Higher Number Of Comorbidities Research Articles

MP17-15 FREQUENCY AND TIMING OF EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS FOLLOWING COMMON STONE PROCEDURES

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-15 FREQUENCY AND TIMING OF EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS FOLLOWING COMMON STONE PROCEDURES Rohail Rashid Kazi, Molly Jung, Yan Xiong, Timothy Kelly, and Andrew Harris Rohail Rashid KaziRohail Rashid Kazi More articles by this author , Molly JungMolly Jung More articles by this author , Yan XiongYan Xiong More articles by this author , Timothy KellyTimothy Kelly More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Emergency department (ED) visits and hospital admissions (HA) following urologic procedures are a concern for payors, providers, and patients. We seek to quantify ED visits and HA after urologic stone procedures. METHODS: A retrospective analysis was conducted using claims data from IBM MarketScan Commercial and Medicare Supplement databases. Adults with urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), or shockwave lithotripsy (SWL) and had ureteral stent codes during the index procedure between 2012 and 2017 were analyzed. All cause vs GU-specific ED visits and HA were evaluated during 30, 60, 90, and 120-day periods. RESULTS: 88,047 patients with mean age of 52.6 years and 44% female gender were identified that met inclusion criteria. Of these patients, 8,924 (10%) had their index procedure as an inpatient and 79,123 (90%) as an outpatient. For inpatients, rate of all cause vs GU-specific ED visits was 10% vs 9% at 30 days, 14% vs 12% at 60 days, 16% vs 14% at 90 days, and 19% vs 15% at 120 days. For outpatients, rate of all cause vs GU-specific ED visits was 9% vs 8% at 30 days, 11% vs 10% at 60 days, 13% vs 11% at 90 days, and 15% vs 12% at 120 days. A similar trend was found when examining rate of all-cause vs GU-specific HA. Younger patients (18-44 years old) tended to have higher rates of ED visits than older patients (>65 years old) following inpatient index stone procedure (13.4% vs 9.6% at 30 days, p ≤0.01). Patients with CCI ≥2 had higher rates of unplanned ED visits following stone procedures compared with those with CCI = 0 (11.3% vs 9.7%, p <0.01). CONCLUSIONS: Nearly one-fifth of patients have an unplanned hospital visit up to 120 days after having stone procedure, regardless of site of treatment. The majority of these visits involve GU-related diagnoses. Younger patients and patients with higher number of comorbidities have unplanned hospital visits in greater proportion than older patients and patients with fewer comorbidities. Further studies need to determine causation of these unplanned visits in order to guide appropriate intervention. Source of Funding: IBM Marketscan Database information provided by BD © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e314-e314 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohail Rashid Kazi More articles by this author Molly Jung More articles by this author Yan Xiong More articles by this author Timothy Kelly More articles by this author Andrew Harris More articles by this author Expand All Advertisement Loading ...

Impact of asthma severity as risk factor to future exacerbations in patients admitted for asthma exacerbation.

BackgroundTo investigate the impact of disease severity on exacerbation patterns and identify its potential as a risk factor for future exacerbations in patients admitted for asthma exacerbations.MethodsWe analyzed frequency and time to next exacerbation over a period of three years in 532 patients admitted for exacerbation. Disease severity was selected as a potential risk factor for the events. Kaplan-Meier analysis was used to identify the probability of future exacerbations. A Cox-proportional hazards model was used to assess independent relative risks.ResultsOut of 532 patients analyzed, the frequency of exacerbations rose as the severity of the asthma increased. The exacerbation rates in the following year were 1.66 per person for patients with mild asthma and 3.98 for patients with severe asthma. The median time to the next exacerbation in patients with mild asthma was 61.4 weeks (95% CI, 40.1-82.6) compared to 15.0 weeks (95% CI, 11.3-18.6) in patients with severe asthma (p<0.001). Multivariate analysis showed that asthma severity (severe vs mild asthma, HR=1.42, 95% CI, 1.07-1.89), a history of 1-2 exacerbations (HR=1.95, 95% CI, 1.45-2.63) or > 2 exacerbations (HR=2.32, 95% CI, 1.56-3.44) in the previous 12 months, and a high number of comorbidities (≥5 vs none, HR=2.5, 95% CI, 1.41-4.45) were independent predictors of the probability of future exacerbations.ConclusionAsthma severity is a strong independent risk factor for future exacerbations, and exacerbation rates also become more frequent as the severity of the asthma increases. These findings help in better understanding of the natural course of exacerbations across the spectrum of asthma disease severity.

