Differences In Case Fatality Rates Research Articles

The impact of HIV co-infection on presentation and outcome in adults with tuberculous pericarditis: Findings from the IMPI trial

Background. Little is known about the impact of HIV infection on clinical presentation, complications, and morbid pericarditis-relatedoutcomes of tuberculous pericarditis and its predictors.Objective. To assess the impact of HIV infection on presentation and outcomes in the multicountry Investigation of the Management of Pericarditis (IMPI) randomised controlled trial of immunotherapy in tuberculous pericarditis conducted in sub-Saharan Africa.Methods. We compared clinical features and outcomes of 1 370 adult patients treated for tuberculous pericarditis (939 and 431 HIVinfected and uninfected, respectively) enrolled in the IMPI trial. Cox proportional hazards models were used to determine independent predictors of outcomes of HIV-associated tuberculous pericarditis.Results. At presentation, HIV-infected (v. uninfected) patients were younger (median age 34.0 years v. 47.7 years), had lower body mass (mean weight 56 kg v. 60 kg), higher prevalence of tachycardia (58.5% v. 51.9%), hypotension (9.4% v. 3.9%), anaemia (65.9% v. 26.8%), and radiographic pulmonary infiltrates compatible with tuberculosis (35.4% v. 27.4%), but had lower rates of peripheral oedema (37.1% v. 48.3%). HIV-infected (v. uninfected) patients were less likely to develop constrictive pericarditis (4.1% v. 10.0% at 1 year, p<0.0001 (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.27 - 0.63, p<0.0001)). However, there was no difference in case fatality rate at 1 year (14.9% v. 12.2%, respectively, p=0.09; (HR 1.20, 95%CI 0.90 - 1.59, p=0.22)). Among HIV-infected patients, heart failure New York Heart Association (NYHA) class III - IV, low body mass, hypotension, and peripheral oedema were independently associated with death.Conclusion. HIV infection alters the cardiovascular presentation and reduces the incidence of constrictive pericarditis, but does notincrease case fatality. Mortality in HIV-infected patients is independently predicted by markers of pericardial and tuberculosis diseaseseverity.

Sex differences and disparities in cardiovascular outcomes of COVID-19.

Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with coronavirus disease 2019 (COVID-19) outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes COVID-19 (NCT05188612). Participants were individuals hospitalized with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 2020 to February 2022. Risk-adjusted ratios (RRs) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women vs. men. Estimates were evaluated by inverse probability weighting and logistic regression models. The overall care cohort included 4499 patients with COVID-19-associated hospitalizations. Of these, 1524 (33.9%) were admitted to intensive care unit (ICU), and 1117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU [RR: 0.80; 95% confidence interval (CI): 0.71-0.91]. In general wards (GWs) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95% CI: 0.90-1.42) and 0.86 (95% CI: 0.70-1.05; pinteraction = 0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (odds ratios: 2.27, 95% CI: 1.73-2.98; 3.85, 95% CI: 3.21-4.63; and 3.95, 95% CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. In contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs: 1.25; 95% CI: 0.94-1.67 vs. 0.83; 95% CI: 0.59-1.16, pinteraction = 0.04). Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19-related complications.

Abstract 11122: Sex Differences and Disparities in Cardiovascular Outcomes of Covid-19

Introduction: Previous analyses on sex differences in case-fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. Hypothesis: We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods: This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19 (NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios (RR) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models Results: The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524 (33.9%) were admitted to ICU, and 1,117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR: 0.80; 95%CI: 0.71-0.91). In general wards and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95%CI: 0.90-1.42) and 0.86 (95%CI: 0.70-1.05; p interaction =0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (OR: 2.27; 95%CI; 1.73-2.98, OR: 3.85; 95%CI: 3.21-4.63 and OR: 3.95; 95%CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in general wards, but not in ICU (RRs: 1.25;9 5%CI: 0.94-1.67 versus 0.83; 95%CI: 0.59-1.16, p interaction =0.04). Conclusions: Women in general wards were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.

Variability in case fatality rate risk due to Covid-19 according to health services provider in Mexico City hospitals.

