Days Of Hospital Admission Research Articles

Characterising biological mechanisms underlying ethnicity-associated outcomes in COVID-19 through biomarker trajectories: a multicentre registry analysis

BackgroundDifferences in routinely collected biomarkers between ethnic groups could reflect dysregulated host responses to disease and to treatments, and be associated with excess morbidity and mortality in COVID-19. MethodsA multicentre registry analysis from patients aged ≥16 yr with SARS-CoV-2 infection and emergency admission to Barts Health NHS Trust hospitals during January 1, 2020 to May 13, 2020 (wave 1) and September 1, 2020 to February 17, 2021 (wave 2) was subjected to unsupervised longitudinal clustering techniques to identify distinct phenotypic patient clusters based on trajectories of routine blood results over the first 15 days of hospital admission. Distribution of trajectory clusters across ethnic categories was determined, and associations between ethnicity, trajectory clusters, and 30-day survival were assessed using multivariable Cox proportional hazards modelling. Secondary outcomes were ICU admission, survival to hospital discharge, and long-term survival to 640 days. ResultsWe included 3237 patients with hospital length of stay ≥7 days. In patients who died, there was greater representation of Black and Asian ethnicity in trajectory clusters for C-reactive protein and urea-to-creatinine ratio associated with increased risk of death. Inclusion of trajectory clusters in survival analyses attenuated or abrogated the higher risk of death in Asian and Black patients. Inclusion of C-reactive protein went from hazard ratio (HR) 1.36 [0.95–1.94] to HR 0.97 [0.59–1.59] (wave 1), and from HR 1.42 [1.15–1.75]) to HR 1.04 [0.78–1.39] (wave 2) in Asian patients. Trajectory clusters associated with reduced 30-day survival were similarly associated with worse secondary outcomes. ConclusionsClinical biochemical monitoring of COVID-19 and progression and treatment response in SARS-CoV-2 infection should be interpreted in the context of ethnic background.

Early Economic Assessment of Faecal Microbiota Transplantation for Patients with Urinary Tract Infections Caused by Multidrug-Resistant Organisms.

The use of faecal microbiota transplantation (FMT) to eradicate intestinal carriage of multidrug-resistant organisms (MDRO) has been described in case reports and small case series. Although few in numbers, these patients suffer from recurrent infections that may exacerbate both the patients' comorbidities and their healths. In the current study, we hypothesized that FMT for MDRO-related urinary tract infections (UTIs) reduces hospitalisations and associated costs. In a cohort of patients referred for FMT from 2015 to 2020, we selected all patients who had consecutively been referred for eradication of MRDO carriage with UTIs. An early economic assessment was performed to calculate hospital-related costs. The overall study cohort was registered at ClinicalTrials, study identifier NCT03712722. We consecutively included five patients with UTIs caused by MDROs. Four of the patients were renal transplant recipients. Patients were followed for median 126days (range 60-320), where the follow-up duration for each patient was aligned with the number of days from the first UTI to FMT. The median number of UTIs per patient dropped from 4 to 0. Investigating hospital costs, hospital admission days dropped by 87% and monthly hospital costs by 79%. FMT was effective in reducing the occurrence of UTIs and mediated a marked reduction in hospital costs. We suggest that this strategy is cost-effective. ClinicalTrials, study identifier NCT03712722.

Epidemiology, Resistance Profiles, and Outcomes of Bloodstream Infections in Community-Onset Sepsis in the United States.

