Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

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The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study

10.21203/rs.2.20901/v3 ◽

2020 ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Clinical Outcomes ◽

Influenza A ◽

Logistic Regression Model ◽

Neuraminidase Inhibitor ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Severe Influenza ◽

The Impact

Abstract Background Guidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. Furthermore, data about the administration of NAIs in the real-world management of Flu-p in China are limited.Methods: Data of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis.Results: In total, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [odds ratio (OR) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality (OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use (OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication (OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians.Conclusions: Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

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The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study

10.21203/rs.2.20901/v1 ◽

2020 ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Clinical Outcomes ◽

Influenza A ◽

Logistic Regression Model ◽

Neuraminidase Inhibitor ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Severe Influenza ◽

The Impact

Abstract Background Guidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. And there is limited data about the administration of NAIs in the real-world management of Flu-p in China.Methods Data of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis.Results Totally, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [ odds ratio ( OR ) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality ( OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use ( OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication ( OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians.Conclusions Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

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Association of Body Mass Index and Hypoglycaemia with Mortality Rates Among Sepsis Patients: A Retrospective Sub-Analysis of the FORECAST Study

10.21203/rs.3.rs-615999/v1 ◽

2021 ◽

Author(s):

Atsushi Tanikawa ◽

Daisuke Kudo ◽

Hiroyuki Ohbe ◽

Shigeki Kushimoto

Keyword(s):

Body Mass Index ◽

Logistic Regression ◽

Hospital Mortality ◽

Regression Model ◽

Glucose Level ◽

High Mortality ◽

Logistic Regression Model ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

High Bmi

Abstract Background: Hypoglycaemia at admission is associated with high mortality in sepsis patients. The association of hypoglycaemia and body mass index (BMI) with mortality in sepsis patients has not been clarified. We aimed to assess the influence hypoglycaemia at admission on mortality in sepsis patients according to BMI categories.Methods: This was a secondary analysis of a multicentre, prospective cohort study of 59 intensive care unit in Japan. The study included 1,184 patients (age ≥16 years) with severe sepsis; the diagnosis was made based on the Sepsis-2 criteria. After excluding patients with missing data of glucose level, BMI, or survival at discharge, patients were divided into groups according to the initial blood glucose level, <70 (hypoglycaemia) or ≥70 (non-hypoglycaemia) mg/dL, and according to BMI categories, <18.5 (low), 18.5–24.9 (normal), and ≥25 (high) kg/m2. The main outcome measure was in-hospital mortality. A multivariate logistic regression model was used to examine the association between hypoglycaemia and in-hospital mortality. BMI category-by-hypoglycaemia interactions were evaluated to assess the heterogeneity of the impact of hypoglycaemia on in-hospital mortality across BMI categories.Results: In total, 1,103 patients, including 65 patients with hypoglycaemia, were analysed. Among patients with hypoglycaemia, 13 had low, 38 had normal, and 14 had high BMI. Patients with hypoglycaemia showed higher in-hospital mortality (18/38, 47.4%) than those without hypoglycaemia (119/584, 20.4%) in the normal BMI group but not in the low and high BMI groups. In the multivariate logistic regression model, hypoglycaemia was not significantly associated with higher mortality in all patients (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.77–2.58). However, there was a significant interaction between patients with normal BMI and hypoglycaemia on in-hospital mortality but not between patients with low or high BMI and hypoglycaemia (OR 2.32, 95% CI 1.05–5.07), and p for interaction: 0.0476).Conclusions: Hypoglycaemia at admission in sepsis patients was associated with high mortality in patients with normal BMI, but not in those with low or high BMI. This association may be used as a prognostic marker in sepsis patients.

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Histological chorioamnionitis is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks

BMC Pediatrics ◽

10.1186/s12887-021-02572-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoli Wang ◽

Haiyuan Li ◽

Qianqian Zhang ◽

Qianwen Shen ◽

Dan Zhu ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Multivariate Logistic Regression Model ◽

