prolonged hospitalization
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2022 ◽  
Author(s):  
Zahedin Kheyri ◽  
Sepehr Metanat ◽  
Hadiseh Hosamirudsari ◽  
Samaneh Akbarpour ◽  
Maryam Shojaei ◽  
...  

Several months have passed since the onset of the COVID-19 pandemic. Multiple characteristics have been proposed as prognostic factors so far. This study aims to provide evidence on the association of neutrophil-to-lymphocyte ratio (NLR) at the hospitalization time and three desired outcomes (mortality, prolonged hospitalization, and intensive care unit [ICU] admission). We designed a single-centre retrospective observational study in Baharloo Hospital (Tehran, Iran) from 20 February to 19 April 2020. Patients with confirmed COVID-19 diagnosis via rt-PCR or chest CT imaging were included. Demographic and clinical data were obtained. The sample was divided into three groups, using tertile boundaries of initial NLR. The differences in mortality, comorbidities, hospitalization duration, drug administration, and ICU admission between these three groups were investigated. The identified confounding factors were adjusted to calculate the odds ratio of death, ICU admission, and prolonged hospitalization. Nine hundred sixty-three patients were included. In total, 151 and 212 participants experienced mortality and ICU admission, respectively. In multivariate logistic regression models, the adjusted odds ratio for mortality event in the second and third tertile of initial NLR after full adjustment were 1.89 (95% CI:1.07-3.32) and 2.57 (95% CI:1.48-4.43) and for ICU admission were 1.85 (95% CI:1.14-3.01) and 2.88 (95% CI:1.79-4.61), respectively. The optimal cut-off value of the initial NLR for predicting mortality was 4.27. Initial NLR can predict mortality and ICU admission in COVID-19 patients. Further investigations for curating the calculated cut-off can propose initial NLR as an indicator of poor prognosis for COVID-19 patients.


Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S9.2-S9
Author(s):  
Meghan M. Branston ◽  
Alan H. Yee

ObjectiveDescribe important patterns of neurologic injury in sports related trauma.BackgroundSports related neurologic trauma represents a unique, complex pattern of injury with potential significant impactful morbidity. An estimated 8.6 million sports injuries occur annually, 300,000 of which result in traumatic brain injury (TBI). The incidence of other nervous system injury is underreported.Design/MethodsRetrospective analysis of consecutive patients who presented to an emergency department between January 1, 2015 and January 1, 2020 with a sports related injury. Characterization of neurologic vs non-neurological bodily injury, sports activity, and demographic data were collected.ResultsOut of 15,525 patients with sports injuries, 390 sustained neurologic involvement of which 50% were between 1-18 years of age. Although TBI represented the majority (85%) of neurologic injury, 5.6% sustained spinal cord involvement and 5.1% had peripheral nerve injury. Spinal cord and peripheral nerve involvement were associated with prolonged hospitalization when compared to those with mild-moderate concussion X2 (1, N = 199) = 5.73, p = 0.0167.ConclusionsSpinal cord and peripheral nerve injury represent the minority of sports related neurologic involvement, however, may lead to significant prolonged hospitalization, morbidity and mortality.


2021 ◽  
Author(s):  
Eric Sy ◽  
Sandy Kassir ◽  
Jonathan F Mailman ◽  
Sarah Lauren Sy

Abstract Background:Older adults are increasingly being admitted to intensive care units, with frailty recognized as a risk factor for worse outcomes. The Hospital Frailty Risk Score (HFRS) was developed for use in administrative databases of older adults, but it has not yet been well-validated for critically ill patients. The objective of this study was to validate the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions in critically ill patients.Methods:We selected index hospitalizations of older adults (≥75 years old) receiving mechanical ventilation, using the United States Nationwide Readmissions Database from January 1, 2016 to November 30, 2018. Frailty risk was determined by the HFRS using International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) codes, and further subcategorized into low (score <5), intermediate (score 5-15), and high (score >15) risk for frailty. We evaluated the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions, using multivariable logistic regression after adjustment for patient and hospital characteristics. Model performance was assessed using the c-statistic, Brier score, and calibration plots.Results:Among the 649,330 weighted index hospitalizations in the cohort, 50.0% were female, the median (interquartile range [IQR]) age was 81 (78-86) years old, and the median (IQR) HFRS was 10.8 (7.7-14.5). Among the cohort, 9.5%, 68.3%, and 22.2% were subcategorized as low, intermediate, and high risk for frailty, respectively. After adjustment, patient hospitalizations with high frailty risk were associated with increased risks of prolonged hospitalization (adjusted odds ratio [aOR] 5.59 [95% confidence interval [CI] 5.24-5.97], c-statistic 0.694, Brier score 0.216) and 30-day emergency hospital readmissions (aOR 1.20 [95% CI 1.13-1.27], c-statistic 0.595, Brier score 0.162), compared to low frailty risks. Conversely, high frailty risk using the HFRS was inversely associated with in-hospital mortality (aOR 0.46 [95% CI 0.45-0.48], c-statistic 0.712, Brier score 0.214). Calibration plots demonstrated good calibration for the adjusted analyses.Conclusions:The HFRS is associated with prolonged hospitalization and 30-day readmission in older adults receiving mechanical ventilation. Further research is necessary to develop frailty scores that accurately and intuitively predict mortality in critically ill patients.