To describe frequency of positive blood cultures, patterns of pathogens' characteristics and their resistance profile in patients with blood cultures drawn due to a presumed diagnosis of community-onset sepsis, and to examine the association between blood culture-positive pathogens and hospital mortality. Retrospective cohort study. Two hundred one U.S. hospitals from 2016 to 2020 using the Premier Healthcare Database. Adult patients presenting with community-onset sepsis who had blood cultures collected within 2 days of hospital admission. We defined sepsis using the U.S. Centers for Disease Control Adult Sepsis Event Surveillance criteria. None. We identified 147,061 patients with community-onset sepsis. The number of blood culture-positive sepsis episodes was 21,167 (14%) and the number of nonblood culture-positive sepsis episodes was 20,326 (14%). Among patients with blood culture-positive sepsis, Gram-negative rods were isolated in 55% of patients, Gram-positive cocci were isolated in 47%. Of those, methicillin-resistant Staphylococcus aureus (MRSA) was 11%, ceftriaxone-resistant Enterobacterales /extended-spectrum β-lactamase was 7%, and carbapenem-resistant Enterobacterales was 1.3%. The crude in-hospital mortality was 17% for culture-negative sepsis, 13% for nonblood culture-positive sepsis, and 17% for blood culture-positive sepsis. In multilevel logistic regression models, compared with culture-negative sepsis, blood culture-positive sepsis (adjusted odds ratio [aOR], 0.89; 95% CI, 0.85-0.94) and nonblood culture-positive sepsis (aOR, 0.82; 95% CI, 0.78-0.87) were associated with lower odds of in-hospital mortality. Acinetobacter species, Pseudomonas aeruginosa , methicillin-sensitive Staphylococcus aureus , and MRSA were associated with higher in-hospital mortality, whereas Escherichia coli , Klebsiella species, Proteus species, and Streptococcus species were associated with lower in-hospital mortality. In patients hospitalized with community-onset sepsis, the prevalence of blood culture-positive sepsis was 14%. Among positive blood culture sepsis resistant organisms were infrequent. Compared with culture-negative sepsis, blood culture-positive sepsis and nonblood culture-positive sepsis were associated with lower in-hospital mortality.

Protecting healthcare personnel and patients over 3years of COVID-19 : Effective protection by masks and hygiene: What else was effective?

Healthcare professionals, particularly those in test centers, laboratories, or specialized COVID-19 wards, are in danger of becoming infected. Patients with special underlying health conditions are at an increased risk of getting very sick, being hospitalized, or dying from COVID-19. Age is a leading risk factor in this context. Currently, FFP2 (Filtering Facepiece 2, European standard), N95 (US standard), and KN95 (Chinese standard) face masks remain the simplest measure of protection. Coronavirus warning apps installed on smartphones have been recommended for anonymous contact tracing and quickly disrupting chains of infection. Preventive testing two to three times per week for healthcare personnel, on the day of hospital admission for patients, and upon facility entry for visitors has been routinely performed or has been requested from external test centers in most medical institutions. However, vaccination is regarded the most effective protective measure against COVID-19. The general recommendation of the World Health Organization is that countries continue to work toward vaccinating at least 70% of their populations, prioritizing the vaccination of 100% of healthcare workers and 100% of the most vulnerable groups, including people who are over 60years of age and those who are immunocompromised or have underlying health conditions. The most vulnerable individuals among patients and healthcare workers should be identified and then their vaccination status should be checked and, if necessary, optimized by booster administration. In Germany, seasonal and institutional recommendations for individual protection by face masks, for hygiene measures, and for preventive testing must follow the updated coronavirus protection regulations (Coronavirus-Schutzverordnungen).

Methemoglobin and Inflammatory Markers in the Context of Mortality in COVID-19 Disease

Context: Today, the world is in search of potential biomarkers for assessing the severity and prognosis of coronavirus disease-2019 (COVID-19) disease with its different clinical presentations. Aim: The aim of this study was to assess the roles of C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT), and methemoglobin (Met-Hb) in the clinical outcome of COVID-19 patients. Settings and Design: This observational cross-sectional study was conducted in COVID-19 cases admitted in the intensive care unit (ICU) of a tertiary care hospital from June 2021 to October 2021. Subjects and Methods: For all selected patients, estimation of CRP, LDH, PCT, and Met-Hb levels was done on the 2nd–3rd days of hospital admission, and definitive outcomes were included sequentially. Results: Out of 495 ICU admissions, 69 patients were evaluated in the end. Out of which, 27 patients died during the hospital stay. The mean Met-Hb, LDH, PCT, and CRP levels in nonsurvivors were significantly high. In multivariate bivariate regression analysis, age (odds ratio [OR]–1.06; 95% confidence interval [CI]: 1.01–1.13; P = 0.021), LDH (OR–1.006; 95% CI: 1.001–1.010; P = 0.013), and CRP (OR–1.03; 95% CI: 1.002–1.6; P = 0.047) were independently associated with nonsurvival of the patients. The receiver operating characteristic curve showed a cutoff value of 684 U/L for LDH which predicted mortality due to COVID-19 disease with 66.7% sensitivity and 70.4% specificity. For CRP, a cutoff value of 28.3 mg/L predicted mortality with 73.8% sensitivity and 59.3% specificity. Conclusions: In conclusion, higher levels of LDH and CRP were related to mortality due to COVID-19 disease. Slightly raised values of Met-Hb in nonsurvivors suggest nonresponding hypoxia. The research in this context may open new options in the treatment of COVID-19 disease.

