first 48 h, was independently associated with survival (OR: 0.04 95% CI (0.002, 0.78), p = 0.034). Conclusions: Identification of mortality risk factors makes it possible to consider specific secondary prevention measures such as the rapid introduction of antiviral treatment. Combined with primary prevention, these measures could help to limit the mortality associated with influenza in older patients.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S706-S706
Author(s):  
Tanaz Petigara ◽  
Ya-Ting Chen ◽  
Zhiwen Liu ◽  
Michelle Goveia ◽  
David Johnson ◽  
...  

Abstract Background The US vaccination schedule includes DTaP, IPV, Hib and HepB doses in the first 6 months of life. A previous analysis found variability in the timing of HepB doses in infants receiving DTaP-IPV/Hib. We explored factors associated with co-administration of DTaP-IPV/Hib and HepB on the same day. Methods This was a retrospective study using the MarketScan® commercial claims and encounters database. Infants born from 1 July 2010 - 30 June 2016, continuously enrolled in an insurance plan for ≥ 13 months and receiving ≥ 3 DTaP-IPV/Hib doses were included. Infants were assessed for HepB claims relative to the first and third DTaP-IPV/Hib doses. Because a HepB birth dose was assumed, the first HepB claim from 29 - 169 days following birth was counted as Dose 2, and the second claim from 170 days - 12 months as Dose 3. Associations between demographic, provider, and insurance characteristics, receipt of other pediatric vaccines, and co-administration of DTaP-IPV/Hib and HepB were analyzed using multivariate logistic regression. Results Among 165,553 infants who received a first DTaP-IPV/Hib dose, 60.7% received HepB Dose 2 on the same day. Among 162,217 infants who received a third DTaP-IPV/Hib dose, 45.1% received HepB Dose 3 on the same day. Infants in the Northeast were less likely (OR=0.38, 95%CI=0.36-0.39), while those in the West were more likely (OR=1.41, 95%CI=1.36-1.46) than infants in the South to receive the first dose of DTaP-IPV/Hib and HepB Dose 2 on the same day. Infants vaccinated by pediatricians (OR=0.54, 95%CI=0.53-0.55) were less likely to receive the first dose of DTaP-IPV/Hib and HepB Dose 2 on the same day compared to infants vaccinated by family physicians. Infants who received PCV on the same day as the first dose of DTaP-IPV/Hib were more likely to receive HepB Dose 2 (OR=6.96, 95%CI=6.30-7.70) that day. These factors were also associated with co-administration of the third dose of DTaP-IPV/Hib and HepB Dose 3. Conclusion Differences in co-administration of DTaP-IPV/Hib and HepB were associated with region of residence, provider type and co-administration of PCV. The reasons underlying these differences merit exploration. A hexavalent vaccine containing DTaP, IPV, Hib, and HepB could improve timeliness of HepB vaccination, while reducing the number of injections during infancy. Disclosures Tanaz Petigara, PhD, Merck & Co., Inc. (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder) Zhiwen Liu, PhD, Merck & Co., Inc., (Employee) Michelle Goveia, MD, Merck & Co., Inc (Employee, Shareholder) David Johnson, MD, MPH, Sanofi Pasteur (Employee, Shareholder) Gary S. Marshall, MD, GlaxoSmithKline (Consultant, Scientific Research Study Investigator)Merck (Consultant, Scientific Research Study Investigator)Pfizer (Consultant, Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Grant/Research Support, Scientific Research Study Investigator, Honorarium for conference lecture)Seqirus (Consultant, Scientific Research Study Investigator)


2020 ◽  
Vol 148 ◽  
Author(s):  
Pingzheng Mo ◽  
Liping Deng ◽  
Xiaoping Liu ◽  
Shicheng Gao ◽  
Ke Liang ◽  
...  

