Case Fatality Rate Of Patients Research Articles

Clinical outcomes after discontinuing anticoagulant therapy in patients with first unprovoked venous thromboembolism.

The duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) should balance the likelihood of VTE recurrence against the risk of major bleeding. Analyze rates and case-fatality rates (CFRs) of recurrent VTE and major bleeding after discontinuing anticoagulation in patients with a first unprovoked VTE after at least 3 months of anticoagulation. We compared the rates and CFRs in patients of the RIETE and COMMAND-VTE registries. We used logistic regression models to identify predictors for recurrent pulmonary embolism (PE) and major bleeding. Of 8,261 patients with unprovoked VTE in RIETE, 4,012 (48.6%) had isolated deep vein thrombosis (DVT) and 4,250 had PE. Follow-up (median, 318 days) showed 543 recurrent DVTs, 540 recurrent PEs, 71 major bleeding episodes, and 447 deaths. The COMMAND VTE registry yielded similar results. Corresponding CFRs of recurrent DVT, PE, and major bleeding, were 0.4%, 4.6%, and 24%, respectively. On multivariable analyses, initial PE presentation (hazard ratio (HR): 3.03; 95%CI: 2.49-3.69), dementia (HR: 1.47; 95%CI: 1.01-2.13), and anemia (HR: 0.72; 95%CI: 0.57-0.91) predicted recurrent PE, whereas older age (HR: 2.11; 95%CI: 1.15-3.87), inflammatory bowel disease (HR: 4.39; 95%CI: 1.00-19.3) and anemia (HR: 2.24; 95%CI: 1.35-3.73) predicted major bleeding. Prognostic scores were formulated, with c-statistics of 0.63 for recurrent PE and 0.69 for major bleeding. Recurrent DVT and PE were frequent but had low CFRs (0.4% and 4.6%, respectively) after discontinuing anticoagulation. Contrary, major bleeding was rare, but had high CFR (24%). A few clinical factors may predict these outcomes.

Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy.

This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.

Myocardial injury and myocardial infarction in hypertensive emergency patients; systematic review

This systematic review aimed to determine the prevalence of myocardial injury, myocardial infarction (MI), and its subtypes in individuals presenting with hypertensive emergency. To find all pertinent published articles from 2017 to 2023 that reported studies on the prevalence of hypertensive emergencies and hypertension-mediated organ damage from inception to the date of database search were included. A systematic search of the Web of Science, PubMed, and MEDLINE databases was conducted. Finally eight articles were selected for the review. The authors collaborated using Google Sheets and Google Documents. Of the selected studies, three were retrospective, two were cross sectional, and three were prospective. In men admitted for hypertensive crises, psychomotor agitation and the burden of cardiovascular risk were much higher. Around one-third of patients experiencing hypertensive crises had elevated cardiac troponin, which can be used to identify individuals who are at a greater risk of death early and to provide important prognostic information. A lower BMI was associated with lower initial and serial troponin levels; this obesity paradox was especially prominent in older and female individuals. Three main factors that contributed to hypertensive emergencies (HE) and urgencies (HU) were stress, excessive salt consumption, and non-compliance. Renin-angiotensin system blockers seemed to be the cornerstone of therapy. The case fatality rate for patients undergoing hypertensive episodes was quite significant.

The Clinical and Economic Impact of Delayed Reperfusion Therapy: Real-World Evidence.

Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.

Clinical risk associated with COVID-19 among 86000 patients with congenital heart disease

ObjectiveTo determine the magnitude of any excess risk of mortality and hospitalisation due to COVID-19 infection in patients with congenital heart disease (CHD) in the UK healthcare system.MethodsMatched case–control study...

Impact of Early Phase DMAT Support Using Natural Disaster Support Techniques for Hospitals Experiencing COVID-19 Outbreak in Japan.