To describe differences in Case Fatality Rate (CFR) for Covid-19 among healthcare subsystems in Mexico City between March and December 2020. This is a retrospective secondary data analysis from the National Epidemiological Surveillance System data of Covid-19 cases. Information about health provider institutions was retrieved from the Catalogue of Health Establishments (CLUES). Logistic regressions were fitted to determine the association between health subsystems and mortality associated to Covid-19. The analyses were divided between hospitalized and ambulatory patients. The probability of dying from Covid-19 was higher among those treated at Instituto Mexicano del Seguro Social (IMSS) (Hospitalized:OR=5.11, Ambulatory:OR=36.57), Instituto de Se-guridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Hospitalized:OR=2.10, Ambulatory:OR=9.19), Secretaría de Salud (SS) (Hospitalized:OR=1.94, Ambulatory:OR=5.29) or other public institutions (Hospitalized: OR=1.70, Ambulatory:OR=9.56) than in those treated in private in-stitutions. Differences in healthcare quality and access between health subsystems are profound. It is imperative to increase the capacity and quality of the different health subsystems to improve health outcomes.

Did patients with COVID-19 receive timely treatment in the early epidemic?-a systematic review and meta-analysis.

Corona virus disease 2019 (COVID-19) showed a significant difference in case fatality rate between different regions at the early stage of the epidemic. In addition to the well-known factors such as age structure, detection efficiency, and race, there was also a possibility that medical resource shortage caused the increase of the case fatality rate in some regions. Medline, Cochrane Library, Embase, Web of Science, CBM, CNKI, and Wanfang of identified articles were searched through 29 June 2020. Cohort studies and case series with duration information on COVID-19 patients were included. Two independent reviewers extracted the data using a standardized data collection form and assessed the risk of bias. Data were synthesized through description and analysis methods including a meta-analysis. A total of 109 articles were retrieved. The time interval from onset to the first medical visit of COVID-19 patients in China was 3.38±1.55 days (corresponding intervals in Hubei province, non-Hubei provinces, Wuhan, Hubei provinces without Wuhan were 4.22±1.13, 3.10±1.57, 4.20±0.97, and 4.34±1.72 days, respectively). The time interval from onset to the hospitalization of COVID-19 patients in China was 8.35±6.83 days (same corresponding intervals were 12.94±7.43, 4.17±1.45, 14.86±7.12, and 5.36±1.19 days, respectively), and when it was outside China, this interval was 5.27±1.19 days. In the early stage of the COVID-19 epidemic, patients with COVID-19 did not receive timely treatment, resulting in a higher case fatality rate in Hubei province, partly due to the relatively insufficient and unequal medical resources. This research suggested that additional deaths caused by the out-of-control epidemic can be avoided if prevention and control work is carried out at the early stage of the epidemic. CRD42020195606.

Analysis of case fatality rate of SARS-CoV-2 infection in the Spanish Autonomous Communities between March and May 2020.

The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA. Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo. Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo. The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA.

Sex Differences in Case Fatality Rate of Patients With Severe Fever With Thrombocytopenia Syndrome.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne disease with high mortality. However, detailed analysis is lacking to explore the complex effect of sex with age or comorbidities.Methods: A retrospective cohort study was performed among 2,938 SFTS patients entered during 2011–2020 in Xinyang, China. The case fatality rate (CFR) was estimated for their association with sex, age, and comorbidities by an interactive way. The difference of immune response between sex was explored in an age dependent way.Results: An overall CFR of 15.3% (450/2,938) was obtained, which appeared to be higher in males than in females [17.7% vs. 13.6%, adjusted odds ratio (aOR) = 1.24; 95% CI, 1.00–1.53; P = 0.048] and increased dramatically with age (P < 0.001). The associations between sex and SFTS fatal outcome were age-dependent and varied according to the status of comorbidities. The mortality-related risk conferred by older age was more pronounced in males, with aOR (95% CI) to be 5.76 (3.75–8.84) vs. 5.30 (3.54–7.95) in female. Sex-stratified analysis disclosed significant associations between death and comorbidities among female patients (aOR = 1.87, 95% CI: 1.40–2.49; P < 0.001), while none among males. Among females, the significant associations between presence of comorbidity and fatal outcome differed among age groups, with aOR (95% CI) decreased from 2.28 (1.16–4.46) in ≤60 years, to 2.06 (1.34–3.18) in 60–70 years and further to 1.55 (0.97–2.47) in >70 years. Altogether 194 SFTS patients were randomly selected for the test of B cells, natural killer (NK) cells, CD4 cells percentages, and anti-SFTSV IgM antibody level, the results revealed that males >60 years had significantly decreased percentages of B cells, CD4 cells, lower anti-SFTSV IgM antibody titer, and increased level of NK cells than male aged ≤60 years, while none of these age specific differences was observed in the females. This finding underlies the more pronounced age specific difference in CFR among male than female.Conclusions: Males had a significantly higher mortality of SFTS than did females, and more likely to be affected by aging for SFTS mortality. This difference can be explained by the effect from comorbidities and the host immunity. It is essential to take a sex- and age-based approach to SFTS treatment and management.