Abstract The epidemic of coronavirus disease 2019 (COVID-19) began in China and had spread rapidly to many other countries. This study aimed to identify risk factors associated with delayed negative conversion of SARS-CoV-2 in COVID-19 patients. In this retrospective single-centre study, we included 169 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from 15th January to 2nd March. The cases were divided into two groups according to the median time of SARS-CoV-2 negative conversion. The differences between groups were compared. In total, 169 patients had a median virus negative conversion time of 18 days (interquartile range: 11–25) from symptom onset. Compared with the patients with short-term negative conversion, those with long-term conversion had an older age, higher incidence of comorbidities, chief complaints of cough and chest distress/breath shortness and severer illness on admission, higher level of leucocytes, neutrophils, aspartate aminotransferase, creatine kinase and erythrocyte sedimentation rate (ESR), lower level of CD3+CD4+ lymphocytes and albumin and more likely to receive mechanical ventilation. In multivariate analysis, cough, leucocytes, neutrophils and ESR were positively correlated with delayed virus negative conversion, and CD3+CD4+ lymphocytes were negatively correlated. The integrated indicator of leucocytes, neutrophils and CD3+CD4+ lymphocytes showed a good performance in predicting the negative conversion within 2 weeks (area under ROC curve (AUC) = 0.815), 3 weeks (AUC = 0.804), 4 weeks (AUC = 0.812) and 5 weeks (AUC = 0.786). In conclusion, longer quarantine periods might be more justified for COVID-19 patients with cough, higher levels of leucocytes, neutrophils and ESR and lower levels of CD3+CD4+ lymphocytes.


2010 ◽  
Vol 2 ◽  
pp. CMT.S2794
Author(s):  
Toni L. Ripley ◽  
Thomas A. Hennebry

Heart failure (HF) is a very prevalent disease in the United States and in Europe, with the highest prevalence among older patients. Population estimates suggest substantial growth among the elderly over the next four decades. However, older patients are underrepresented in clinical trials evaluating HF therapies and are less likely to receive the medications shown in these trials to reduce the morbidity and mortality associated with HF. Age-related differences exist in cardiovascular function that may affect disease progression, clinical presentation, and/or response to therapy. Further, medication use in older patients is complicated by physiologic changes in pharmacokinetics and the presence of multiple co-morbidities, which leads to polypharmacy and the related complications. We reviewed the pharmacotherapy clinical trials in HF to review the results specifically in older patients. Trials were included in this review if clinical endpoints were evaluated, if data regarding the participants’ age was reported, and if the intervention studied was in a medication class that is generally recommended for patients with HF by published guidelines. Although some non-randomized data shows benefits of standard therapies may be maintained among patients with HF ≥ 60 years old, the randomized controlled trials that have been published to date showed no benefit and no harm in this group. Cautious HF management among older patients is critical as additional evidence is pursued.


2006 ◽  
Vol 7 (3) ◽  
pp. 108
Author(s):  
G. Guerra ◽  
G. Zuliani ◽  
A. Cherubini ◽  
C. Ruggiero ◽  
F. Di Todaro ◽  
...  

2021 ◽  
Vol 14 (2) ◽  
pp. 42-54
Author(s):  
Wasim Md Mohosin Ul Haque ◽  
Chinmay Saha Podder ◽  
Nandini Chowdhury ◽  
Md Mohim Ibne Sina ◽  
SKM Shameem Kawser ◽  
...  

Background and objectives: Various new manifestations and risk factors for COVID-19 have been unveiled in the course of the current pandemic. Understanding the clinical spectrums as well as the risk factors associated with the adverse outcome of the disease is critical to combat this pandemic. This study was conducted to identify the clinical features, overall outcome and the factors associated with adverse outcome of the hospitalised COVID-19 patients in a semi-urban healthcare setting. Methods: This study was conducted at Debidwar Upazila (sub-district) Health Complex under the Cumilla district from April 2020 to October 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 patients, aged 18 years and above, admitted at the Health Complex were enrolled in the study. All patients were followed till their recovery, referral or death. The data were collected in a pre-designed semi-structured questionnaire that included demographic, epidemiological, clinical and laboratory parameters. Result: Out of 50 RT-PCR positiveCOVID-19 adult participants, 30 (60%) were males and 20 (40%) were females. Twenty-four percent, 36%, and 40% of the patients had mild, moderate and severe disease respectively. The most common clinical symptom was fever (96%), followed by cough (86%) and shortness of breath (60%). Hypertension (54%), diabetes mellitus (40%), bronchial asthma (20%) and chronic obstructive pulmonary disease (COPD, 14%) were the major co-morbid conditions. Of the total cases, 2 (4%) died and 8 (16%) required referral to tertiary care hospital while 40 (80%) recovered. COPD was associated with poor outcome (OR 19; 95% CI: 2.88, 125.31; p < 0.05). Smokers were 7 times more likely to exhibit the negative outcome than non-smokers (95% CI: 1.52, 32.33; p < 0.05). Conclusion: In this study, COPD was associated with a negative outcome. Further study with larger sample should be carried out to determine the spectrum of risk factors. Ibrahim Med. Coll. J. 2020; 14(2): 42-54


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261866
Author(s):  
Hiromichi Hara ◽  
Keitaro Okuda ◽  
Jun Araya ◽  
Hirofumi Utsumi ◽  
Daisuke Takekoshi ◽  
...  