Introduction:Hospitals experiencing a COVID-19 outbreak are in a similar situation to those affected by natural disasters, with a breakdown in command and coordination, shortage of personnel and supplies, and increased stress among staff. In Japan, when a COVID-19 outbreak occurs, the first step is for the hospital or health center to respond. However, if the local authorities are unable to respond, the Ministry of Health, Labour and Welfare dispatch Disaster Medicine Assistance Team (DMAT) by request of the local government to facilitate early recovery. This study will examine the effectiveness of early phase support by DMAT.Method:Patients and healthcare workers in 31 hospitals supported by DMAT after an outbreak occurred between April 2020 and January 2021 were included in the study. Attack rate and case fatality rate for patients and the attack rate for healthcare workers were analyzed for each of the two groups: those that started support less than ten days after the first positive case and those that started support more than ten days after the first positive case.Results:For hospitals that started support in less than ten days, the attack rate was 27.9%, the case fatality rate was 17.4% for patients, and the attack rate for healthcare workers was 9.7%. For hospitals that took more than ten days to start support, the attack rate was 44.8%, the case fatality rate was 23.1% for patients, and the attack rate for healthcare workers was 14.3%. The attack rate (p&lt;0.001) and case fatality rate (p=0.011) for patients and attack rate for healthcare workers (p&lt;0.001) were significantly lower in hospitals that started support in less than ten days.Conclusion:Early intervention of DMAT support using natural disaster support techniques for hospitals experiencing an outbreak reduced the attack rate and case fatality rate for patients and healthcare workers.

Complications, Sequelae and Case Fatality Rate in Pediatric Patients with Meningitis in Dominican Republic. (P12-9.005)

<h3>Objective:</h3> To Determine the most frequent complications in pediatric patients with meningitis, to define the most common sequelae and to correlate pathological history with deaths due to meningitis. <h3>Background:</h3> Multiple cases of meningitis have been diagnosed and treated in the Dominican Republic, however, there are currently limited epidemiological data on this disease, in which complication factors and case fatality rate are pointed out. <h3>Design/Methods:</h3> It is a retrospective, probabilistic, randomized, descriptive study where 115 patients diagnosed with meningitis were selected from 2010 January 1st to December 31st 2020, older than 2 months to 14 years. Clinical records were reviewed and the data was processed and tabulated in Excel using frequencies and percentages. <h3>Results:</h3> 51.3% (59/115) of the cases affected by meningitis were male and the most frequent ages were 1 to 4 years old (36.52%;42/115), followed by 2 months to 1 year of age (28.70%; 33/115). 42.60% (49/115) patients had intrahospital complications, the most common were acute diarrheal disease (18.37%;9/49), sepsis (14.29%;7/49) and seizures (12.24%;6/49;). 69.38% (34/49) patients with complications had some type of pathological history, the most common being tonsillitis (23.53%;8/34), ventriculoperitoneal shunt placement (20.58%;7/34), and hydrocephalus (20.58%;7/34). After discharge 32.17% (37/115) had long-term sequelae such as epilepsy (32.43%;12/37), headache (29.73%;11/37) and delayed motor development (16.22%;6/37). The case fatality rate in patients with meningitis was 7.83% (9/115), of which 88.89% (8/9) suffered from bacterial meningitis, 66.67% presented sepsis (6/9), 22.22% (2/9) had a ventriculoperitoneal shunt and 22.22% (2/9) were premature. The most affected age range was from 2 months to one year (55.55%;5/9). <h3>Conclusions:</h3> Meningitis is a lethal disease that, if not treated and diagnosed in time, can present complications and serious sequelae, as evidenced in this study. The risk of death is higher from bacterial meningitis and during the first year of life. <b>Disclosure:</b> Mr. Peralta has nothing to disclose. Miss Montilla has nothing to disclose. Dr. Gomez has received research support from Roche . Prof. Mueses Jimenez has nothing to disclose. Dr. Mejia has nothing to disclose.

Association of severe mental illness and septic shock case fatality rate in patients admitted to the intensive care unit: A national population-based cohort study.