Understanding the Differences in COVID-19 Case Fatality Rates Observed Across Alabama Counties.

To understand county-level variation in case fatality rates of COVID-19, a statewide analysis of COVID-19 incidence and fatality data was performed, using publicly available incidence and case fatality rate data of COVID-19 for all 67 Alabama counties and mapped with health disparities at the county level. A specific adaptation of the Shewhart p-chart, called a funnel chart, was used to compare case fatality rates. Important differences in case fatality rates across the counties did not appear to be reflective of differences in testing or incidence rates. Instead, a higher prevalence of comorbidities and vulnerabilities was observed in high fatality rate counties, while showing no differences in access to acute care. Funnel charts reliably identify counties with unexpected high and low COVID-19 case fatality rates. Social determinants of health are strongly associated with such differences. These data may assist in public health decisions including vaccination strategies, especially in southern states with similar demographics.

Higher fatality from COVID-19 in patients with cancer in the UK than in Europe

Echoing concerns expressed by oncologists early in the COVID-19 pandemic, a study led by researchers from Imperial College London (London, UK) has reported that the survival of patients with cancer after infection with SARS-CoV-2 seems to be disparate between the UK and countries in continental Europe, with apparently more detrimental outcomes for patients in the UK compared with their European counterparts. In the retrospective study, David Pinato (Imperial College London) and colleagues analysed the risk of death from all causes at 30 days and 6 months following a diagnosis of COVID-19, in 468 patients with cancer from the UK and 924 patients with cancer from Italy, Spain, France, Belgium, and Germany. The data were obtained from the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres between Feb 27 and Sept 10, 2020. Notably, compared with the continental Europe cohort, the UK cohort had a lower proportion of patients with breast cancer (12·39% vs 23·70%) and a higher proportion of patients with gynaecological or genito-urinary cancers (31·20% vs 14·29%). Even after adjusting for key clinicopathological factors, including age, comorbidities, and tumour stage and status (although the authors noted that their analyses could be affected by unmeasured bias, such as of SARS-CoV-2 viral load), patients in the UK had a significantly higher case-fatality rate at 30 days after a COVID-19 diagnosis than did those in Europe (40·38% vs 26·5%; p<0·0001). This difference in case-fatality rate persisted at 6 months after a COVID-19 diagnosis (47·64% in the UK vs 33·33% in Europe; p<0·0001). Similarly, the risk of death at 30 days after a COVID-19 diagnosis was 1·52-times higher for UK patients than for their European counterparts; at 6 months, this risk of death remained elevated at 1·41-times higher in the UK versus Europe. The authors also reported that UK patients diagnosed with COVID-19 were less likely to be receiving either COVID-19-specific therapies (eg, corticosteroids or antiviral drugs) or to have received active anti-cancer treatment within the previous 4 weeks, compared with those in Europe. In multivariable analyses, exposure to any COVID-19 treatment was associated with a reduced risk of death at both 30 days and at 6 months, whereas receipt of anticancer therapy exerted a protective effect on the risk of death at the 6 month timepoint only. Study author Mieke Van Hemelrijck (King's College London, London, UK) told The Lancet Oncology, “the difference observed between the UK and Europe highlights the need to carefully continue cancer screening, diagnosis, and treatment during the pandemic. Whilst these numbers are disturbing, we have to be careful when drawing conclusions as the analyses of this observational study cannot account for all the variety in cancer patients registered into the study in Europe and the UK. It is never easy to handle all heterogeneity in these analyses, and hence these results could be considered as a first important indicator for the urgent need of further evaluations of cancer care in the pandemic.” Ajay Aggarwal (London School of Hygiene & Tropical Medicine, London, UK), who was not involved in the study, noted: “These estimates need to be considered cautiously, as the study looks at only five hospitals, concentrated in London, out of the 160–70 hospitals providing cancer care in the UK National Health Service. There are also challenges with merging varying-size patient cohorts from hospitals across European countries to create a representative cohort for comparison. Furthermore, there is a likely underestimation of the true prevalence of COVID-19 in the study among hospitalised and community-based cancer patients with active malignancy or in remission, and therefore we would expect the case fatality rate to be lower than presented.” Pasquale Rescigno (Candiolo Cancer Institute, Turin, Italy) added that “the authors cautiously interpret their results trying to identify reasons for this unbalance. UK patients were less likely to receive any kind of anti-COVID-19 treatments, [including drugs] like hydroxychloroquine, that proved ineffective; and others, like steroids, anti-interleukin-6, and remdesevir, which showed benefit depending on disease severity, but it is worth pointing out that the European cohort of this study was enriched for patients with breast cancer, who were, overall, the ones showing a decreased risk of death”. The authors conclude by stressing the importance of vaccinating and of giving anti-COVID-19 therapy to infected patients with cancer. Finally, and as also emphasised by Rescigno, “the effort of the vaccination campaign in the UK might revert this imbalance, since the number of vaccinated citizens in the UK has so far vastly exceeded that of other European countries”.