Objectives Recently, incidence of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD) is increasing worldwide. We aimed to identify factors associated with severity of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD). Methods All patients diagnosed as Mab-PD based on the official ATS/IDSA statement between 2017 January 1 and 2021 July 31 were included (n = 13). We reviewed medical records, bacteriological and laboratory data of the patients. Severity of lung lesions and esophageal diameters in chest CT were quantitatively evaluated. Gaffky score in the sputum was used as airway mycobacterial burden. We explored the factors associated with high CT score and high Gaffky score. Results Maximum diameter of esophagus (MDE) in severe disease (CT score≧10) was greater than that in milder disease (CT score<10) (18.0±7.9mm, 9.3±3.1mm, respectively, p = 0.01), and MDE was well correlated with CT score (R = 0.69, p = 0.007). MDE in high mycobacterial burden group (Gaffky score ≧5) tended to be greater than that in low mycobacterial burden group (Gaffky score <5) (16.1±6.8mm, 10.1±5.5mm, respectively, p = 0.12), and MDE was well correlated with Gaffky score (R = 0.68, p = 0.009). Lung lesions were bilateral and predominant in middle or lower lobes. Conclusions Esophageal dilatation was correlated with severity of Mab-PD and airway mycobacterial burden. Gastroesophageal reflux might be associated with Mab disease progression.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 361-361
Author(s):  
Ang Li ◽  
Qian V. Wu ◽  
Greg Warnick ◽  
Edward N. Libby ◽  
David A. Garcia ◽  
...  

Abstract Introduction: Chemotherapy backbones with immunomodulatory drugs have become the standard of care for the treatment of multiple myeloma (MM). Despite improved survival outcomes, thrombotic complications remain a concern especially in the older patients with co-morbidities. A meta-analysis showed that lenalidomide might be associated with lower rate of thromboembolism than thalidomide-containing regimen in patients with newly diagnosed MM with (0.7 vs. 2.6 per 100-patient-cycle) or without prophylaxis (0.8 vs. 4.1 per 100-patient-cycle) (JTH 2011;9:653). As thalidomide is still commonly used outside of the United States, it is important to understand if the thromboprophylaxis guideline is generalizable to all immunomodulatory drugs. However, no prior study has directly compared the thrombotic incidence between the two regimens while accounting for confounders. In the current propensity score weighted study, we have examined the incidence of venous (VTE) and arterial (ATE) thromboembolism and survival for older patients with newly diagnosed MM treated with lenalidomide- versus thalidomide-containing regimen. Methods: We performed a retrospective cohort study using the SEER-Medicare database and selected all patients 66 or older with newly diagnosed MM 2007 to 2013. Patients were included if they had a prescription of IMID within twelve months of diagnosis and complete enrollment for fee-for-service and prescription drug coverage. Patients were followed from the IMID index date until first VTE occurrence or death and they were censored for disenrollment from Medicare A/B/D, enrollment in health maintenance organization, or 12/31/2014. We defined VTE (including pulmonary embolism and deep vein thrombosis) and ATE (including acute stroke and myocardial infarction) using previously validated ICD-9-CM codes with positive predictive value of 75-95% (Thromb Res 2010;126:61, Am Heart J 2004;148:99, Stroke 2014;45:3219). We used inverse probability of treatment weighting (IPTW) to balance potential confounders (demographics, year of diagnosis, co-morbidities, concurrent medications) where a standardized difference (SD) of <0.1 was considered adequate balance. Weighted Kaplan-Meier curves and Cox models (HR) were used to compare overall survival. Weighted cumulative incidence curves and Fine-Gray subdistribution hazards models (SHR) were used to compare VTE and ATE incidence where death was treated as a competing risk. Variance was estimated via 200 bootstraps. Results: Among 2397 older MM patients that met the study criteria, 78% received lenalidomide (n=1863) and 22% thalidomide (n=534). There was a strong temporal trend of increasing lenalidomide use over time (Table 1). The lenalidomide group was more likely to receive bortezomib and lower dose of dexamethasone and less likely to receive anticoagulant prophylaxis. All confounders were balanced between the two treatment groups after IPTW. The 12-month incidence of VTE (10%) and ATE (5%) were similarly high in both groups (Figure 1a-b). Lenalidomide vs. thalidomide had a SHR of 1.11 (0.59-2.02) for VTE and a SHR 0.96 (0.45-1.98) for ATE. Overall survival was also not significantly different with a HR of 0.88 (0.60-1.18) for lenalidomide vs. thalidomide. Conclusion: In this propensity score weighted study of older patients with newly diagnosed MM, the cumulative incidences of VTE and ATE were similarly high in both lenalidomide- and thalidomide-treatment groups. The lack of difference in overall survival should be interpreted with caution as residual confounding such as severity of disease could influence this outcome. Our results suggest that appropriate risk stratification and vigilant thromboprophylaxis remain essential for MM patients receiving all types of immunomodulatory drugs. Disclosures Garcia: Retham Technologies LLC: Consultancy; Shingoi: Consultancy; Portola: Research Funding; Boehringer Ingelheim: Consultancy; Bristol Meyers Squibb: Consultancy; Janssen: Consultancy, Research Funding; Incyte: Research Funding; Daiichi Sankyo: Research Funding; Pfizer: Consultancy. Lyman:Amgen: Other: Research support; Halozyme; G1 Therapeutics; Coherus Biosciences: Consultancy; Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees.


