Mortality among Hospitalized Dengue Patients with Comorbidities in Mexico, Brazil, and Colombia

Dengue patients with comorbidities may be at higher risk of death. In this cross-sectional study, healthcare databases from Mexico (2008–2014), Brazil (2008–2015), and Colombia (2009–2017) were used to identify hospitalized dengue cases and their comorbidities. Case fatality rates (CFRs), relative risk, and odds ratios (OR) for in-hospital mortality were determined. Overall, 678,836 hospitalized dengue cases were identified: 68,194 from Mexico, 532,821 from Brazil, and 77,821 from Colombia. Of these, 35%, 5%, and 18% were severe dengue, respectively. Severe dengue and age ≥ 46 years were associated with increased risk of in-hospital mortality. Comorbidities were identified in 8%, 1%, and 4% of cases in Mexico, Brazil, and Colombia, respectively. Comorbidities increased hospitalized dengue CFRs 3- to 17-fold; CFRs were higher with comorbidities regardless of dengue severity or age. The odds of in-hospital mortality were significantly higher in those with pulmonary disorders (11.6 [95% CI 7.4–18.2], 12.7 [95% CI 9.3–17.5], and 8.0 [95% CI 4.9–13.1] in Mexico, Brazil, and Colombia, respectively), ischemic heart disease (23.0 [95% CI 6.6–79.6], 5.9 [95% CI 1.4–24.6], and 7.0 [95% CI 1.9–25.5]), and renal disease/failure (8.3 [95% CI 4.8–14.2], 8.0 [95% CI 4.5–14.4], and 9.3 [95% CI 3.1–28.0]) across the three countries; the odds of in-hospital mortality from dengue with comorbidities was at least equivalent or higher than severe dengue alone (4.5 [95% CI 3.4–6.1], 9.6 [95% CI 8.6–10.6], and 9.0 [95% CI 6.8–12.0). In conclusion, the risk of death because of dengue increases with comorbidities independently of age and/or disease severity.

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Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Neuroepidemiology ◽

10.1159/000516670 ◽

2021 ◽

pp. 1-7

Author(s):

Amélie Gabet ◽

Clémence Grave ◽

Edouard Chatignoux ◽

Philippe Tuppin ◽

Yannick Béjot ◽

...

Keyword(s):

Case Fatality ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Index Hospitalization ◽

Sectional Study ◽

Stroke Patients ◽

National Hospital ◽

Cross Sectional ◽

Increased Risk ◽

Systèmes D’Information

Introduction: COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of COVID-19 at a nationwide scale. Methods: This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (Programme de Médicalisation des Systèmes d’Information, included in the Système National des Données de Santé). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. Results: Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without COVID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. Conclusion: Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

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Healthcare resource utilisation for chronic kidney disease and other major non-communicable chronic diseases in China: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-051888 ◽

2022 ◽

Vol 12 (1) ◽

pp. e051888

Author(s):

Chao Yang ◽

Jianyan Long ◽

Ying Shi ◽

Zhiye Zhou ◽

Jinwei Wang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Relative Risk ◽

Hospital Mortality ◽

Hospital Stay ◽

Healthcare Resource ◽

Cross Sectional Study ◽

Resource Utilisation ◽

Sectional Study ◽

Cross Sectional ◽

Healthcare Resource Utilisation

ObjectiveTo evaluate the healthcare resource utilisation for chronic kidney disease (CKD) and other major non-communicable chronic diseases (NCDs) in China.DesignA cross-sectional study.SettingA national inpatient database of tertiary hospitals in China.ParticipantsThe study included a total of 19.5 million hospitalisations of adult patients from July 2013 to June 2014. Information on CKD and other major NCDs, including coronary heart disease (CHD), stroke, hypertension, diabetes, chronic obstructive pulmonary disease (COPD) and cancer, was extracted from the unified discharge summary form.Outcome measuresCost, length of hospital stay and in-hospital mortality.ResultsThe percentages of hospitalisations with CKD, CHD, stroke, hypertension, diabetes, COPD and cancer were 4.5%, 9.2%, 8.2%, 18.8%, 7.9%, 2.3% and 19.4%, respectively. For each major NCD, the presence of CKD was independently associated with longer hospital stay, with increased percentages ranging from 7.69% (95% CI 7.11% to 8.28%) for stroke to 21.60% (95% CI 21.09% to 22.10%) for CHD. Hospital mortality for other NCDs was also higher in the presence of CKD, with fully adjusted relative risk ranging from 1.91 (95% CI 1.82 to 1.99) for stroke to 2.65 (95% CI 2.55 to 2.75) for cancer. Compared with other NCDs, CKD was associated with the longest hospital stay (22.1% increase) and resulted in the second highest in-hospital mortality, only lower than that of cancer (relative risk, 2.23 vs 2.87, respectively).ConclusionsThe presence of diagnosed CKD alongside each major NCD was associated with an additional burden on the healthcare system. Healthcare resource utilisation and prognosis of CKD were comparable with those of other major NCDs, which highlights the importance of CKD as a major public health burden.

