scholarly journals COVID-19 Mortality in Patients with a Ward-Based Ceiling of Care

Stresses ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 277-284
Author(s):  
Matthew Ingram ◽  
Ellen Tullo ◽  
Laura Mackay ◽  
Avinash Aujayeb ◽  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Observational Study ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Clinical Risk Factors ◽  
Organ Support ◽  
Inpatient Mortality ◽  
Distinct Subgroup ◽  
Clinical Variables

Objectives: COVID-19 patients thought unlikely to benefit from organ support, thereby having a ward-based ceiling of care (WBCoC), represent a distinct subgroup. There are no associated studies in mortality. We sought to identify clinical risk factors for inpatient COVID-19 mortality. Design and setting: this was a retrospective observational study of patients admitted to Northumbria Healthcare NHS Foundation Trust. Clinical variables were associated with inpatient mortality via logistic regression. Participants: all patients admitted with COVID-19 infection and who had a WBCoC at point of admission were included (n = 114). Main outcome measures: the outcome measure was inpatient death.

Abstract O.07: The Clinical Risk Factors of Intravenous Immunoglobulin Resistance and Coronary Artery Lesion of Kawasaki Disease: Retrospective Analysis of 602 Cases

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
lijian xie ◽  
Cuizhen Zhou ◽  
Renjian Wang ◽  
Tingting Xiao ◽  
Jie Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Clinical Evidence ◽  
Clinical Risk Factors ◽  
Ivig Treatment ◽  
Ivig Resistance ◽  
Sensitive Group

Introduction: The incidence of Kawasaki disease (KD) in China is increasing for years. The current coronary artery lesion (CAL) incidence is 5-10% in KD with intravenous immunoglobulin (IVIG) treatment. And the 10-20% KD patients still exhibit IVIG resistance. However, little clinical evidence on the occurrence of either CAL or IVIG resistance for big KD sample study in China during the past decade. Objective: In order to find clinical risk factors of CAL and IVIG resistance of KD in China. Methods: We retrospectively analyzed the clinical manifestations, laboratory results, treatment and complications of cardiac vascular of 602 KD cases from 2007 to 2012 admitted at Shanghai Children’s Hospital. The SAS 9.2 edition was used for statistical analysis. The mean ± standard deviation or the median were used for measurements. Case numbers and percentages were used for the count number. The t-test and the Mann-Whitney test were both used for mean comparisons. Single factor and multi-factor logistic regression analyses were used to analyze the risk factors. Results: 1. The KD gender male to female ratio was 1.85: 1. The KD median age was 2.0 years old (one month to 11.7 years old). 20.1% cases (121 of 602) exhibited CAL. There was no difference of CAL incidence between the gender (p=0.09). 2. The incidence of bright red cracked lips (p=0.001), peeling of the skin of the toes (p=0.021) and perianal skin peeling (p=0.031) are less in group with CAL. 3. Among the 602 cases, there were 525 cases that were sensitive to IVIG therapy. 100 of those cases had CAL with an incidence of 19.1%. Among the 26 IVIG resistance cases, there were 9 cases with CAL with an incidence of 34.6%, which was higher than the IVIG sensitive group (p=0.05). 4. ESR (p=0.014), CRP (p=0.017), PLT (p=0.003) and Hb (p=0.032) were much higher in the IVIG resistance group than the IVIG sensitive group, even though the IVIG resistance group started the IVIG treatment earlier (p=0.003). 5. Logistic regression analysis was conducted to show that GPT≥80IU/L was the independent risk factor of IVIG resistance, risk ratio was 2.945 (p=0.012) . Conclusion: This research suggests that risk factors of clinical evidence for IVIG resistance and CAL in KD.

scholarly journals Chronic suppurative otitis media in Nepal: ethnicity does not determine whether disease is associated with cholesteatoma or not

2010 ◽  
Vol 125 (1) ◽  
pp. 22-26 ◽  
Author(s):  
D Thornton ◽  
T P C Martin ◽  
P Amin ◽  
S Haque ◽  
S Wilson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Otitis Media ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Chronic Suppurative Otitis Media ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Suppurative Otitis Media ◽  
Ethnic Affiliation ◽  
Caucasian Patients