Inosine Pranobex Significantly Decreased the Case-Fatality Rate among PCR Positive Elderly with SARS-CoV-2 at Three Nursing Homes in the Czech Republic.

During the COVID-19 pandemic, the elderly population has been disproportionately affected, especially those in nursing homes (NH). Inosine pranobex (IP) has been previously demonstrated to be effective in treating acute viral respiratory infections. In three NH experiencing the SARS-CoV-2 virus epidemic, we started treatment with IP as soon as clients tested PCR+. In Litovel, CZ, the difference in case-fatality rate (CFR) for the PCR+ group using vs. not using IP was statistically significant, and the odds ratio (OR) was 7.2. When comparing all those taking IP in the three NH vs. the non-drug PCR+ group in Litovel, the odds ratio was lower for all three NH, but still significant at 2.9. The CFR in all three tested NHs, age range 75–84, compared to the CFR in all NHs in the Czech Republic, was significantly reduced (7.5% vs. 18%) (OR: 2.8); there was also a significant difference across all age groups (OR: 1.7). In our study with 301 residents, the CFR was significantly reduced (OR: 2.8) to 11.9% (17/142) in comparison to a study in Ireland with 27.6% (211/764). We think the effect of IP was significant in this reduction; nevertheless, these are preliminary results that need larger-scale trials on COVID-19 patients.

The "sex gap" in COVID-19 trials: a scoping review.

BackgroundMany studies investigate the role of pharmacological treatments on disease course in Corona Virus Disease 2019 (COVID-19). Sex disparities in genetics, immunological responses, and hormonal mechanisms may underlie the substantially higher fatality rates reported in male COVID-19 patients. To optimise care for COVID-19 patients, prophylactic and therapeutic studies should include sex-specific design and analyses. Therefore, in this scoping review, we investigated whether studies on pharmacological treatment in COVID-19 were performed based on a priori sex-specific design or post-hoc sex-specific analyses.MethodsWe systematically searched PubMed, EMBASE, UpToDate, clinical trial.org, and MedRxiv for studies on pharmacological treatment for COVID-19 until June 6th, 2020. We included case series, randomized controlled trials, and observational studies in humans (≥18 years) investigating antiviral, antimalarial, and immune system modulating drugs. Data were collected on 1) the proportion of included females, 2) whether sex stratification was performed (a priori by design or post-hoc), and 3) whether effect modification by sex was investigated.Findings30 studies were eligible for inclusion, investigating remdesivir (n = 2), lopinavir/ritonavir (n = 5), favipiravir (n = 1), umifenovir (n = 1), hydroxychloroquine/chloroquine (n = 8), convalescent plasma (n = 6), interleukin-6 (IL-6) pathway inhibitors (n = 5), interleukin-1 (IL-1) pathway inhibitors (n = 1) and corticosteroids (n = 3). Only one study stratified its data based on sex in a post-hoc analysis, whereas none did a priori by design. None of the studies investigated effect modification by sex. A quarter of the studies included twice as many males as females.InterpretationAnalyses assessing potential interference of sex with (side-)effects of pharmacological therapy for COVID-19 are rarely reported. Considering sex differences in case-fatality rates and genetic, immunological, and hormonal mechanisms, studies should include sex-specific analyses in their design to optimise COVID-19 care.FundingNone