Sex differences in a cohort of COVID-19 Italian patients hospitalized during the first and second pandemic waves

BackgroundCoronavirus disease 2019 (COVID-19) severity seems to be influenced by genetic background, sex, age, and presence of specific comorbidities. So far, little attention has been paid to sex-specific variations of demographic, clinical, and laboratory features of COVID-19 patients referred to the same hospital in the two consecutive pandemic waves.MethodsDemographic, clinical, and laboratory data were collected in 1000 COVID-19 patients (367 females and 633 males), 500 hospitalized in the first wave and 500 in the second one, at the ASST Spedali Civili of Brescia from March to December 2020. Statistical analyses have been employed to compare data obtained in females and males, taking into account their age, and during the first and second COVID-19 waves.ResultsThe mean age at the time of hospitalization was similar in females and males but was significantly higher for both in the second wave; the time elapsed from symptom onset to hospital admission did not differ between sexes in the two waves, and no correlation was observed between delayed hospital admission and length of hospitalization. The number of multi-symptomatic males was higher than that of females, and patients with a higher number of comorbidities were more frequently admitted to intensive care unit (ICU) and more frequently died. Older males remained in the ICU longer than females and showed a longer disease duration, mainly the first wave. The highest levels of white blood cells, neutrophils, C-reactive protein, and fibrinogen were significantly higher in males and in the first, and along with higher levels of D-dimer, ferritin, lactate dehydrogenase, and procalcitonin which were preferentially documented in patients requiring ICU or died. While the rate of death in ICU was higher in males, the overall death rate did not differ between the sexes; however, the deceased women were older.ConclusionsThese data indicate that once patients were hospitalized, the risk of dying was similar between females and males. Therefore, future studies should aim at understanding the reasons why, for a given number of SARS-CoV-2 infections, fewer females develop the disease requiring hospitalization.HighlightsAlthough the hospitalized males were significantly more, the similar number of hospitalizations of the > 75-year-old females and males could be due to the fact that in Brescia province, elderly women are about twice as many as men.Although males spent more days in the hospital, had a longer disease duration, developed a critical illness more frequently, and were admitted and died in the ICU more than females, the total rate of deaths among patients was not significantly different between sexes.Overall, the most frequent comorbidities were cardiovascular diseases, which were preferentially seen among patients hospitalized in the second wave; it is possible that the knowledge gained in the first wave concerning the association between certain comorbidities and worse disease evolution has guided the preferential hospitalization of patients with these predominant comorbidities.

Incidence Rates and Case-Fatality Rates of Cerebral Vein Thrombosis: A Population-Based Study.

Cerebral vein thrombosis (CVT) incidence is estimated to be >10 per 1 000 000 per year. Few population-based studies investigating case-fatality rates (CFRs) and pyogenic/nonpyogenic CVT incidence are available. We assessed trends in CVT incidence between 2002 and 2012, as well as adjusted in-hospital CFRs and incidence of hospital admissions for pyogenic/nonpyogenic CVT in a large Northwestern Italian epidemiological study. Primary and secondary discharge diagnoses of pyogenic/nonpyogenic CVT were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 325, 671.5, and 437.6. Age, sex, vital status at discharge, length of hospital stay, and up to 5 secondary discharge diagnoses were collected. Concomitant presence of intracerebral hemorrhage (ICH) was registered, and comorbidities were assessed through the Charlson comorbidity index. A total of 1718 patients were hospitalized for CVT (1147 females—66.8%; 810 pyogenic and 908 nonpyogenic CVT, 47.1% and 52.9%, respectively), with 134 patients (7.8%) experiencing a concomitant ICH. The overall incidence rate for CVT was 11.6 per 1 000 000 inhabitants with a sex-specific rate of 15.1 and 7.8 per 1 000 000 in females and males, respectively. CVT incidence significantly increased in women during time of observation (P=0.007), with the highest incidence being at 40 to 44 years (27.0 cases per 1 000 000). In-hospital CFR was 3%, with no difference between pyogenic/nonpyogenic CVT. Patients with concomitant ICH had a higher in-hospital CFR compared with patients without ICH (7.5% versus 2.7%; odds ratio, 2.96 [95% CI, 1.45–6.04]). In-hospital CFR progressively increased with increasing Charlson comorbidity index (P=0.003). Age (odds ratio, 1.03 [95% CI, 1.02–1.05]), Charlson comorbidity index ≥4 (odds ratio, 4.33 [95% CI, 1.29–14.52]), and ICH (odds ratio, 3.05 [95% CI, 1.40–6.62]) were independent predictors of in-hospital mortality. In a large epidemiological study, CVT incidence was found to be comparable to the one registered in population-based studies reported after the year 2000. CVT incidence increased among women over time. In-hospital CFR was low, but not negligible, in patients with concomitant ICH. Age, ICH, and a high number of comorbidities were independent predictors of in-hospital mortality. Pyogenic CVT was not a predictor of in-hospital CFR, although its high proportion was not confirmed by internal validation.