Atopic Diseases ◽

Multivariate Logistic Regression ◽

Preterm Children ◽

Increased Risk ◽

Anthropometric Indexes

Abstract Background Chorioamnionitis is associated with various neonatal short- and long-term morbidities. The effect of chorioamnionitis on premature children’s outcomes remains controversial. The aim of this study is to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children. Methods Singleton, preterm children (< 34 weeks), whose mother underwent pathological placental examinations, were retrospectively enrolled and the outcomes were assessed at 24–40 months during follow-up. Wheezing and atopic diseases including eczema, food allergies, and allergic rhinitis were screened by a questionnaire along with medical diagnosis. Anthropometric indexes and blood pressure were measured. Cognitive and behavioural developments were assessed by the Gesell Development and Diagnosis Scale. Blood IgE and routine examination were analyzed with venous blood and serum metabolomic profiling was assessed via liquid chromatography-mass spectrometry (LC-MS). A multivariate logistic regression model was used to estimate the association between HCA and the current outcomes. Results Among the 115 enrolled children, 47 were exposed to HCA. The incidence of wheezing was significantly higher in children exposed to HCA, as 38.30% of children who were exposed to HCA and 16.18% of children who were not had been diagnosed with wheezing. After adjusting for related confounders in the multivariate logistic regression model, there remained a 2.72-fold increased risk of wheezing in children with HCA (adjusted odds ratio, aOR, 2.72; 95% confidence interval, 1.02–7.23). Moreover, 163 differential metabolites, such as butanoic acid, annotemoyin 1 and charine, were identified in the HCA exposed children’s serum. Enrichment analysis revealed that these compounds participated in diverse key metabolomic pathways relating to physical and neuro- developments, including glycerophospholipid, alpha-linolenic acid and choline metabolisms. There were no significant differences in atopic diseases, serum IgE, eosinophils’ level, anthropometric indexes, blood pressure, or cognitive or behavioural developments between the two groups. Conclusion HCA exposure is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks.

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Nature contact by window opening and depressive symptoms among Older Adults: A cross-sectional analysis of the Chinese Longitudinal Healthy Longevity Survey

10.1101/2020.09.25.20201970 ◽

2020 ◽

Author(s):

Xurui Jin ◽

Hao Zhang ◽

Kehan Zhang ◽

Yu Leng ◽

Yali Zhao ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Depressive Symptoms ◽

Regression Model ◽

Logistic Regression Model ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Window Opening ◽

Older Populations ◽

At Home

BACKGROUND: Recent evidence suggests that window-view and window-ventilation may contribute to mental wellbeing. Compared to their younger counterparts, older adults spend more time at home and have less contact with natural environments due to social isolation and physical decline. However, the association of residential window-opening with depressive symptoms is understudied among older populations. METHODS: We used data from a community-based cohort study conducted in 23 provinces of China including 13,125 adults age 65 years or older (mean age: 83.8 years [SD: 11.1]). We created the window opening index (WOI) as a proxy of window-view and window-ventilation, leveraging relevant data on self-reported frequencies of manual window opening at home. Depressive symptoms were assessed by the 10-item version of the Centre for Epidemiological Studies Depression scale no fewer than 10. We used multivariate logistic regression model to examine the association between window opening and depressive symptoms. RESULTS: In the multivariate logistic regression model controlling for a set of well-designed mood-influencing environmental and individual-level covariates, a protective effect of window opening on depressive symptoms was observed, with 16% lower odds per interquartile increment in WOI (odds ratio: 0.84, 95%-CI: 0.81-0.87). Subgroup analyses indicated that the beneficial effects were more pronounced among those with higher socioeconomic status (higher levels of education, urban residents) and better surrounding environments (lower exposure of ambient fine particular matter, proximity to park, or higher levels of residential greenness). DISCUSSION: The results point to the benefits of well-designed household window-opening environments on the mental health of older populations and suggest a synergistic effect of window-opening and favorable surrounding natural environment.

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Suicide after contact with substance misuse services: a national registry study

BJPsych Open ◽

10.1192/bjo.2020.23 ◽

2020 ◽

Vol 6 (3) ◽

Author(s):