Medicine ◽  
2021 ◽  
Vol 100 (48) ◽  
pp. e27862
Author(s):  
Yusuke Katayama ◽  
Tetsuhisa Kitamura ◽  
Jun Tanaka ◽  
Shota Nakao ◽  
Masahiko Nitta ◽  
...  

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohammad Taghi Beigmohammadi ◽  
Sama Bitarafan ◽  
Azin Hoseindokht ◽  
Alireza Abdollahi ◽  
Laya Amoozadeh ◽  
...  

Abstract Background and objective Because of the effect of vitamins on modulating the immune system function, we have evaluated the effect of supplementation with vitamins A, B, C, D, and E in ICU-admitted patients with COVID-19. Methods This study was a randomized and single-blinded clinical trial in which 60 subjects were randomly assigned to two groups. The intervention group (n=30) received vitamins, and the control group did not receive any vitamin or placebo. The intervention was included 25,000 IU daily of vitamins A, 600,000 IU once during the study of D, 300 IU twice daily of E, 500 mg four times daily of C, and one amp daily of B complex for 7 days. At baseline and after the 7-day intervention, the serum levels of inflammatory markers, vitamins, and the SOFA score were assessed. In addition, the mortality rate and duration of hospitalization were evaluated after the intervention (IRCT registration number: IRCT20200319046819N1/registration date: 2020-04-04, https://www.irct.ir/trial/46838). Results Significant changes were detected in serum levels of vitamins (p < 0.001 for all vitamins), ESR (p < 0.001), CRP (p = 0.001), IL6 (p = 0.003), TNF-a (p = 0.001), and SOFA score (p < 0.001) after intervention compared with the control group. The effect of vitamins on the mortality rate was not statistically significant (p=0.112). The prolonged hospitalization rate to more than 7 days was significantly lower in the intervention group than the control group (p=0.001). Regarding the effect size, there was a significant and inverse association between receiving the intervention and prolonged hospitalization (OR = 0.135, 95% CI 0.038–0.481; p=0.002); however, after adjusting for confounders, it was not significant (OR=0.402, 95% CI 0.086–1.883; p=0.247). Conclusion Supplementation with vitamins A, B, C, D, and E could improve the inflammatory response and decrease the severity of disease in ICU-admitted patients with COVID-19.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alfiya Mukharyamova

Delirium is a common and serious geriatric syndrome with core features of acute onset and inattention. It is often underdiagnosed and is associated with many adverse outcomes, such as prolonged hospitalization, institutionalization, functional impairment and death. This review summarizes an approach to the recognition, work-up, management and prevention of delirium.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N H Karunawan ◽  
R T Pinzon ◽  
B B Siswanto

Abstract Background Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia associated with stroke. Based on the National Health Survey (Riskesdas) the prevalence of stroke in Indonesia increased from 7% in 2013 to 10.9% in 2018. Understanding the clinical features and clinical outcomes differences between AF and non-AF in stroke can help the clinician for further management. Purpose To compare the clinical features and clinical outcomes of stroke patients with AF and non-AF by using the data from the Bethesda Stroke Registry in Indonesia. Methods This cross-sectional study was based on a stroke registry, data were collected using the electronic medical record in our hospital. All patients ≥18 years of age, who developed stroke between January 1, 2011, and December 31, 2018, were included in this study. Data about clinical features and clinical outcomes were collected. The clinical outcomes included mortality, prolonged hospitalization (LOS &gt;6 days), and disability was evaluated using the modified Rankin scale (MRS). The statistical measures calculated were Chi-square-test and Fischer's exact test. Results Data of the total 8447 patients enrolled in the registry, data of 8248 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 226 (2.7%) stroke patents. Comparing with non-AF patients, AF patients were older (47.8% vs 26.0%), higher proportion on of women (48.2% vs39.9%), higher prevalence of ischemic heart disease (16.4% vs 4.7%), loss of consciousness (37.6% vs 23.2%), aphasia (29.6% vs 13.6%) mortality (20.8% vs 10.6%), prolonged hospitalizaton (10.24 [1–80] vs 7.18 [1–73]), worse disability (67.3% vs 43.2%), p&lt;0.05. Comparing with AF patients, non-AF patients had a significantly higher prevalence of hypertension (52.9% vs 40.3%) and diabetes mellitus (33.5% vs 32.7%), p&lt;0.05. Stroke patients with AF was significantly associated with higher in-hospital mortality (RR: 1.19, 95% CI: 1.05–1.35, p&lt;0.001), worse disability (RR: 1.16, 95% CI: 1.11–1.22, p&lt;0.001), and prolonged hospital stay RR: 1.39, 95% CI: 1.22–1.59, p&lt;0.001) than in stroke patents with non-AF. Conclusions AF in stroke affected the poor outcomes by contributing to higher in-hospital mortality, prolonged hospitalization, and worse disability. Older age, Women and IHD were more strongly associated with Stroke n AF than non AF FUNDunding Acknowledgement Type of funding sources: None.


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