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Risk factors for mortality among tuberculosis patients on treatment at Bugando Medical Centre in north-western Tanzania: a retrospective cross-sectional study

Tanzania Journal of Health Research ◽

10.4314/thrb.v18i4.1 ◽

2016 ◽

Vol 18 (4) ◽

Author(s):

Daniel W. Gunda ◽

Semvua B. Kilonzo ◽

Salum M. Bulegesi ◽

Bonaventura C.T. Mpondo ◽

Elichilia R. Shao

Keyword(s):

Risk Factors ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Risk Of Death ◽

Tb Treatment ◽

Bugando Medical ◽

Increased Risk ◽

Bugando Medical Centre ◽

North Western

Background: Tuberculosis (TB) is still an important cause of morbidity and mortality worldwide. Though it can effectively be treated, still a significant proportion of patients die on the course of their treatment. The objective of this study was to determine the outcome and risk factors of mortality among patients diagnosed with TB in a tertiary hospital in north-western Tanzania.Methods: A retrospective cross sectional study was done among all patients diagnosed with TB between January and December 2015 at Bugando Medical Centre. Information of demographic characteristics, smear positivity, haemoglobin concentration, HIV status, CD4 counts for HIV positive patients and treatment outcomes were collected and analysed. TB treatment outcomes as dead or alive were calculated and logistic regression was done to determine the factors associated with increased risk of death of patients on anti-TB treatment.Results: In total 701 patients were diagnosed with TB during the study period. Of these, 361 (51.5%) were males with a median age of 38 (IQR 27- 47) and 421 (60.06%) were younger than 40 years. Majority of the participants 409 (58.35%) had smear positive pulmonary tuberculosis and about half of patients (51.07%) tested positive for HIV. Of the enrolled patients 610 (87.02%) were alive at the end of TB treatment while 91 (12.98%) died in the course of treatment. The odds of deaths of patients on anti-TB treatment were strongly associated with male sex, HIV co infection and severe anaemia.Conclusion: The proportion of patients who die from TB treatment at BMC is high, with an increased risk of death among HIV co-infected, older than 40 years and severely anaemic patients. Improvement of strategies for early diagnosis and prompt treatment of TB patients will potentially improve treatment outcome.

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Prevalence of diabetes and hypertension and their interaction effects on cardio-cerebrovascular diseases: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11122-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhehui Wang ◽

Tubao Yang ◽

Hanlin Fu

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Interaction Effects ◽

Cross Sectional Study ◽

Cerebrovascular Diseases ◽

Sectional Study ◽

Additive Interaction ◽

Cross Sectional ◽

Multiplicative Interaction ◽

Increased Risk

Abstract Background Hypertension and diabetes mellitus are two of the major risk factors for cardio-cerebrovascular diseases (CVDs). Although prior studies have confirmed that the coexistence of the two can markedly increase the risk of CVDs, few studies investigated whether potential interaction effects of hypertension and diabetes can result in greater cardio-cerebrovascular damage. We aimed to investigate the prevalence of hypertension and diabetes and whether they both affect synergistically the risk of CVDs. Methods A cross-sectional study was conducted by using a multistage stratified random sampling among communities in Changsha City, Hunan Province. Study participants aged > = 18 years were asked to complete questionnaires and physical examinations. Multivariate logistic regression models were performed to evaluate the association of diabetes, hypertension, and their multiplicative interaction with CVDs with adjustment for potential confounders. We also evaluated additive interaction with the relative excess risk ratio (RERI), attribution percentage (AP), synergy index (SI). Results A total of 14,422 participants aged 18–98 years were collected (men = 5827, 40.7%). The prevalence was 22.7% for hypertension, 7.0% for diabetes, and 3.8% for diabetes with hypertension complication, respectively. Older age, women, higher educational level, unmarried status, obesity (central obesity) were associated with increased risk of hypertension and diabetes. We did not find significant multiplicative interaction of diabetes and hypertension on CVDs, but observed a synergistic additive interaction on coronary heart disease (SI, 1.43; 95% CI, 1.03–1.97; RERI, 1.94; 95% CI, 0.05–3.83; AP, 0.26; 95% CI, 0.06–0.46). Conclusions Diabetes and hypertension were found to be associated with a significantly increased risk of CVDs and a significant synergistic additive interaction of diabetes and hypertension on coronary heart disease was observed. Participants who were old, women, highly educated, unmarried, obese (central obese) had increased risk of diabetes and hypertension.