5589320 FOLLOW-UP RESULTS OF A PHASE 2 STUDY ASSESSING THE SAFETY AND EFFICACY OF MITAPIVAT TREATMENT, AN ORAL PYRUVATE KINASE ACTIVATOR, FOR UP TO 60 WEEKS IN SUBJECTS WITH SICKLE CELL DISEASE

Background: Sickle cell disease (SCD) is a devastating red blood cell (RBC) disorder. The root cause of SCD is polymerization of sickle hemoglobin (HbS) upon deoxygenation, resulting in poorly deformable sickled RBCs with shortened lifespan. 2,3-diphosphyglycerate (2,3-DPG), a glycolytic intermediate in RBCs, promotes deoxygenation by lowering hemoglobin (Hb)-oxygen affinity. Mitapivat (AG-348) is an oral allosteric activator of pyruvate kinase (PK), a key enzyme in RBC glycolysis generating adenosine triphosphate (ATP) and reducing 2,3-DPG levels. Aims: To report follow-up data of the safety and efficacy of mitapivat treatment in subjects with SCD (ESTIMATE study; www.trialregister.nl NL8517; EudraCT 2019-003438-18). Methods: The ESTIMATE study is a phase 2, investigator initiated, open-label study. Subjects ≥16 years with SCD (HbSS, HbS/β0 or HbS/β+), 1-10 vaso-occlusive crises (VOCs) in the prior year and/or prior SCD-related complications, a Hb level >6.1 g/dL and ≤11.1 g/dL, and no chronic transfusions are eligible and treated with mitapivat after obtaining informed content. In the 8-week dose finding period, initial dosing is 20 mg twice daily, escalated to max. 100 mg twice daily, and followed by an up to 52-week fixed dose extension period (FDEP). Primary endpoints are safety, based on adverse events (AEs), and efficacy of mitapivat treatment on RBC sickling (Point of Sickling (PoS), oxygen gradient ektacytometry). Key secondary endpoints are changes in Hb level, markers of hemolysis, ATP/2,3-DPG levels, and Hb-oxygen affinity (p50, Hemox Analyzer). Results: Until Jan. 2022, 9 subjects were treated with mitapivat. Baseline characteristics were: median age 22 years (range 16-59 years), 6/9 (67%) female, and 6/9 (67%) used hydroxyurea. 7/9 (78%) had HbSS, 1/9 (11%) had HbS/β0, and 1/9 (11%) had HbS/β+. One subject with a non-treatment related serious AE (SAE) of a urinary tract infection (grade 4), was lost to follow-up shortly after first dosing. No other SAEs or treatment-emergent AEs (TEAEs) grade ≥3 occurred. The remaining 8 subjects had a median treatment duration of 38 weeks (range 11-60 weeks). 6/8 (75%) took 100 mg mitapivat twice daily in the FDEP, and 2/8 (25%) took 50 mg mitapivat twice daily after a single dose reduction because of progressive transaminase increase. The most common TEAEs were (n>2 subjects): ALT or AST increase (both 5/9, 56%; all grade 1), and headache (4/9, 44%; grade 1-2). Three VOCs occurred: one related to excessive alcohol consumption with no need for hospitalization, and two in subjects with documented noncompliance the week before hospitalization. Mean annual VOC rate and SCD-related hospital admission days were, respectively, 1.5±1.3 and 5.9±7.1 days at baseline, and reduced to 0.5±0.7 and 1.6±3.1 days when weighting cases by follow-up duration (p=0.021 and p=0.134, respectively). Table 1 summarizes mean changes in parameters of primary and key secondary endpoints of scheduled visits in the FDEP compared to baseline. Hb level significantly increased, accompanied by a decrease in markers of hemolysis (absolute reticulocyte count, total bilirubin, lactate dehydrogenase). Mean PoS decreased, and p50, 2,3-DPG level and ATP/2,3-DPG ratio significantly improved. Conclusion: Treatment with mitapivat for up to 60 weeks in subjects with SCD showed no treatment related TEAEs grade ≥3. Improvements in anemia, markers of hemolysis, oxygen affinity, 2,3-DPG level and ATP/2,3-DPG ratio were seen.