P–094 Kidney function impairment in primary infertile men

Abstract Study question We investigated the prevalence of kidney function impairment in a homogeneous cohort of white-European primary infertile men. Summary answer Mild kidney function impairment characteristics were found in 9% of asymptomatic and unaware patients presenting for primary infertility investigation. What is known already Infertile men have shown a worse overall health status compared to the fertile counterpart. We investigated the prevalence of kidney function impairment in a homogeneous cohort of white-European primary infertile men. Study design, size, duration In this corss-sectional study, complete clinical and laboratories data from a cohort of 557 consecutive men aged &amp;gt;18 years, presenting for primary infertility investigation were analyzed. Participants/materials, setting, methods Comorbidities (as scored with the Charlson Comorbidity Index (CCI)) were collected in each patient. Primary outcome was the presence of functional impairment of the kidney (defined as an estimated glomerular filtration rates &amp;lt;90 ml/min/1.73m², according to the Kidney Outcomes Quality Initiative). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) function was used for eGFR calculation. Logistic regression analyses tested the association between kidney function impairment and clinical and semen features. Main results and the role of chance Of 557, 51 (9.3%) patients depicted at least a mild loss of kidney function (eGFR&amp;lt;90 ml/min /1.73m²). Median [interquartile (IQR)] age was 38 (35–42) years for normal kidney function group vs. 41 (36–46.5) years for those with impaired renal function (p &amp;lt; 0.001). Those with impaired renal function had also a higher BMI [26.1 (24.4–27.8) vs. 24.9 (23.2–26.8); p = 0.002] and higher numbers of comorbidities [CCI≥ 1 in 11 (21.5%) vs. 40 (7.9%) patients (p &amp;lt; 0.001)]. Of note, they had more frequently history of hypertension [10 (19.6%) vs. 31 (6.1%), p = 0.001]. Groups did not differ in terms of hormonal and semen features. At logistic regression analysis, older age and CCI≥1 were associated with a higher risk of impaired eGFR (OR 1.06; 95%CI 1.01–1.11; p = 0.016 and OR 2.41; 95%CI 1.06–5.15; p = 0.028, respectively)(table). No association was found between sperm parameters and eGFR impairment (all p &amp;gt; 0.05), after accounting for age, CCI, BMI, FSH, testicular volume, and varicocele. Limitations, reasons for caution Mild kidney function impairment characteristics were found in 9% of asymptomatic and unaware patients presenting for primary infertility investigation. Age and the rate of comorbidities are associated with reduced eGFR. Wider implications of the findings: This novel finding confirms growing data on a significant association of male infertility with a poorer overall male health status. Trial registration number Not applicable

Patterns of Fitbit Use and Activity Levels Among African American Breast Cancer Survivors During an eHealth Weight Loss Randomized Controlled Trial.

This study examined adherence with a physical activity tracker and patterns of activity among different subgroups of African American/Black breast cancer survivors (AABCS). Secondary analysis of weight loss trial that used an activity tracker (FitBit) with or without a commercial eHealth program (SparkPeople) over 12 months. AABCS (N = 44) in New Jersey. Adherence with tracker use, steps per day, and active minutes per week were compared by demographic and clinical characteristics using nonparametric statistics. Median adherence was over 6 days per week throughout the 12-months. Adherence was significantly correlated with steps and active minutes (p < 0.015). Groups with lower adherence included: those with 5 or more conditions (p = 0.039), had higher number of household members (p = 0.008), and younger than 60 years (p = 0.044). Median number of steps per day remained consistently around 7000 throughout 12 months. Factors associated with lower activity included: age > 60; retirement; higher number of household members, comorbidity, or baseline BMI; and those in the SparkPeople + Fitbit group. Self-monitoring, goal setting, and self-efficacy were significantly correlated with activity levels (p < 0.05). Use of a physical activity tracker may help increase activity levels in AABCS. Certain subgroups, e.g. those older than age 60 years, retired, with BMI over 40, higher number of comorbidities or more household members, may require additional interventions.