AbstractObjectives:To determine the frequency of cholesteatoma in a population of patients with chronic suppurative otitis media, and to determine whether this frequency is affected by ethnicity.Patients:The study included 6005 patients with chronic suppurative otitis media seen during the course of 30 charitable surgical ‘ear camps’ in Nepal.Main outcome measures:Proportion of patients with each subtype of disease, and their ethnicity. A secondary outcome measure was concordance of surname with Nepalese ethnic affiliation.Results:A total of 762 patients were grouped as being of Tibeto-Mongolian origin, and 4875 as Indo-Caucasian. The rate of chronic suppurative otitis media with cholesteatoma, expressed as a proportion of the rate of all chronic suppurative otitis media subtypes, was 17.8 per cent in Tibeto-Mongolian patients and 18.6 per cent in Indo-Caucasian patients (p > 0.05). The effect of other risk factors (i.e. age, gender and geographical district) on disease distribution was also non-significant. Analysis of secondary outcome measures indicated that patients' surnames were a reliable predictor of ethnicity in this Nepalese population.Conclusion:There is almost complete concordance in proportions of patients with significant genetic, cultural, and even geographical heterogeneity, suggesting that, in Nepal, the aetiology of cholesteatoma owes little to these factors.

Abstract P077: Hypertension And Ischemic Stroke; The Effect Of A Combined Anti-hypertension Medications And Thrombolytic Therapy

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Nicolas Poupore ◽  
Bridgette Allen ◽  
Thomas I Nathaniel
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Characteristic Curve ◽  
Management Strategies ◽  
Recombinant Tissue Plasminogen Activator ◽  
Clinical Risk Factors ◽  
High Density Lipoproteins ◽  
Clinical Risk

Background: The aim of this study is to identify clinical risk factors in acute ischemic stroke ( AIS) pretreated with anti-hypertensive (anti-HTN) medications with a subsequent thrombolytic therapy that are associated with potential worsening or improving neurological functions. Methods: We analyzed retrospectively collected data from consecutive AIS patients with a combined anti-HTN medications and recombinant tissue plasminogen activator (rtPA) therapy for AIS. We used logistic regression model to identify demographic and clinical risk factors that are associated with improving or worsening neurologic functions in AIS patients with a combined anti-HTN and thrombolytic therapy. The overall correct classification of the logistic regression models was determined using the Hosmer-Lemeshow test, while the area under the receiver operating characteristic curve was used to test the sensitivity of the model. The variance inflation factor was used to check for multicollinearity. Results: In the adjusted analysis, patients with increasing age (Odd ratio (OR)=1.035, 95% CI, 1.022-1.049, P <0.001), female AIS patients (OR = 1.630, 95% CI, 1.182-2.248, P =0.002) with a history of substance abuse (OR = 2.315, 95% CI, 1.107-4.842, P = 0.026) were associated with worsening neurologic functions. However, Caucasians (OR = 0.535, 95% CI, 0.361-0.793, P = 0.002) with dyslipidemia (OR = 0.655, 95% CI, 0.479-0.897, P = 0.008), obesity (OR = 0.642, 95% CI, 0.472-0.873, P = 0.005), high-density lipoproteins (HDL; OR = 0.988, 95% CI, 0.976-1.000, P = 0.045), and with a direct admission (OR = 0.509, 95% CI, 0.341-0.761, P = 0.001) were associated with improving neurologic function in AIS patients with a combined anti-HTN medications and rtPA therapy. Conclusion: Our findings reveal specific demographic and clinical risk factors that are associated with worsening or improving neurological functions in AIS pretreated anti-HTN medications with a subsequent thrombolytic therapy. This finding suggests the development of management strategies to manage identified clinical risk factors in AIS patients pretreated with anti-HTN medications prior to thrombolytic therapy.

scholarly journals The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study

2018 ◽  
Vol 33 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Wataru Takayama ◽  
Hazuki Koguchi ◽  
Akira Endo ◽  
Yasuhiro Otomo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Independent Risk Factor ◽  
Retrospective Observational Study ◽  
Multivariate Logistic Regression ◽  
Chest Injuries ◽  
Independent Risk Factors

AbstractObjectivesThe aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA).MethodsThis retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed.ResultsA total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant.ConclusionsLong duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times.TakayamaW, KoguchiH, EndoA, OtomoY. The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171–175.