Patients with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, or major depressive disorder) have been reported to have excess mortality rates from infection compared to patients without SMI, but whether SMI is associated with higher or lower case fatality rates (CFRs) among infected patients remains unclear. The primary objective was to compare the 90-day CFR in septic shock patients with and without SMI admitted to the intensive care unit (ICU), after adjusting for social disadvantage and physical health comorbidity. We conducted a nationwide, population-based cohort study of all adult patients with septic shock admitted to the ICU in France between January 1, 2014, and December 31, 2018, using the French national hospital database. We matched (within hospitals) in a ratio of 1:up to 4 patients with and without SMI (matched-controls) for age (5 years range), sex, degree of social deprivation, and year of hospitalization. Cox regression models were conducted with adjustment for smoking, alcohol and other substance addiction, overweight or obesity, Charlson comorbidity index, presence of trauma, surgical intervention, Simplified Acute Physiology Score II score, organ failures, source of hospital admission (home, transfer from other hospital ward), and the length of time between hospital admission and ICU admission. The primary outcome was 90-day CFR. Secondary outcomes were 30- and 365-day CFRs, and clinical profiles of patients. A total of 187,587 adult patients with septic shock admitted to the ICU were identified, including 3,812 with schizophrenia, 2,258 with bipolar disorder, and 5,246 with major depressive disorder. Compared to matched controls, the 90-day CFR was significantly lower in patients with schizophrenia (1,052/3,269 = 32.2% versus 5,000/10,894 = 45.5%; adjusted hazard ratio (aHR) = 0.70, 95% confidence interval (CI) 0.65,0.75, p < 0.001), bipolar disorder (632/1,923 = 32.9% versus 2,854/6,303 = 45.3%; aHR = 0.70, 95% CI = 0.63,0.76, p < 0.001), and major depressive disorder (1,834/4,432 = 41.4% versus 6,798/14,452 = 47.1%; aHR = 0.85, 95% CI = 0.81,0.90, p < 0.001). Study limitations include inability to capture deaths occurring outside hospital, lack of data on processes of care, and problems associated with missing data and miscoding in medico-administrative databases. Our findings suggest that, after adjusting for social disadvantage and physical health comorbidity, there are improved septic shock outcome in patients with SMI compared to patients without. This finding may be the result of different immunological profiles and exposures to psychotropic medications, which should be further explored.

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis.

A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.

P15 Elizabethkingia anophelis became the major Elizabethkingia species in bacteraemia patients in Northern Taiwan

Abstract Background Elizabethkingia species are antibiotic-resistant microbes. It is a serious bacterial pathogen that can cause the patient to die. Thanks to the technology of sequencing, we can identify different strains of Elizabethkingia species. The Elizabethkingia genus currently comprises 6 species, E. meningoseptica, E. miricola, E. anophelis, E. bruuniana, E. ursingii and E. occul. In the previous study in Taiwan, E. meningoseptica was the major strain that caused infection from 2009 to 2016. But in another reference, we found that E. anophelis became the dominant strain in other countries. Due to this ascertainment, we did an experiment to check the true situation in Taiwan. Methods Because of the limitation of the tool, in our hospital, we could spread different strains of Elizabethkingia Species by the traditionally identified methods in our bacteria room. That's why we collected the bacteria to our bacteria bank for research. In this study, we collected 65 Elizabethkingia species from bacteraemia patients. And the storage period from January 2018 to June 2020. Then we used the DNA extraction kit to collect the DNA and did the PCR to check whether the target gene was detected or not. Once anoR gene was detected, it would be E. anophelis, if the mengF gene was detected, it would be E. meningoseptica, or if the ureGF gene was detected, it would be E. miricola. Results In this study, we found E. anophelis became the major species (37/65, 56.9%), and E. meningoseptica is the second most common species (28/65, 43.1%). We didn't find any E. miricola. Conclusions The transmission route of E. anophelis remains unclear. The case-fatality rate of patients with E. anophelis infection is critically high, ranging from 24% to 60%. To avoid hospital associated infection with E. anophelis, environment cleaning plays an important role. In a recent study, UVC machines can reduce the infection rate, and may be another solution for environment cleaning besides bleach wipes.

Uncovering common pathobiological processes between COVID-19 and pulmonary arterial hypertension by integrating Omics data.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to the current pandemic. Many factors, including age and comorbidities, influence the severity and mortality of COVID-19. SARS-CoV-2 infection can cause pulmonary vascular dysfunction. The COVID-19 case-fatality rate in patients with pulmonary arterial hypertension (PAH) is higher in comparison with the general population. In this study, we aimed to identify pathobiological processes common to COVID-19 and PAH by utilizing the human protein-protein interactome and whole-genome transcription data from peripheral blood mononuclear cells (PBMCs) and from lung tissue. We found that there are significantly more interactions between SARS-CoV-2 targets and PAH disease proteins than expected by chance, suggesting that the PAH disease module is in the neighborhood of SARS-CoV-2 targets in the human interactome. In addition, SARS-CoV-2 infection-induced changes in gene expression significantly overlap with PAH-induced gene expression changes in both tissues, indicating SARS-CoV-2 and PAH may share common transcriptional regulators. We identified many upregulated genes and downregulated genes common to COVID-19 and PAH. Interestingly, we observed different co-regulation patterns and dysfunctional signaling pathways in PBMCs versus lung tissue. Endophenotype enrichment analysis revealed that genes regulating fibrosis, inflammation, hypoxia, oxidative stress, immune response, and thromboembolism are significantly enriched in the COVID-19-PAH co-expression modules. We examined the network proximity of the targets of repositioned drugs for COVID-19 to the co-expression modules in PBMCs and lung tissue, and identified 42 drugs that can be potentially used for COVID-19 patients with PAH as a comorbidity. The uncovered common pathobiological pathways arecrucial for discovering therapeutic targets and designing tailored treatments for COVID-19 patients who also have PAH.