Population age structure only partially explains the large number of COVID-19 deaths at the oldest ages

Background: To date, any attention paid to the age shape of COVID-19 deaths has been mostly in relation to understanding the differences in case fatality rates between countries. Objective: We explore differences in the age distribution of deaths from COVID-19 among six European countries which have old age structures. We do this by way of a cross-country comparison and put forward some reasons for potential differences. Methods: We estimate the distribution of deaths by 10-year age groups and the counterfactual age distribution under the assumption that all populations had the age structure of Italy. For this, we use 10-year age-grouped COVID-19 death counts and the corresponding population exposures for France, Italy, the Netherlands, Germany, Sweden, Spain, and China. Results: All included European countries experienced a high proportion of deaths at older ages. The relative proportion of deaths at ages above 90 years is lowest in Italy when compared to the other countries in the study despite Italy having the oldest population in Europe. Contribution: Population age structure seems essential for understanding COVID-19-related mortality, but other factors may play an important role, particularly at older ages in European populations.

Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry

ObjectivesTo confirm whether a relationship exists between male sex and coronavirus disease 2019 (COVID-19) mortality and whether this relationship is age dependent. Patients and MethodsWe queried the COVID-19 Research Network, a multinational database using the TriNetX network, to identify patients with confirmed COVID-19 infection. The main end point of the study was all-cause mortality. ResultsA total of 14,712 patients were included, of whom 6387 (43%) were men. Men were older (mean age, 55.0±17.7 years vs 51.1±17.9 years; P<.001) and had a higher prevalence of hypertension, diabetes, coronary disease, obstructive pulmonary disease, nicotine dependence, and heart failure but a lower prevalence of obesity. Before propensity score matching (PSM), all-cause mortality rate was 8.8% in men and 4.3% in women (odds ratio, 2.15; 95% CI, 1.87 to 2.46; P<.001) at a median follow-up duration of 34 and 32 days, respectively. In the Kaplan-Meier survival analysis, the cumulative probability of survival was significantly lower in men than in women (73% vs 86%; log-rank, P<.001). After PSM, all-cause mortality remained significantly higher in men than in women (8.13% vs 4.60%; odds ratio, 1.81; 95% CI, 1.55 to 2.11; P<.001). In the Kaplan-Meier survival analysis, the cumulative probability of survival remained significantly lower in men than in women (74% vs 86%; log-rank, P<.001). The cumulative probability of survival remained significantly lower in propensity score–matched men than in women after excluding patients younger than 50 years and those who were taking angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications on admission. ConclusionAmong patients with COVID-19 infection, men had a significantly higher mortality than did women, and this difference was not completely explained by the higher prevalence of comorbidities in men.

Study on clinical classification of Japanese encephalitis by Bayes discriminant analysis

Objective: To construct Bayes discriminant function for clinical classification of common and severe Japanese encephalitis (JE) cases, and to identify cases accurately with quantitative indicators. Methods: Samples of confirmed common and severe JE cases reported by the epidemic surveillance system of Gansu Provincial Center for Disease Control and Prevention from 2005 to 2017 were collected. Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis were used to screen meaningful clinical indicators, so as to construct and evaluate Bayes discriminant function. Results: There were 256 common JE cases and 257 severe JE cases. There were no significant differences in sex, age and occupation distributions between the two groups (P>0.05) and there was significant difference in case fatality rate (P<0.05). Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis, combined with using related literature, to screen 11 clinical indicators for the construction of Bayes discriminant function. Interactive validation showed that the sensitivity of discriminant function was 71.48% (95%CI: 65.53%-76.93%) and the specificity was 73.93% (95%CI: 68.11%-79.19%). The area under ROC curve was 0.761 (95%CI: 0.720-0.803) and the total accuracy rate was 72.71%. Conclusion: Bayes discriminant function can be used to identify common and severe JE cases more accurately, which is helpful for the reasonable treatment and good prognosis of JE patients.