Radioisotopic evaluation of reparative osteogenesis in various forms of osteomyelitis of the mandible

The aim of this work is the rationale for using radiological method of examination in diagnosing and monitoring the mandibular osteomyelitis treatment. A total of 60 patients with traumatic (first group) and odontogenic (second group) mandibular osteomyelitis were examined. Among them, there were 24 (40%) males and 36 (60%) females aged between 20 and 45 years. The patients received intravenous injection of Technefor (99MTc) with the radiation activity of 300-400 megabecquerel 3-4 hours before scintigraphy. The mandible radiopharmaceutical uptake was measured using a computerized gamma camera. The level of 99MTc accumulation in the bone tissue was quantified by gamma-radiation. A patient was examined on the day of hospital admission and on day 14 after surgical treatment of osteomyelitis of the mandible. Our studies have shown that all forms of traumatic and odontogenic osteomyelitis are accompanied by significant changes in 99MTc uptake in the mandible, however, both 99MTc uptake and its decrease after surgical treatment were most obvious in odontogenic osteomyelitis. The increase in 99MTc uptake in traumatic mandibular osteomyelitis was 38,1% (up to 1669,9 gamma-radiation pulses), 140,9% (up to 2913,7 gamma-radiation pulses) and 129% (up to 2772,7 gamma-radiation pulses) in the acute, subacute and chronic stages of the disease, respectively. The increase in 99MTc uptake in odontogenic mandibular osteomyelitis was 160,0% (up to 3144,1 gamma-radiation pulses), 218,1% (up to 3846,6 gamma-radiation pulses) and 275,2% (up to 4537,6 gamma-radiation pulses) in the acute, subacute and chronic stages of the disease, respectively. The increase in 99MTc uptake was due to blood flow enhancement, metabolic disorders, activation of osteoblast and osteoclasts in the bone tissue. The decrease in 99MTc uptake after the treatment indicated the positive response to treatment. Scintigraphic examination was more sensitive and specific in comparison to X-ray diagnostics of mandibular ostemyelitis. The sensitivity of scintigraphic findings ranged from 60.0% to 100%, and the specificity was 100% at different stages of ostemyelitis.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

Heat exposure and hospitalisation for epileptic seizures: A nationwide case-crossover study in Brazil

Climate change is increasing human exposure to heat, especially in tropical regions such as Brazil where temperature reaches up to 40 °C in summer. However, the association between heat exposure and epileptic seizures has not been well demonstrated in Brazil, where lifetime prevalence of epilepsy can range from 11.9/1000 to 21/1000. We collected a total of 225,699 hospitalisation records for epileptic seizures of 1816 municipalities in Brazil, during the hot season from 2000 to 2015, covering nearly 79% of the national population. We implemented a time-stratified case-crossover design combined with distributed lag model with further stratified investigations regarding sex, age, socioeconomic status and region. We found temperature impact threshold was 26 °C in Brazil nationally. Every 1 °C increase from the threshold was associated with an overall 4.3% increased risk of hospitalisation for epileptic seizures on the current day of hospital admission and up to seven days before, which was most pronounced on the second-day exposure to heat. Females, individuals aged 20–30 and persons living in high-income or Southeast regions were more vulnerable. Our results highlight the enhanced risk of heat exposure for epilepsy patients and could contribute to epilepsy management, such as forecasting epileptic seizures. Multi-dimensional adaptive strategies were proposed, covering individual protection, occupational health surveillance, and urban planning management, aiming to reduce heat-induced hospitalisations for epilepsy, and be generalizable to other heat-related diseases.