Determinants of Non-Adherence to the Medications for Dyslipidemia: A Systematic Review.

PurposeDyslipidemia is a major cardiovascular risk factor, and its control leads to less cardiovascular events. Many patients will need some medications to achieve ideal targets. Non-adherence to medications is a complex problem with high impact on their effectiveness. This study aims to identify the determinants of non-adherence to medications in patients with dyslipidemia.Patients and MethodsWe conducted a systematic review. PubMed and Scopus databases were searched for original articles, published between 2000 and 2020, using the MeSH terms “Dyslipidemias” and “Medication Adherence”.ResultsFrom the initial 3502 identified articles, we selected 46 to include in the final qualitative synthesis. The determinants associated with non-adherence were lower age (≤50 years), female sex, African American ethnicity, smoking habits, being a new user of lipid-lowering medications, reporting or having concerns about lipid-lowering medication side effects and some comorbidities (chronic obstructive pulmonary disease, Alzheimer’s disease/dementia, depression and diabetes). On the contrary, adherence is higher in older patients, alcohol drinking habits, taking β-blockers, having a higher number of comorbidities, having a history of cardiovascular events, cardiac interventions or revascularization procedures, having health insurance and having more provider follow-up visits.ConclusionThere are important identifiable determinants of non-adherence in patients with dyslipidemia. These patients benefit from a specific approach to minimize the problem and maximize the potential benefit of the prescription.

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

BackgroundKnee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder.MethodsWe performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated.ResultsOverall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant.ConclusionOur results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.

Tailored or adapted interventions for adults with chronic obstructive pulmonary disease and at least one other long-term condition: a mixed methods review.

Tailored or adapted interventions for adults with chronic obstructive pulmonary disease and at least one other long-term condition: a mixed methods review.

Role of Multiple Comorbidities and Therapies in Conditioning the Clinical Severity of DRESS: A Mono-Center Retrospective Study of 25 Cases.

DRESS/DiHS is a complex and potentially fatal drug reaction. Little is known about risk factors and elements that can help to identify patients with a severe reaction early. The aim of the study was to investigate those factors favoring the disease and its severity by analyzing the clinical conditions and therapies preceding the reaction. We conducted a retrospective analysis on patients admitted to our center between 2010 and 2020 who were discharged with a diagnosis of DRESS. We used the RegiSCAR diagnostic criteria. We defined the severity of DRESS using the criteria of Mizukawa et al. We included 25 patients (15 females) with a median age of 66 years. Skin involvement, eosinophilia, and liver injury were the most important aspects. Allopurinol was found to be the most involved drug. Reaction severity was significantly associated with the number of daily medications (p = 0.0067) and an age of at least 68 years (p = 0.013). In addition, 75% of severe cases had at least three comorbidities in history, and most of the severe cases were female. In our study the advanced age, the high number of comorbidities and home therapies, and the inflammatory state were found to be predisposing elements to the development of the disease and its severity.

Heparin-Induced Thrombocytopenia: Are We Ordering Too Much

Introduction:Heparin induced thrombocytopenia (HIT) is a well described cause of IgG antibody mediated platelet consumption.Over-testing for HIT is highly prevalent in the hospital setting. Physicians' fear of missing the diagnosis might contribute to these findings, despite the high negative predictive value of the 4T probability score and the HIT Expert Probability (HEP) score. Also, the initiation of HIT treatment pending confirmatory testing, results in a subsequent increase of costs and exposure of patients to the unnecessary risks of anticoagulation. The aim of our study is to identify clinical and laboratory factors that might affect the decision of testing for HIT in the setting of low or intermediate pretest probability and to prove that this entity is over-investigated and over-treated in the in-hospital environment.Methods:We conducted a cross-sectional retrospective observational study at Hofstra University Northwell Health Staten Island Hospital. Inclusion criteria were patients 18 years and older who had undergone anti-PF4-heparin antibody testing on an inpatient basis, from January 2013 till August 2015. Patients were excluded only if the test was done as outpatient. Statistical analysis was conducted using independent-sample t- test, Chi-square test or Fisher's exact test. All statistical tests were 2-sided and conducted at the 0.05 level of significance. Data was analyzed using the SAS® System Version 9.3 (SAS Institute Inc., Cary, NC).Results:Data was collected on 89 patients who underwent anti-PF4-heparin antibody testing. 84 patients (94%) underwent HIT testing with a low 4T score, as compared to 5 patients (6%) with a high 4T score. There was no significant difference in the proportion of testing with respect to gender, age, the service under which the patient was admitted (medicine vs. surgery), presence of a hematology consult, a history of cardiac surgery, type of heparin used and an elevated Charleson score. 80% (n=74) of patients had another cause for thrombocytopenia and had the HIT panel ordered despite a low/intermediate 4T score (Table 1).In our study, 5 patients tested positive for HIT. 3 of the patients had high 4T and HEP score pretest probability, while 2 of the patients had intermediate 4 T score and high HEP score pretest probability. All 60 patients with a low 4 T score tested negative for HIT (Table 2).After ordering HIT serology, heparin was discontinued in 82 patients. 17 patients with low/intermediate 4T score were started on anticoagulation, 2 of them had new bleeding event. 6 patient with high 4T score were started on anticoagulation, and 1 of them had a bleeding event (Table 3).Conclusion:HIT poses a significant diagnostic challenge. It is an uncommon cause of thrombocytopenia that carries significant morbidity and mortality. Our study showed that HIT testing using ELISA immunoassays is being ordered excessively in the setting of low to intermediate pretest probability leading to unwarranted treatments at significant costs and carrying an important burden on the healthcare system. However, a high number of comorbidities did not seem to lower the threshold for ordering HIT panel. It is very challenging to conduct randomized trials on less common diseases in the clinical setting to improve test ordering practices. The HEP score might be an important adjunct to clinical decision making in the future but this requires more studies being conducted. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study.