Community-acquired serious bacterial infections in the first 90 days of life: a revisit in the era of multi-drug-resistant organisms.

Infants in the first 90 days of life are more prone to develop serious bacterial infections (SBIs). Multi-drug-resistant organisms (MDROs) are emerging as important pathogens causing SBIs. We reviewed the epidemiology of SBIs in infants 0-90days old and compared the clinical features, laboratory values and final outcome for SBIs due to MDROs vs. non-MDROs. Episodes of culture-proven SBIs (bacteremia, urinary tract infections, or meningitis) with age at onset of 0-90days during a 7-year period were retrospectively reviewed. Health care-associated infections were excluded. We collected demographics, clinical features, and laboratory and microbiology data. We compared clinical characteristics, laboratory data, microbiologic results and final outcome for SBIs due to MDROs vs. non-MDROs. Ninety-four episodes (88 patients) including bacteremia (42.6%), urinary tract infections (54.3%) and meningitis (3.1%) were caused by Gram-negative bacteria (67%), and Gram-positive bacteria (33%). Escherichia coli, Klebsiella pneumoniae and GBS were the most common causes. MDROs caused SBIs in 39 patients (44.3%). SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs (74.4% vs. 0%, P ≤ 0.001), but no difference in case-fatality rate (12.8% vs. 12.2%, P = 1.0). Clinical features or basic laboratory values were not statistically different between the two groups. The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs, which causes more delay in providing targeted antimicrobial therapy. Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner.

Risk factors for death from invasive pneumococcal disease, Europe, 2010.

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were significantly associated with death. Non-pneumococcal conjugate vaccine (PCV) serotypes among children <5 years of age and 7-valent PCV serotypes among persons 5-64 years of age were associated with increased risk for death; among adults >65 years of age, risk did not differ by serotype. These findings highlight differences in case-fatality rates between serotypes and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs.

Gender differences in case fatality rates of acute myocardial infarction in Serbia

We sought to investigate sex differences in clinical characteristics, treatment and in in-hospital mortality in patients admitted with ST elevation myocardial infarction (STEMI) in Serbia. From October 2010 to September 2013, a total of 2348 patients have been hospitalized and received medical treatment for STEMI in 19 hospitals, referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry. There were 773 women and 1575 men. Women were older than man, with a higher prevalence of family history of coronary artery disease, hypertension, and diabetes. They were less likely to be smokers and more likely to have a prior angina and history of heart failure. Fewer women than men presented within 2 h from symptom onset ( P = 0.005). They presented more with Killip class ≥2 than men ( P = 0.004). A significantly lower proportion of women was treated with aspirin (91.3% vs 94.3%, P = 0.007), clopidogrel (88% vs. 91%, P = 0.02), heparins (61.6% vs. 66.5%, P = 0.01) and primary percutaneous coronary interventions (62.1% vs. 69.7%, P < 0.001). The in-hospital mortality was significantly higher for women than for men (13.2% vs. 6.4%, P < 0.001). After adjustment for any confounders, women showed an increased risk of in-hospital mortality (odds ratio: 1.97, 95% confidence interval: 1.28–3.01, P = 0.002). Several factors contribute to the excess in-hospital case fatality rates in Serbian women. Most notably disparities in medical treatment appear to play a crucial role.

Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome

ObjectiveThe prevalence, predictors and outcome of myopericarditis in patients with tuberculous (TB) pericarditis are unknown.MethodsEighty-one patients (mean age±SD, 36.1±13.3 years; 54 (66.7%) men; 58 (71.6%) HIV seropositive) with TB pericarditis...