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Leptin as a Key Player in Insulin Resistance of Liver Cirrhosis? A Cross-Sectional Study in Liver Transplant Candidates

Journal of Clinical Medicine ◽

10.3390/jcm9020560 ◽

2020 ◽

Vol 9 (2) ◽

pp. 560 ◽

Cited By ~ 3

Author(s):

Iva Košuta ◽

Anna Mrzljak ◽

Branko Kolarić ◽

Marijana Vučić Lovrenčić

Keyword(s):

Insulin Resistance ◽

Resistance Index ◽

Cross Sectional Study ◽

Model Assessment ◽

Sectional Study ◽

Cross Sectional ◽

Risk Of Death ◽

Increased Risk ◽

Cirrhotic Patients ◽

Transplant Candidates

Insulin resistance is associated with increased risk of death and liver transplantation in the cirrhotic population, independent of disease aetiology. However, factors accounting for insulin resistance in the context of cirrhosis are incompletely understood. This study aimed to investigate the association between adiponectin and leptin with insulin resistance in cirrhotic patients and to assess the influence of disease severity on insulin resistance and metabolic status. This cross-sectional study included 126 non-diabetic cirrhotic transplant candidates. The homeostasis model assessment 2 model was used to determine the insulin resistance index, and fasting adiponectin, leptin, insulin, c-peptide, glucose, HbA1c, and lipid profiles were analysed. Insulin resistance was detected in 83% of subjects and associated with increased leptin, fasting plasma glucose and body mass index, and lower triglyceride levels. Logistic regression analysis identified leptin and triglycerides as independent predictors of insulin resistance (OR 1.247, 95% CI 1.076–1.447, p = 0.003; OR 0.357, 95% CI 0.137–0.917, p = 0.032.). Leptin levels remained unchanged, whereas adiponectin levels increased (p < 0.001) with disease progression, and inversely correlated with HbA1c (ρ = −0.349, p < 0.001). Our results indicate that leptin resistance, as indicated by elevated leptin levels, can be regarded as a contributing factor to insulin resistance in cirrhotic patients, whereas triglycerides elicited a weak protective effect. Progressively increasing adiponectin levels elicited a positive effect on glucose homeostasis, but not insulin sensitivity across disease stages.

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Coronary Heart Disease Risk in Patients with Schizophrenia: A Lebanese Cross-Sectional Study

Journal of Comorbidity ◽

10.15256/joc.2017.7.107 ◽

2017 ◽

Vol 7 (1) ◽

pp. 79-88 ◽

Cited By ~ 3

Author(s):

Chadia Haddad ◽

Souheil Hallit ◽

Pascale Salameh ◽

Tarek Bou-Assi ◽

Marouan Zoghbi

Keyword(s):

Metabolic Syndrome ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cross Sectional Study ◽

Therapeutic Education ◽

Sectional Study ◽

Cross Sectional ◽

The Metabolic Syndrome ◽

Chd Risk ◽

Increased Risk

Background: Coronary heart disease (CHD) is a leading cause of premature death in patients with schizophrenia. CHD risk in Lebanese patients with schizophrenia remains unknown. Objectives: To (i) evaluate CHD risk of patients with schizophrenia in Lebanon; and (ii) detect the modifiable and non-modifiable factors affecting this risk. Methods: Cross-sectional study of 329 patients with schizophrenia aged 20–75 years. Ten-year hard CHD risk was calculated using the Framingham risk score. A logistic regression was conducted taking the dichotomous hard CHD (<10% and ≥10%) as the dependent variable. Results: Ten-year hard CHD risk was low (<10%) in 60.8% of patients, intermediate (10–20%) in 31.6%, and high (>20%) in 7.6%. Multivariate analysis showed that the mean 10-year hard CHD risk was 8.76±6.92 (10.82±6.83 in men and 3.18±2.90 in women). Ten-year hard CHD risk was higher in patients with the metabolic syndrome (odds ratio [OR] 2.67, confidence interval [CI] 1.54–4.64), a longer duration of schizophrenia (OR 1.03, CI 1.01–1.05), a history of other medical illnesses (OR 2.02, CI 1.18–3.47), and in those participating in art therapy (OR 2.13, CI 1.25–3.64) or therapeutic education (OR 1.93, CI 0.93–4.01). Ten-year hard CHD risk was lower in patients receiving risperidone (OR 0.23, CI 0.08–0.68), any anti-epileptic (OR 0.41, CI 0.24–0.73), or any benzodiazepine (OR 0.33, CI 0.17–0.66) medication. Conclusion: CHD is prevalent in patients with schizophrenia in Lebanon. Physicians are recommended to monitor the components of the metabolic syndrome to identify patients with increased risk of cardiovascular diseases.