scholarly journals Dialysate Cytokine Levels do not Predict Encapsulating Peritoneal Sclerosis

2014 ◽  
Vol 34 (6) ◽  
pp. 594-604 ◽  
Author(s):  
Catriona Goodlad ◽  
Frederick W.K. Tam ◽  
Sohail Ahmad ◽  
Gurjeet Bhangal ◽  
Bernard V. North ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Residual Renal Function ◽  
Clinical Risk Factors ◽  
Clinical Markers ◽  
Clinical Risk ◽  
Long Duration ◽  
Chemotactic Protein ◽  
Cytokine Levels ◽  
Elisa Technique

BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD). There is no well-validated method for predicting which patients will develop the condition, although known risk factors include long duration of PD, high glucose exposure and lack of residual renal function. We have investigated whether dialysate cytokines (MCP-1 (monocyte chemotactic protein-1), CCL18 (pulmonary and activation-regulated cytokine, PARC), IL-6 (interleukin-6), CCL15 (leukotactin) and angiogenin) could be used to predict the onset of EPS more effectively than known clinical risk factors.MethodsSamples of dialysate and clinical data were prospectively collected from 151 patients at the West London Renal center between 2003 and 2010. Dialysate cytokine levels were measured using the enzyme-linked immunoabsorbant assay (ELISA) technique. Encapsulating peritoneal sclerosis subsequently developed in 17 patients during a follow-up period of 27 – 113 months. Cytokines found at higher levels in dialysate of pre-EPS patients were investigated as candidate predictors of EPS using logistic regression analysis.ResultsDialysate IL-6, MCP-1 and CCL15 were significantly higher in patients who subsequently developed EPS; however, a logistic regression model using dialysate cytokines to predict EPS was no better than a model using well-recognized clinical markers (length of time on PD and membrane transport status).ConclusionsAlthough MCP-1, IL-6 and CCL15 were found at higher levels in the dialysate of patients who subsequently developed EPS, dialysate levels of these cytokines do not improve prediction of future EPS above a model using known clinical risk factors.

scholarly journals Myocardial Injury in COVID-19 Patients: Association with Inflammation, Coagulopathy and In-Hospital Prognosis

2021 ◽  
Vol 10 (10) ◽  
pp. 2096
Author(s):  
Victor Arévalos ◽  
Luis Ortega-Paz ◽  
Juan José Rodríguez-Arias ◽  
Margarita Calvo ◽  
Leticia Castrillo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Charlson Comorbidity Index ◽  
Myocardial Injury ◽  
Protective Factor ◽  
C Reactive Protein ◽  
Clinical Variables ◽  
Reactive Protein ◽  
Comorbidity Index ◽  
Adjusted Logistic Regression

The exact mechanisms leading to myocardial injury in the coronavirus disease 2019 (COVID-19) are still unknown. In this retrospective observational study, we include all consecutive COVID-19 patients admitted to our center. They were divided into two groups according to the presence of myocardial injury. Clinical variables, Charlson Comorbidity Index (CCI), C-reactive protein (CRP), CAC (COVID-19-associated coagulopathy), defined according to the ISTH score, treatment and in-hospital events were collected. Between March and April 2020, 331 COVID-19 patients were enrolled, 72 of them (21.8%) with myocardial injury. Patients with myocardial injury showed a higher CCI score (median (interquartile range), 5 (4–7) vs. 2 (1–4), p = 0.001), higher CRP values (18.3 (9.6–25.9) mg/dL vs. 12.0 (5.4–19.4) mg/dL, p ˂ 0.001) and CAC score (1 (0–2) vs. 0 (0–1), p = 0.001), and had lower use of any anticoagulant (57 patients (82.6%) vs. 229 patients (90.9%), p = 0.078), than those without. In the adjusted logistic regression, CRP, myocardial injury, CCI and CAC score were positive independent predictors of mortality, whereas anticoagulants resulted as a protective factor. Myocardial injury in COVID-19 patients is associated with inflammation and coagulopathy, resulting in a worse in-hospital prognosis. Treatment with anticoagulant agents may help to improve in-hospital outcomes.

scholarly journals Factors Defining the Development of Severe Illness in Patients with COVID-19: A Single-Center, Retrospective, Observational Study