Abstract TP188: Location of Intracerebral Hemorrhage in a Tri-ethnic Cohort: The ERICH Study

Background: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) is an ongoing case-control study of spontaneous ICH among non-hispanic whites, non-hispanic blacks, and Hispanics. Prior studies have identified hypertension as a greater risk for non-lobar (NL) ICH as compared with lobar (L) ICH. Given the greater reported prevalence of hypertension among black and Hispanic populations, we hypothesized that the location of ICH may differ by race/ethnicity. Methods: At the time of this analysis, we had ICH location data, lobar vs. non-lobar, on 648 subjects. We performed univariate analysis on known and potential predictors of ICH location: age, sex, race/ethnicity, hypertension, diabetes, BMI, creatinine, cholesterol, aspirin use, smoking, alcohol use, caffeine use, and INR. INR was dichotomized at &gt;1.1. After forcing in age, sex, race, history of diabetes, aspirin use and INR, we added significant and near-significant (p&lt;0.2) variables in a stepwise fashion to complete our final logistic regression model. Our outcome measure was lobar ICH. Conditional pairwise testing was performed for race/ethnicity. Results: Of the 648 subjects (mean age 61.12 ± 14.51 years; 39.8% female; 35.0% Hispanic, 26.5% white, 38.4% black), 181 (27.9%) presented with lobar ICH. Hypertension was present in 525 subjects (75.1% L, 83.3% NL; p=.018), diabetes in 152 (26.0% L, 22.5% NL; p=.348), high cholesterol in 244 (45.9% L, 34.5% NL; p=.008), aspirin use in 200 (37.0% L, 28.5% NL; p=.035), and INR &gt;1.1 (24.1% L, 21.8% NL; p=.535) In our final model, race/ethnicity (p&lt;.024) was associated with location of ICH. Furthermore, white race/ethnicity was associated with L ICH, compared with black (b=.57, p=.016) or Hispanic (b=.56, p=.018). Hypertension (b=-0.63, p=.009) was associated with NL ICH, and smoking (b=0.51, p=.007) was associated with L ICH. Discussion: Our results suggest that there are significant racial/ethnic differences in the distribution of lobar and non-lobar ICH. The conditional pairwise testing for race/ethnicity showed a significantly higher rate of lobar ICH in whites, compared with blacks or Hispanics. These findings are intriguing given the differences in case-fatality rates and age at ICH onset.

A five-year review of Pseudomonas aeruginosa bacteremia in children hospitalized at a single center in southern China

Pediatric Pseudomonas aeruginosa bacteremia is uncommon. It is mostly seen with impaired immune defenses and is most often nosocomially acquired, but it does occasionally occur in the previously healthy. Empiric antibiotics not effective against P. aeruginosa can result in poor outcomes. To determine the risk factors for P. aeruginosa bacteremia, all pediatric cases of P. aeruginosa bacteremia hospitalized at a single center over a 5-year period were reviewed. A retrospective cohort study (2006-2010) of P. aeruginosa bacteremia in children under 14 years of age assessing demographics, the presence of underlying diseases, whether nosocomially acquired, clinical and laboratory findings, P. aeruginosa antibiotic susceptibility, antibiotic therapy, and clinical outcomes was performed. Thirty-one children, mean age 46 months, had P. aeruginosa bacteremia (2.6% positive blood cultures); 18 cases were nosocomial, none were multi-resistant, and 13 (42%) had P. aeruginosa isolated from a site other than blood. Ten cases occurred in previously healthy children, all of which were community-acquired, and these children were more likely to present with seizures and gastrointestinal findings than those with underlying conditions. The overall case fatality rate was 52% (16/31); 6/16 were previously healthy. Fatal cases had more leukopenia, elevated aspartate aminotransferase, and lower prealbumin A. Fewer fatal cases (6/16 vs. 14/15) had initial antibiotic coverage effective for P. aeruginosa (p=0.002). No difference in case fatality rate (p>0.05) or antibiotic sensitivity (p>0.05) was found between community-acquired and nosocomial cases. P. aeruginosa bacteremia in children is rare but often fatal if initial antibiotics do not cover P. aeruginosa. Factors indicative of P. aeruginosa bacteremia remain elusive, especially in previously healthy young children. However, P. aeruginosa bacteremia should be considered if children present with a grave illness, seizures, serious gastrointestinal findings, hypotension, and leukopenia.