A CASE SERIES on the Convalescent Plasma use in SARSCOV2 PCR Positive Filipino Patients in Makati Medical Center

The COVID-19 pandemic has caused tremendous stress in the healthcare system worldwide with millions of death and morbidities. Convalescent plasma therapy has given hope for cure at this time of great uncertainty. Multiple studies and literature review attempted to understand the efficacy of the therapy but unable to provide definite and clear answers. This case series presents data on 55 Filipino patients who were given convalescent plasma therapy. In this observation, mean age of patients is 63 ± 13 years old, predominantly male (67.27%, N=37), all Filipinos, with 2 or more co-morbidities, with severe and critical case (92.73%, N=51), with symptoms of fever, difficulty of breathing and body malaise. Majority of the plasma were collected in -house, given after 2 weeks of illness but within 7 days of hospital admission. More patients were discharged at 60%(N=33). No improvement in Vital signs, Laboratory results and Chest X-ray was noted after Convalescent plasma therapy. The lack of high quality studies on plasma therapy and definitive cure in COVID-19 infection maintains convalescent plasma therapy as a possible cure, mostly at times of infection in a pandemic scale. High quality clinical trials in the use of Convalescent plasma therapy is encouraged to provide high quality data as basis of treatment recommendation.

"New Parameters in Covid-19 Therapy Guidance: A Retrospec-Tive Study"

Laboratory examinations with new parameters can help the clinician through the path of care of COVID-19 patient. The aims of this study to evaluate the relationship between the severity of the disease, the qualitative and hemocytometric data obtained within three days of hospital admission; and between the latter and the stage of the disease described by the patient.

Effects of ambient air pollution on cause-specific hospitalizations in Wuhan during 2017–2019

BackgroundFew studies have focused on the associations between air pollutants and multiple organ system diseases in the entire hospitalized population. The present study aims to explore the short-term effects of six routinely monitored air pollutants on the broad causes of hospital admissions and estimate the resulting hospital admission burdens. MethodsDaily hospital admission records from 2017 to 2019 were obtained from the Wuhan Information center of Health and Family Planning. Generalized additive models (GAMs) were employed to evaluate the effects of air pollutants on the percent increase in the cause-specific daily number of hospital admissions. Increased hospital admission numbers, days, and expenses were also estimated. ResultsA total of 2636,026 hospital admissions were identified. We found that both PM2.5 and PM10 increased the risk of hospital admissions for most disease categories. Short-term exposure to PM2.5 was positively associated with hospitalizations of several rarely studied disease categories, such as diseases of the eye and adnexa (2.83%, 95%CI: 0.96–4.73%, P < 0.01) and diseases of the musculoskeletal system and connective tissue (2.17%, 95% CI: 0.88–3.47%, P < 0.001). NO2 was observed to have a robust effect on diseases of the respiratory system (1.36%, 95%CI: 0.74–1.98%, P < 0.001). CO was significantly associated with hospital admissions for six disease categories. Furthermore, each 10-μg/m3 increase in PM2.5 was associated with an annual increase of 13,444 hospital admissions (95% CI: 6239–20,649), 124,344 admission days (95% CI: 57,705–190,983), and 166-million-yuan admission expenses (95% CI: 77–255). ConclusionOur study suggested that particulate matter (PM) had a short-term effect on hospital admissions of most major disease categories and resulted in a considerable hospital admission burden. In addition, the health effects of NO2 and CO emissions require more attention in megacities.

Sural nerve involvement in Guillain-Barré syndrome: Clinical and prognostic implications. A prospective cohort

BackgroundSural sparing is common in Guillain-Barré syndrome (GBS). However, one third of patients have sural nerve compromise. Its clinical implications associated factors and short-term prognosis are still unknown. The objective of this study is to identify if sural nerve compromise is associated with a worse prognosis and to describe clinical and electrophysiological characteristics in Guillain-Barré syndrome. Materials and methodsWe prospectively analyzed patients with Guillain-Barré diagnosis with vs without sural nerve compromise. All patients underwent nerve conduction studies within the first 3 days of hospital admission. Clinical and electrophysiological characteristics were compared between groups. Results174 patients were included in this study. Acute inflammatory demyelinating polyneuropathy was the predominant variant (43.7 %). Thirty percent of patients had sural nerve involvement. In the comparative analysis between affected vs unaffected sural groups, age ≥50 years and Guillain-Barré disability score ≥3 demonstrated a statistically significant difference. Regarding short-term recovery period for independent walking, there was no significant difference. In the multivariate analysis, age ≥50 years was identified as independent factors for sural nerve compromise on admission. Conclusionsural nerve compromise occurs in 30 % of patients with GBS and is not associated with a worse functional prognosis. Age ≥50 years was identified as an independent factor for sural nerve compromise.