1152. Risk factors for 30-day all-cause mortality in hospitalized patients with COVID-19 receiving immunomodulator therapy: a retrospective cohort study

Abstract Background The case fatality rate of patients hospitalized with COVID-19 is estimated at 13-17% with higher rates in the critically ill (37-45%). Attenuation of the inflammatory cascade has potential to reduce mortality. The purpose of this retrospective cohort study was to evaluate risk factors for 30-day all-cause mortality in hospitalized patients with COVID-19 who received tocilizumab or baricitinib. Methods This was a retrospective cohort study of the first 100 patients that received each medication. Cases were patients with 30-day all-cause mortality from start of immunomodulator, with controls those who received the medication and survived. Patient demographics, laboratory results, vital signs, and clinical management of COVID-19 were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day all-cause mortality. Variables with p &amp;lt; 0.2 on univariate analysis were analyzed via multivariate logistic regression. Results From February-September 2021, 194 patients treated with an immunomodulator (97 in each group) were evaluated. Patients who received tocilizumab were less likely to be fully vaccinated (4.1% vs. 19.6%, p = 0.001) and were more likely to require mechanical ventilation at baseline (23.7% vs. 11.3%, p = 0.023). There were no between group differences in remdesivir or dexamethasone use. For the primary outcome, 81 patients (41.8%) experienced 30-day all-cause mortality with no difference between groups (tocilizumab: 46.4% vs. baricitinib: 37.1%; p = 0.19). Variables associated with higher odds for 30-day all-cause mortality in multivariate analysis: age ≥ 65, mechanical ventilation at baseline, and higher daily dexamethasone use. Fully vaccinated patients had lower odds for mortality (Table 1). Conclusion In COVID-19 hospitalizations, age ≥ 65, mechanical ventilation at baseline, and higher daily dexamethasone doses were associated with 30-day all-cause mortality. Mortality was lower in patients fully vaccinated compared to those unvaccinated. Use of a specific immunomodulator did not impact mortality. Disclosures Thomas L. Walsh, MD, Accelerate Diagnostics: Honoraria.

Cost-effectiveness analysis of the multi-strategy WHO emergency care toolkit in regional referral hospitals in Uganda.

Low- and middle-income countries bear a disproportionate amount of the global burden of disease from emergency conditions. To improve the provision of emergency care in low-resource settings, a multifaceted World Health Organization (WHO) intervention introduced a toolkit including Basic Emergency Care training, resuscitation area guidelines, a trauma registry, a trauma checklist, and triage tool in two public hospital sites in Uganda. While introduction of the toolkit revealed a large reduction in the case fatality rate of patients, little is known about the cost-effectiveness and affordability. We analysed the cost-effectiveness of the toolkit and conducted a budget analysis to estimate the impact of scale up to all regional referral hospitals for the national level. A decision tree model was constructed to assess pre- and post-intervention groups from a societal perspective. Data regarding mortality were drawn from WHO quality improvement reports captured at two public hospitals in Uganda from 2016-2017. Cost data were drawn from project budgets and included direct costs of the implementation of the intervention, and direct costs of clinical care for patients with disability. Development costs were not included. Parameter uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. Our model estimated the incremental cost-effectiveness of implementing the WHO emergency care toolkit measuring all costs and outcomes as disability-adjusted life-years (DALYs) over a lifetime, discounting both costs and outcomes at 3.5%. Implementation of the WHO Toolkit averted 1,498 DALYs when compared to standard care over a one-year time horizon. The initial investment of $5,873 saved 34 lives (637 life years) and avoided $1,670,689 in downstream societal costs, resulted in a negative incremental cost-effectiveness ratio, dominating the comparator scenario of no intervention. This would increase to saving 884 lives and 25,236 DALYs annually with national scale up. If scaled to a national level the total intervention cost over period of five years would be $4,562,588 or a 0.09% increase of the total health budget for Uganda. The economic gains are estimated to be $29,880,949 USD, the equivalent of a 655% return on investment. The model was most sensitive to average annual cash income, discount rate and frequency survivor is a road-traffic incident survivor, but was robust for all other parameters. Improving emergency care using the WHO Toolkit produces a cost-savings in a low-resource setting such as Uganda. In alignment with the growing body of literature highlighting the value of systematizing emergency care, our findings suggest the toolkit could be an efficient approach to strengthening emergency care systems.