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Severe Acute Malnutrition among Unoperated Ethiopian Children with Congenital Heart Disease: A Wake-up Call to Reverse the Situation, A Retrospective Cross-Sectional Study

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i5.9 ◽

2020 ◽

Vol 30 (5) ◽

Author(s):

Bruk Assefa ◽

Henok Tadele

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk ◽

Anthropometric Assessment

BACKGROUND፡ Children with Congenital Heart Disease (CHD) are at increased risk for severe acute malnutrition (SAM). We aimed to determine the magnitude and determinants of SAM among children with CHD in a tertiary hospital.METHODS: Retrospective cross-sectional study was conducted among children with CHD between 2016 and 2019. Clinical and anthropometric data were retrieved from medical records. Anthropometric assessment was done by using WHO standard growth curves. Data analysis was done using Statistical Package for Social Sciences V22. Statistical significance was set at p-value<0.05, and multivariable logistic regression was used to determin predictors.RESULTS: There were 2400 pediatric admissions during the study period,CHD accounted for 6.5%(156) of admissions. For review, 141 records were eligible. The gender distribution was comparable, males 51.1% (72). Infants (<12 months) and older children (>12 months) accounted for 57.4% (81) and 42.6% (60) of study subjects, respectively. SAM was documented in 51.8% (73) of the study subjects, [95% CI: 44.7-60.2]. Infants had higher odds of SAM compared to children aged >12 months[adjusted odds ratio (AOR)= 4.48, 95%CI:2.07-9.70]. Anemic children had higher odds for SAM[AOR =3.76, 95% CI:1.54-9.18]. Children without acyanotic CHD with heart failure(HF) were 58% less likely to develop SAM[AOR= 0.42, 95% CI:0.19-0.96].CONCLUSION: The burden of SAM among children with CHD is high. Younger age,anemia and acyanotic CHD with HF predicted SAM.Screening for anemia and targeted anthropometric assessment are recommended for early SAM detection.

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Multiple sclerosis is not associated with an increased risk for severe COVID-19: a nationwide retrospective cross-sectional study from Germany

Neurological Research and Practice ◽

10.1186/s42466-021-00143-y ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Daniel Richter ◽

Simon Faissner ◽

Dirk Bartig ◽

Lars Tönges ◽

Kerstin Hellwig ◽

...

Keyword(s):

Multiple Sclerosis ◽

Hospital Mortality ◽

Large Scale ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Administrative Database ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

Abstract Background Since the coronavirus disease 2019 (COVID-19) has risen, several risk factors have been identified, predicting a worse outcome. It has been speculated that patients with Multiple sclerosis (MS) have an increased risk for a severe course of COVID-19 due to a suspected higher vulnerability. Therefore, we aimed to analyze the impact of comorbid MS on the outcome of patients with COVID-19 in Germany. Methods We conducted a retrospective cross-sectional study using the administrative database of all hospitalized patients diagnosed with PCR-confirmed COVID-19 (n = 157,524) in Germany during 2020. The cohort was stratified according to the presence (n = 551) or absence (n = 156,973) of comorbid MS, including discrimination of MS subtypes. Primary outcome measures were admission to the intensive care unit (ICU), use of invasive or non-invasive ventilation, and in-hospital mortality. Differences were investigated using rates and odds ratios as estimates. Pooled overall estimates, sex-stratified estimates, age-group stratified estimates, and MS subtype stratified estimates were calculated for all outcomes under the random-effects model. Results Among 157,524 patients hospitalized with COVID-19, 551 had a concurrent MS diagnosis (0.3%). Overall, univariate analysis showed lower rates of ICU admission (17.1% versus 22.7%, p < 0.001), lower use of ventilation (9.8% versus 14.5%, p < 0.001) and lower in-hospital mortality (11.1% versus 19.3%, p < 0.001) among COVID-19 patients with comorbid MS. This finding was stable across the subgroup analysis of sex and MS subtype but was attenuated by age-stratification, confirming equal odds of in-hospital mortality between COVID-19 patients with and without MS (log OR: 0.09 [95% CI: − 0.40, 0.59]). Conclusions Although there might be differences in risk within the MS patients’ population, this large-scale nationwide analysis found no evidence for a worse outcome of COVID-19 in patients with comorbid MS compared to non-MS individuals.

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SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

Thorax ◽

10.1136/thoraxjnl-2020-215414 ◽

2020 ◽

Vol 75 (12) ◽

pp. 1089-1094 ◽

Cited By ~ 22

Author(s):

Adrian Shields ◽

Sian E Faustini ◽

Marisol Perez-Toledo ◽

Sian Jossi ◽

Erin Aldera ◽

...

Keyword(s):

Intensive Care ◽

Healthcare Workers ◽

Venous Blood ◽

Cross Sectional Study ◽

Nasopharyngeal Swab ◽

Sectional Study ◽

University Hospitals ◽

Cross Sectional ◽

General Internal ◽

Increased Risk

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.

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