Loneliness, social isolation, and healthcare utilization in the general population.

Due to increasing pressure on healthcare resources, knowledge of factors that affect healthcare utilization (HCU) is important. However, the evidence of a longitudinal association between loneliness and social isolation respectively, and HCU is limited. The present prospective cohort study investigated the association of loneliness and social isolation with HCU in the general population over time. Data from the 2013 Danish "How are you?" survey (n = 27.501) were combined with individual-level register data with almost complete follow-up over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and preexisting chronic disease. Loneliness measured was significantly associated with more general practice contacts (incident rate ratio [IRR] = 1.03, 95% confidence interval [CI] [1.02, 1.04]), more emergency treatments (IRR = 1.06, [1.03, 1.10]), more emergency admissions (IRR = 1.06, [1.03, 1.10]), and hospital admission days (IRR = 1.05, [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which social isolation was associated with fewer planned outpatient treatments (IRR = 0.97, [0.94, 0.99]). Wald test demonstrated that the association of loneliness with emergency admissions and hospital admissions days was not significantly different from the effects of social isolation on those outcomes. Our findings suggest that loneliness slightly increased the number of general practice contacts and emergency room treatments. Overall, the effects of loneliness and social isolation on HCU were small. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical observation of glucocorticoid therapy for critically ill patients with COVID-19 pneumonia

We aimed to investigate the clinical effects of intravenous glucocorticoid (GC) therapy for severe COVID-19 pneumonia. Seventy-two patients hospitalized with severe COVID-19 pneumonia who were discharged or died between 5 January 2020 and 3 March 2020 at Huangshi Infectious Disease Hospital were included. Patients were divided into a treatment group (GC group) and non-treatment group (non-GC group) according to whether they had received GCs within 7 days of hospital admission. There was no significant difference between groups for Acute Physiology and Chronic Health Evaluation (APACHE) II score and 28-day survival rate. The rate of invasive mechanical ventilation was higher in the GC group than in the non-GC group. On day 7 after admission, the GC group had shorter fever duration and higher white blood cell count than the non-GC group. In subgroup analysis by age and severity, there was no significant difference in 28-day survival rate and other indicators. Compared with those in the non-GC group, patients in the GC group more frequently required admission to the intensive care unit. In the present study, we found no significant improvement in patients with severe COVID-19 pneumonia treated with GCs within 7 days of admission.

Effectiveness of Remdesivir Treatment Protocols Among Patients Hospitalized with COVID-19: A Target Trial Emulation.

Remdesivir is recommended for certain hospitalized patients with COVID-19. However, these recommendations are based on evidence from small randomized trials, early observational studies, or expert opinion. Further investigation is needed to better inform treatment guidelines with regard to the effectiveness of remdesivir among these patients. We emulated a randomized target trial using chargemaster data from 333 US hospitals from 1 May 2020 to 31 December 2021. We compared three treatment protocols: remdesivir within 2 days of hospital admission, no remdesivir within the first 2 days of admission, and no remdesivir ever. We used baseline comorbidities recorded from encounters up to 12 months before admission and identified the use of in-hospital medications, procedures, and oxygen supplementation from charges. We estimated the cumulative incidence of mortality or mechanical ventilation/extracorporeal membrane oxygenation with an inverse probability of censoring weighted estimator. We conducted analyses in the total population as well as in subgroups stratified by level of oxygen supplementation. A total of 274,319 adult patients met the eligibility criteria for the study. Thirty-day in-hospital mortality risk differences for patients adhering to the early remdesivir protocol were -3.1% (95% confidence interval = -3.5%, -2.7%) compared to no early remdesivir and -3.7% (95% confidence interval -4.2%, -3.2%) compared to never remdesivir, with the strongest effect in patients needing high-flow oxygen. For mechanical ventilation/extracorporeal membrane oxygenation, risk differences were minimal. We estimate that, among hospitalized patients with COVID-19, remdesivir treatment within 2 days of admission reduced 30-day in-hospital mortality, particularly for patients receiving supplemental oxygen on the day of admission.