2020 ◽  
Author(s):  
Xiong Yibai ◽  
Tian Yaxin ◽  
Liu Bin ◽  
Ruan Lianguo ◽  
Lu Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Lactate Dehydrogenase ◽  
Critical Illness ◽  
Observational Study ◽  
Risk Score ◽  
Severe Illness ◽  
Single Center ◽  
Training Set ◽  
Validation Set

Abstract Objective Early triage of patients with coronavirus disease 2019 (COVID-19) is pivotal in managing the disease. However, data on the risk factors for the development of severe disease remains scant. Here, we report a clinical risk score system for severe illness and highlight possible protective factors, which might inform proper treatment strategies.Methods We conducted a retrospective, single-center, observational study at the JinYinTan Hospital from January 24,2020 to March 31, 2020. We evaluated the demographic, clinical, and laboratory data and performed a 3-fold cross-validation to split the data into training set and validation set. We then screened the prognostic factors for severe illness using the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression, and finally conducted a risk score to estimate the probability of critical illness in the training set. Data from the validation set were used to validate the score. Furthermore, the clinical factors of those patients who recovered were compared with those who did not recover from the rapidly worsened illness. We then employed logistic regression tools to delineate the possible protective factors.Results A total of 302 patients were included. From 47 potential risk factors, 6 variables were measured as the risk score: sex(female) (OR, 0.372; 95%CI, 0.211-0.655), Chest Computed Tomography abnormality (OR, 1.90; 95%CI, 1.36-2.66), neutrophil value (OR, 1.33; 95%CI, 1.18-1.50), neutrophil to lymphocyte ratio (OR, 1.23; 95%CI, 1.14-1.34), lactate dehydrogenase (OR, 1.01; 95%CI, 1.006-1.012), albumin (OR, 0.77; 95%CI, 0.71-0.84). The mean AUC of development cohort was 0.82 (95% CI, 0.81-0.92) and the AUC of validation cohort was 0.894 (95% CI, 0.78-0.95). Our comparison data from patients who rapidly worsened but recovered with those who did not showed that 4 variables were predictive factors: Prealbumin (OR, 1.028; 95%CI, 1.010-1.057), percentage of lymphocytes (OR, 1.213; 95%CI, 1.062-1.385), lactate dehydrogenase (OR, 0.984; 95%CI, 0.973-0.996), Prothrombin ativity (OR, 1.065; 95%CI, 1.018-1.115).Conclusion and Relevance In this study, we developed a predictive risk score and highlight 4 factors that might predict recovery from suddenly worsened illness. This report may help define the potential of developing critical illness and recovery prospects in patients with rapidly worsened condition.

scholarly journals Evaluation of pre-slaughter losses of Italian heavy pigs

2017 ◽  
Vol 57 (10) ◽  
pp. 2072 ◽  
Author(s):  
Eleonora Nannoni ◽  
Gaetano Liuzzo ◽  
Andrea Serraino ◽  
Federica Giacometti ◽  
Giovanna Martelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Observational Study ◽  
Economic Impact ◽  
Logistic Regression Analysis ◽  
Stocking Density ◽  
Retrospective Observational Study

A retrospective observational study evaluated the risk factors for pre-slaughter losses (i.e. animal deaths occurring during transport and lairage) and their economic impact in Italian heavy pigs (~160 kg bodyweight). Of the 3 344 730 pigs transported, 1780 (0.053%) died before slaughter, with most losses occurring during transport (56.6%). The estimated economic impact was of 424 000 €. The percentage of batches with at least one animal lost pre-slaughter increased during summer (P < 0.001). The proportion of pre-slaughter losses was higher when journey lasted more than 90 min (P < 0.001) and was positively correlated with transport duration (P < 0.01). Losses were higher (P < 0.01) in batches transported at low stocking densities (i.e. when heavier pigs were transported). Batches with lower slaughtering order (i.e. longer lairage time) had higher proportions of losses (P < 0.001). Logistic regression analysis showed that the odds of a given batch to have at least one animal lost pre-slaughter were 1.32 times higher for batches slaughtered in summer, 1.54 times higher if journey durations exceeded 90 min, 1.25 times higher for batches with low slaughtering order, and not significantly influenced by stocking density during transport.

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