2016 ◽  
Vol 11 (6) ◽  
pp. 960-967 ◽  
Author(s):  
Sana’ M.H. Al Aqqad ◽  
Balamurugan Tangiisuran ◽  
Irfhan Ali Hyder Ali ◽  
Razul Md. Nazri Md. Kassim ◽  
Jyi Lin Wong ◽  
...  

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10559-10559
Author(s):  
Karen L. Sherman ◽  
Jeffrey D. Wayne ◽  
Mark Agulnik ◽  
David J. Bentrem ◽  
Karl Y. Bilimoria

10559 Background: National guidelines for extremity sarcoma recommend multidisciplinary consultation, but treatment approaches are not standardized. Our objectives were to (1) examine trends in the multimodality treatment of extremity sarcoma in the US, (2) examine adjuvant therapy practice patterns, and (3) identify factors associated with the use and sequencing of adjuvant treatment. Methods: Using the National Cancer Data Base (2000-2009), use of multimodality treatment for non-metastatic extremity sarcoma was examined. Regression models were developed to identify factors associated with adjuvant therapy receipt and treatment sequence. Results: A total of 22,051 patients underwent resection (Stage I: 45%, stage II: 28%, Stage III: 27%). Trend analysis demonstrated relatively constant rates of radiation therapy (RT) (58% to 65%), chemotherapy (21% to 23%), and any adjuvant therapy (65% to 72%), however the proportion receiving neoadjuvant therapy increased (RT: 14% to 28%; chemotherapy: 9% to 13%; any: 18% to 27%; all p <0.001). Stage-specific treatment use is shown in the table below. Though RT rates were similar for all histologies, chemotherapy rates for synovial sarcoma were higher for all stages (I: 24.3%; II: 24.9%; III: 53.2%, p < 0.001). After adjusting for differences in tumor factors, patients were more likely to receive neoadjuvant therapy (chemotherapy and/or RT) if treated at high-volume academic center (p<0.001). After adjusting for histology, patients were more likely to receive adjuvant radiation therapy if younger, healthier, privately insured, or tumor size >5cm. Patients were more likely to receive adjuvant chemotherapy if were younger, healthier (fewer comorbidities), underinsured, treated at a high-volume academic center, or tumor size >5cm. Conclusions: Use of a multimodality approach for extremity sarcoma management has increased over time, particularly for neoadjuvant therapy. However, practice patterns are related to hospital type and socioeconomic factors. There may remain opportunities to increase multidisciplinary care and multimodality treatment for extremity sarcoma in the United States. [Table: see text]


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