Low immunoglobulin levels affect the course of COPD in hospitalized patients

BackgroundChronic obstructive pulmonary disease (COPD) affects up to 10% of Canadians. Patients with COPD may present with secondary humoral immunodeficiency as a result of chronic disease, poor nutrition or frequent courses of oral corticosteroids; decreased humoral immunity may predispose these patients to mucosal infections. We hypothesized that decreased serum immunoglobulin (Ig) levels was associated with the severity of an acute COPD exacerbations (AECOPD).MethodsA prospective study to examine cardiovascular risks in patients hospitalized for AECOPD, recruited patients on the day of hospital admission and collected data on length of hospital stay at index admission, subsequent emergency department visits and hospital readmissions. Immunoglobulin levels were measured in serum collected prospectively at recruitment.ResultsAmong the 51 patients recruited during an admission for AECOPD, 14 (27.5%) had low IgG, 1 (2.0%) low IgA and 16 (31.4%) low IgM; in total, 24 (47.1%) had at least one immunoglobulin below the normal range. Patients with low IgM had longer hospital stay during the index admission compared to patients with normal IgM levels (6.0 vs. 3.0 days, p = 0.003), but no difference in other clinical outcomes. In the whole cohort, there was a negative correlation between serum IgM levels and length of hospital stay (R = − 0.317, p = 0.024). There was no difference in clinical outcomes between subjects with normal and low IgG levels.ConclusionIn patients presenting with AECOPD, low IgM is associated with longer hospital stay and may indicate a patient phenotype that would benefit from efforts to prevent respiratory infections.Trial registration statement: Retrospectively registered.

Vaccination against SARS-CoV-2 in pregnancy during the Omicron wave: the prospective cohort study of the Italian obstetric surveillance system

ObjectivesEvidence on the effects of the SARS-CoV-2 Omicron variant on vaccinated and unvaccinated pregnant women is sparse. This study aimed to compare maternal and perinatal outcomes of women infected with SARS-CoV-2 during the Omicron wave in Italy, according to their vaccine protection. MethodsThis national prospective cohort study enrolled pregnant women with a positive SARS-CoV-2 nasopharyngeal swab within 7 days of hospital admission between 1 January and 31 May, 2022. Women who received at least one dose of vaccine during pregnancy and those who completed the vaccine cycle with the first booster were considered protected against moderate or severe COVID-19 (MSCD). A multivariable logistic regression model evaluated the association between vaccine protection and disease severity. Maternal age, educational level, citizenship, area of birth, previous comorbidities, and obesity were analysed as potential risk factors. ResultsMSCD was rare (41/2147, 1.9%; 95% CI, 1.4–2.6), and the odds of developing it were significantly higher among unprotected women (OR, 2.78; 95% CI, 1.39–5.57). Compared with protected women (n = 1069), the unprotected (n = 1078) were more often younger, with lower educational degrees, and foreigners. A higher probability of MSCD was found among women with previous comorbidities (OR, 2.86; 95% CI, 1.34–6.12) and those born in Asian countries (OR, 3.05; 95% CI, 1.23–7.56). The percentage of preterm birth was higher among women with MSCD compared with milder cases (32.0% [8/25] versus 8.4% [161/1917], p < 0.001) as well as the percentage of caesarean section (52.0% [13/25] versus 31.6% [606/1919], p 0.029). DiscussionAlthough severe maternal and perinatal outcomes were rare, their prevalence was significantly higher among women without vaccine protection. Vaccination during pregnancy has the potential to protect both the mother and the baby, and it is therefore strongly recommended.