Analysis of risk factors for COVID-19-related fatal outcome in 337991 patients with type 1 and type 2 diabetes mellitus in 2020–2022 years: Russian nationwide retrospective study

BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death.AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2).MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)).RESULTS: Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1–8.8%; DM2–17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age ≥65 years (OR =4.01, 95% CI: 1.42–11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98–26.29); for T2DM: age ≥ 65 years (OR =2.53, 95% CI: 1.96–3.27), male (OR =1.51, 95% CI: 1.23–1.84), duration DM ≥10 years (OR =2.01, 95% CI: 1.61–2.51), BMI ≥ 30 kg/m2 (OR =1.26, 95% CI: 1.02–1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01–2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89–88.99) and presence of disability ( OR =1.40, 95% CI: 1.14–1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30–2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23–1.84)); dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39–0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46–0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06–0.59; SD2 OR =0.20, 95% CI: 0.16–0.26.CONCLUSION: The common risk factor for fatal outcome in both DM1 and DM2 was age ≥65 years; in DM1 — history of hypertension and DFS, in DM2 — male sex, diabetes duration ≥10 years, BMI ≥30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.

Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD.

Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD.

Seizures in COVID-19: the relationship between biomarkers and prognosis.

ObjectiveTo assess the prevalence of seizure, associated risk factors, and prognosis in patients with SARS-CoV-2 infection and identify predictive biomarkers in SARS-CoV-2 patients with seizure.MethodsA cohort of 17,806 patients with SARS-CoV-2 infection admitted to two university hospitals in Adana between March 11, 2020 and January 1, 2021 was analyzed retrospectively. The patients’ demographic characteristics, laboratory findings, and systemic and neurological symptoms at admission and on the day of seizure onset were evaluated.ResultsNeurological findings were detected in 877 of the 17,806 patients. Of these, 45 patients (0.25%) had seizure (status epilepticus in 4/45 patients, 8.9%). Patients with seizure had a mean age of 55.3 years (range 17–88) and 57.8% were male. Seizure was more common in the 18–44 (24.4%) and ≥ 65 age groups (44.4%) and in those with multiple comorbidity. The case fatality rate for patients with seizure among all SARS-CoV-2 patients was 0.135% (95% CI 80.86–188.71). However, no patient with a previous diagnosis of epilepsy died during SARS-CoV-2 infection. High neutrophil, platelet, and ferritin levels and low lymphocyte and calcium levels on the day of seizure development compared to admission were associated with higher mortality (p = 0.004, 0.008, 0.028, 0003, and 0.002, respectively).ConclusionsSeizures are not uncommon during SARS-CoV-2 infection, with a higher risk of mortality in older patients and those with higher inflammatory markers.

SILENT HYPOXIA IN COVID-19: IS IT MORE DANGEROUS? A RETROSPECTIVE COHORT STUDY

TYPE: Late Breaking Abstract TOPIC: Critical Care PURPOSE: Silent hypoxia is the presence of hypoxia in absence of subjective experience of breathing discomfort. The aim of our study is to explore differences in disease outcomes in patients with silent hypoxia compared to patients with dyspneic hypoxia. METHODS: We retrospectively reviewed data of COVID-19 patients who were hypoxic at the time of presentation. Clinical, laboratory and treatment parameters were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality. RESULTS: Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. Out of 811 patients,174 (21.45%) did not have complaints of shortness of breath since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in hypoxic patients admitted with complaints of dyspnea (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851). CONCLUSIONS: Silent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively as dyspneic hypoxia for improving disease outcomes. CLINICAL IMPLICATIONS: Silent hypoxia and dyspneic hypoxia have similar outcomes, it is of paramount importance to do pulse oximetry in every patient diagnosed with SARS-CoV-2 infection. DISCLOSURE: Nothing to declare. KEYWORD: Silent Hypoxia

Case fatality rate in patients of COVID-19 with anemia.