Martin Ø. Myhre ◽

Anine T. Kildahl ◽

Fredrik A. Walby

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Mental Health Services ◽

Health Services ◽

Regression Model ◽

Logistic Regression Model ◽

Substance Misuse ◽

National Registry ◽

Multivariate Logistic Regression Model ◽

Increased Risk

Background People with substance use disorders have a well-known increased risk for taking their own life. Previous research has mainly focused on suicide in mental health services, whereas there is limited knowledge regarding suicide after contact with substance misuse services. Aims The aim of the current study was to describe the utilisation of both mental health services and substance misuse services among people who have died by suicide within a year of contact with substance misuse services. Method We used an explanatory observational design, where all suicide deaths in the period from 2009 to 2016 were retrieved from the Norwegian Cause of Death Registry and linked with the Norwegian Patient Registry. The people who had been in contact with substance misuse services within a year before their death were included in the sample (n = 419). The analysis was stratified by gender, and variables with significant differences between men and women were entered into a multivariate logistic regression model. Results More women (73.5%) than men (60.6%) had contact with mental health services in their last year (P = 0.01). In the adjusted logistic regression model, poisoning was more common among women (adjusted odds ratio (AOR) = 1.81, 95% CI 1.09–3.02) and women were more likely to be diagnosed with a sedative, hypnotic or anxiolytic use disorder (F14) in their last year (AOR = 2.77, 95% CI 1.37–5.68). Conclusions This study highlights gender differences for suicide in substance misuse services, and the importance of collaboration and cooperation between substance misuse services and mental health services.

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The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study

10.21203/rs.2.20901/v2 ◽

2020 ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Clinical Outcomes ◽

Influenza A ◽

Logistic Regression Model ◽

Neuraminidase Inhibitor ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Severe Influenza ◽

The Impact

Abstract Background Guidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. And there is limited data about the administration of NAIs in the real-world management of Flu-p in China. Methods Data of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis. Results Totally, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [ odds ratio ( OR ) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality ( OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use ( OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication ( OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians. Conclusions Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

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Work absence and multimorbidity in Portugal: results from the 1st National Health Examination Survey

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1390 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Matos ◽

C Matias Dias ◽

A Félix

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Chronic Diseases ◽

National Health ◽

Logistic Regression Model ◽

Health Examination ◽

Work Absence ◽

Health Examination Survey ◽

Absence From Work ◽

The Impact

Abstract Background Studies on the impact of patients with multimorbidity in the absence of work indicate that the number and type of chronic diseases may increase absenteeism and that the risk of absence from work is higher in people with two or more chronic diseases. This study analyzed the association between multimorbidity and greater frequency and duration of work absence in the portuguese population between the ages of 25 and 65 during 2015. Methods This is an epidemiological, observational, cross-sectional study with an analytical component that has its source of information from the 1st National Health Examination Survey. The study analyzed univariate, bivariate and multivariate variables under study. A multivariate logistic regression model was constructed. Results The prevalence of absenteeism was 55,1%. Education showed an association with absence of work (p = 0,0157), as well as professional activity (p = 0,0086). It wasn't possible to verify association between the presence of chronic diseases (p = 0,9358) or the presence of multimorbidity (p = 0,4309) with absence of work. The prevalence of multimorbidity was 31,8%. There was association between age (p < 0,0001), education (p < 0,001) and yield (p = 0,0009) and multimorbidity. There is no increase in the number of days of absence from work due to the increase in the number of chronic diseases. In the optimized logistic regression model the only variables that demonstrated association with the variable labor absence were age (p = 0,0391) and education (0,0089). Conclusions The scientific evidence generated will contribute to the current discussion on the need for the health and social security system to develop policies to patients with multimorbidity. Key messages The prevalence of absenteeism and multimorbidity in Portugal was respectively 55,1% and 31,8%. In the optimized model age and education demonstrated association with the variable labor absence.

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Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01590-z ◽

2021 ◽

Author(s):

Yusuke Katayama ◽

Tetsuhisa Kitamura ◽

Kosuke Kiyohara ◽

Kenichiro Ishida ◽

Tomoya Hirose ◽

...

Keyword(s):

Logistic Regression ◽

Propensity Score ◽

Hospital Mortality ◽

Regression Model ◽

Traffic Accident ◽

Logistic Regression Model ◽

Cardiopulmonary Arrest ◽

Population Based ◽

Fluid Administration ◽

Secondary Outcome

Abstract Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

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Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.745204 ◽

2021 ◽

Vol 9 ◽

Author(s):

Huabin Wang ◽

Zhongyuan He ◽

Jiahong Li ◽

Chao Lin ◽

Huan Li ◽

...

Keyword(s):

Logistic Regression ◽

Intensive Care ◽

Hospital Mortality ◽

Regression Model ◽

Clinical Outcomes ◽

Poor Prognosis ◽

Logistic Regression Model ◽

Plasma Osmolality ◽

Pediatric Intensive Care ◽

Linear Spline

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs.Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed.Results: In total, 5,620 pediatric patients were included in this study. An approximately “U”-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966–1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38–2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84–1.94). The interactions between plasma osmolality and age or complications were not significant.Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.

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