Usefulness of procalcitonin at admission as a risk-stratifying biomarker for 50-day in-hospital mortality among patients with community-acquired bloodstream infection: an observational cohort study

PurposeTo assess the association between plasma procalcitonin concentration at hospital admission and the risk of 50-day in-hospital mortality among patients with community-acquired bloodstream infections.MethodsWe carried out a retrospective, observational cohort study with all consecutive patients with bacteriologically confirmed community-acquired bloodstream infections hospitalized between 2006 and 2012. We aimed to assess the association between plasma procalcitonin at admission and 50-day in-hospital mortality. Patients were included in the analysis if they had undergone a blood culture test within 48 hours of hospitalization with a concomitant procalcitonin assay (time < 12 hours between the two tests). Inclusion in the study began on the day of hospital admission, and each patient was followed until death, discharge from the hospital, or last known follow-up in the 50 days following hospital admission. The endpoint was the occurrence of all-cause in-hospital mortality during the 50 days following hospital admission.ResultsDuring the 7-year study period, 1593 patients were admitted to one of the healthcare facilities of the University Hospital of Nancy from home or through the emergency department and had positive blood cultures and concomitant procalcitonin assays. Among the patients, 452 met the selection criteria and were analyzed. In ROC analysis, procalcitonin at baseline was significantly associated with 50-day in-hospital mortality, with an optimal threshold > 4.24 ng/mL. A baseline procalcitonin > 4.24 ng/mL was independently associated with an increased risk of in-hospital mortality (multivariable logistic regression: odds ratio, 2.58; 95% CI, 1.57–4.25; P = 0.0002; Cox proportional hazard regression: hazard ratio, 2.01; 95% CI, 1.30–3.11; P = 0.002). In sensitivity analyses, baseline procalcitonin quartiles were independently associated with 50-day in-hospital mortality (multivariable logistic regression: odds ratio, 1.47; 95% CI, 1.17–1.85; P = 0.001; Cox proportional hazard regression: hazard ratio, 1.31; 95% CI, 1.07–1.60; P = 0.008). The independent associations between baseline procalcitonin and the risk of 50-day in-hospital mortality were maintained after adjusting for C-reactive protein and sepsis status at admission.ConclusionOur data provide the first evidence of the usefulness of plasma procalcitonin at admission as a risk-stratifying biomarker for predicting 50-day in-hospital mortality among patients with community-acquired bloodstream infections.

Impact of muscle mass on the prognosis of liver transplantation for infants with biliary atresia.

Sarcopenia in adult cirrhotic patients is associated with increased morbidity and mortality whereas in children it is still being studied. Anthropometric variables in cirrhotic children are not reliable for assessing muscle mass as they may be altered by ascites, edema, and organomegaly. Measuring the area of the psoas showed good correlation with muscle mass in adults. We aimed to study in cirrhotic infants undergoing liver transplantation the association of the psoas area with liver transplant prognosis as well as with several analytical and anthropometric parameters used to evaluate nutritional status. Retrospective cohort of 29 infants with cirrhosis due to biliary atresia who underwent abdominal CT scan as a pre-transplant study. We measured the psoas muscle index (PMI) at L4-L5 since it best correlates with muscle mass in pediatric patients. As there are no validated cut-off points to define sarcopenia in children under one year of age, PMI was recorded as a continuous variable and correlated with different prognostic, clinical, and analytical variables. The SPSS 17.0 package was used for statistical analysis and a P < 0.05 was considered significant. 29 infants (10 boys, 19 girls) were studied. 62% were Caucasian and the rest were South American. The mean age at CT scan was 8.5 months (range 3-15 months). There was a negative correlation between PMI and days of admission prior to liver transplant, previous infections, and bone fractures. Among the analytical parameters, cholinesterase, albumin, and prealbumin correlated positively with PMI (P < 0.05). No relationship was observed with anthropometric parameters: weight, height, BMI, brachial perimeter, or bioimpedance. During surgery, patients with lower PMI had a greater need for plasma transfusion, and in the immediate postoperative period, there was a longer stay in intensive care, more days of mechanical ventilation, and more days of hospital admission (P < 0.05). On the contrary, no relationship was found with other complications: bleeding, re-interventions, biliary leaks, rejection, thrombosis, re-transplantation, or infections. The decrease in muscle mass is associated with increased morbidity in infants with biliary atresia undergoing liver transplantation. Muscle mass in these patients cannot be adequately assessed with anthropometric measurements commonly used in the clinic.