Objective: To analyze SARS-CoV2 patients who presented to Military Hospital Rawalpindi having normal hemoglobin levels and those with low hemoglobin. Study Design: Cross Sectional study. Setting: Pathology Laboratory, Military Hospital Rawalpindi, Pakistan. Period: March 2020 to July 2020. Material &amp; Methods: Patients of both genders and all age groups with positive PCR for Corona virus were included. Patients of both the genders and all age groups with negative PCR for corona virus. 2ml blood sample was taken in EDTA tubes from the patients in wards and Intensive care unit and Hemoglobin level was checked using the Sysmex KX21 analyzer. Results: 400 COVID positive patients were studied with Hemoglobin ranging from 7.0g/dl to 17g/dl. It was seen that patients with low Hemoglobin levels were increasingly shifted to ventilators as compared to those with normal Hemoglobin whereas, the Ferritin level was raised in patients who expired. Conclusion: Most patients who expired due to COVID-19 virus infection had low hemoglobin level and high Ferritin level.

Severe Fever with Thrombocytopenia Syndrome, a Viral Hemorrhagic Fever, Endemic to Japan: Achievements in and Directions for Medical Research.

Severe fever with thrombocytopenia syndrome (SFTS), a novel infectious disease caused by a novel bunyavirus and with a high case fatality rate (CFR), was reported by Chinese scientists in 2011. The causative virus, Dabie bandavirus also known as the SFTS virus (SFTSV), belongs to the genus Bandavirus (formerly named Phlebovirus) of the family Phenuiviridae (formerly named Bunyaviridae). SFTS was also reported to be endemic in South Korea and Japan in 2013. SFTSV circulates between some species of ticks and animals in nature. Humans are infected with SFTSV through bites from ticks such as Haemaphysalis longicornis and Amblyomma testidinarium. Domesticated animals, such as cats and dogs, are also infected with SFTSV and shown SFTS-like symptoms with a high CFR, likely having been infected through tick bites in the living environment. Furthermore, there have been cases of patients with SFTS who were infected with SFTSV through close contact with sick cats or dogs. The CFR in patients with SFTS is approximately 30% in Japan. There is always a risk of SFTSV infection in human populations living in endemic areas. Therefore, the development of specific therapies and vaccines is urgently needed to reduce the number of fatal SFTS cases.

COVID-19 mortality in cirrhosis is determined by cirrhosis-associated comorbidities and extrahepatic organ failure: Results from the multinational LEOSS registry.

Background and ObjectiveInternational registries have reported high mortality rates in patients with liver disease and COVID‐19. However, the extent to which comorbidities contribute to excess COVID‐19 mortality in cirrhosis is controversial.MethodsWe used the multinational Lean European Open Survey on SARS‐CoV‐2‐infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021, when the wild‐type and alpha variant were predominant. We compared symptoms, disease progression and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Mortality was also compared with that of patients with spontaneous bacterial peritonitis (SBP) without SARS‐CoV‐2 infection, a common bacterial infection and well‐described precipitator of acute‐on‐chronic liver failure.ResultsAmong 7096 patients with SARS‐CoV‐2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalized. Risk factors for severe COVID‐19, such as diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis. Case fatality rate in patients with cirrhosis was 31.4% with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child‐Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001). After PSM for demographics and comorbidity, the COVID‐19 case fatality of patients with cirrhosis did not significantly differ from that of matched patients without cirrhosis (28.8% vs. 26.1%; p = 0.644) and was similar to the 28‐day mortality in a comparison group of patients with cirrhosis and SBP (33.3% vs. 31.5%; p = 1.000).ConclusionsIn immunologically naïve patients with cirrhosis, mortality from wild‐type SARS‐CoV‐2 and the alpha variant is high and is largely determined by cirrhosis‐associated comorbidities and extrahepatic organ failure.