PurposeThere is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection.MethodsWe did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection.Results121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency.ConclusionThe outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).Supplementary InformationThe online version contains supplementary material available at 10.1007/s10875-021-01066-8.

Risk Factors Influencing the Outcomes of Kidney Re-Transplantation.

BackgroundOur kidney transplant waitlist includes 20% re-transplantations (TX2). Knowing what to expect is a clinical obligation.Material/MethodsWe compared graft and patient survival of all 162 TX2 patients, transplanted 2000 to 2009, with 162 patients after first transplantation (TX1) matched for age, sex, living/non-living donation, and transplantation date. Patient follow-up was 10 years.ResultsTX2 graft and patient survivals were inferior to TX1 (p<0.001 and p=0.047). TX2 patients had a longer cumulative dialysis vintage, more human leucocyte antigen (HLA) mismatches, more panel-reactive HLA antibodies, more often received induction therapy with rabbit-antithymocyte globulin (rATG), and had a lower body mass index (all p<0.05). Death from infection and graft failure by rejection was more frequent after TX2 (both p<0.05) but not after TX1. Multivariable Cox regression analysis revealed that both cohorts had graft failure and death risk associated with infection and cardiovascular disease, and graft failure by humoral rejection. However, only TX2 patients had an additional risk of graft failure with early inferior graft function and of patient death with ≥2 comorbidities. Moreover, Kaplan-Meier analysis showed that TX2 and not TX1 patients had a lower graft and patient survival associated with infection and with ≥2 comorbidities (all p<0.05).ConclusionsRe-transplantation is associated with worse graft outcomes mainly because of immunologic and graft-quality reasons, although the high number of comorbidities and infection severities aside from cardiovascular disease drive mortality. The more frequent rATG induction of TX2 patients could promote infection by enhancing immunosuppression. By addressing comorbidities, outcomes could possibly be improved.

Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review.

AimsTo identify, systematically evaluate and summarise the best available evidence on the frequency of long COVID‐19 (post‐acute COVID‐19 syndrome), its clinical manifestations, and the criteria used for diagnosis.MethodsSystematic review conducted with a comprehensive search including formal databases, COVID‐19 or SARS‐CoV‐2 data sources, grey literature, and manual search. We considered for inclusion clinical trials, observational longitudinal comparative and non‐comparative studies, cross‐sectional, before‐and‐after, and case series. We assessed the methodological quality by specific tools based on the study designs. We presented the results as a narrative synthesis regarding the frequency and duration of long COVID‐19, signs and symptoms, criteria used for diagnosis, and potential risk factors.ResultsWe included 25 observational studies with moderate to high methodological quality, considering 5440 participants. The frequency of long COVID‐19 ranged from 4.7% to 80%, and the most prevalent signs/symptoms were chest pain (up to 89%), fatigue (up to 65%), dyspnea (up to 61%), and cough and sputum production (up to 59%). Temporal criteria used to define long COVID‐19 varied from 3 to 24 weeks after acute phase or hospital discharge. Potentially associated risk factors were old age, female sex, severe clinical status, a high number of comorbidities, hospital admission, and oxygen supplementation at the acute phase. However, limitations related to study designs added uncertainty to this finding. None of the studies assessed the duration of signs/symptoms.ConclusionThe frequency of long COVID‐19 reached up to 80% over the studies included and occurred between 3 and 24 weeks after acute phase or hospital discharge. Chest pain, fatigue, dyspnea, and cough were the most reported clinical manifestations attributed to the condition. Based on these systematic review findings, there is an urgent need to understand this emerging, complex and challenging medical condition. Proposals for diagnostic criteria and standard terminology are welcome.

Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study

ObjectiveTo assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA).DesignProspective cohort study.SettingTwo provincial central...

Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty (p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure (p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.

Associations Between Comorbidities and Severe Maternal Morbidity

(Obstet Gynecol. 2020;136:892–901) Severe maternal morbidity (SMM) includes long- or short-term consequences to a woman’s health due to pregnancy and childbirth. Since 1993, the US has seen a two-fold increase in the rate of SMM. The rate of SMM is nearly double for non-Hispanic Black women compared to non-Hispanic white women. Compared to women without chronic conditions, women with multiple chronic conditions are 3.8 times more likely to experience severe maternal morbidity and mortality. This study investigated the differences in risk of SSM associated with having zero, one, two or three or more comorbidities. The hypothesis of the study was that a higher number of comorbidities would be associated with a greater risk of SMM, and that these associations would vary by race.

Nationwide Trends in Tube-Related Genitourinary Interventions for Medicare Beneficiaries.

To evaluate national trends in tube-related genitourinary interventions, with specific attention to primary operator specialty. Using a 5% national sample of Medicare claims data from 2005 to 2015, all claims associated with nephrostomy tube, nephro-ureteral tube, and ureteral stent placement and exchange were identified. The annual volume of the nine billable procedures were analyzed to evaluate trends in the number of procedures performed and primary operator specialty over time. The Charleston Comorbidity Index (CCI) was used to evaluate patient comorbidities and to determine differences in patient populations treated by interventional radiologists and urologists. The total volume of tube-related genitourinary interventions has increased over the course of the study period, representing 455.0 services per 100,000 Medicare Fee-for-Service beneficiaries in 2005 to 607.2 services in 2015, an increase of 33.4%. Interventional radiologists performed the majority of all procedures in all procedure types and for each year (>90%) with the exception of nephro-ureteral catheter placement or ureteral stent placement, for which urologists performed the overwhelming majority of procedures each year (>85%). Interventional radiologists performed 63% of their total number of procedures on patients with a CCI= 3 or higher, and urologists performed 42% of their total number of procedures on patients with a CCI= 3 or higher (P < .01). Tube-related genitourinary interventions have demonstrated persistent growth over the 2005 to 2015 decade. Interventional radiologists are the dominant providers for the majority of these interventions compared with urologists while delivering care to a patient population with a higher number of comorbidities.

POS1251 ROLE OF SYSTEMIC AUTOINMUNE CONDITIONS IN HOSPITAL ADMISSIONS RELATED TO COVID-19

Background:The COVID-19 pandemic continues worldwide and has had a strong impact on public health, quality of life and economy of the general population. To date, the number of infections and deaths are still increasing. From the beginning of the pandemic, efforts were intensified to identify risk factors for development of the severe form of COVID-19. In this sense underlying medical comorbidities have been shown to have a worse prognosis in these patients.Objectives:In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid – 19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions.Methods:An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and Covid-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid -19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI).Results:406 patients were included with RMDs and Covid- 19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68; [1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR IJD: 0.41 [0.21-0.51], p=0.01; OR non-autoimmune: 0.33; [0.18-0.61]; p=0.000). After adjusting by confounders, autoimmune RMD had higher risk of hospital admissions compared to the rest (OR: 1.75; [1.04-2.95]; p=0.03), and specifically systemic autoimmune condition had higher risk compared to IJD (OR of IJD 0.33; [0.14-.076]; p=0.009) and compared to non–autoimmune (OR non autoimmune 0.28; [0.13-0.59], p=0.001). Advanced age (OR: 1.10; [1.07-1.12], p&lt;0.001), male (OR 0.58; [0.33-1.02], p=0.06), and more number of comorbidities (OR 1.39; [1.02-1.90] p=0.03) also increased the risk of hospitalization related to COVID-19.Conclusion:One third of the RMD patients infected with COVID-19 required hospital admission. This study shows that patients with autoimmune and specifically with systemic autoimmune conditions have a higher risk of hospitalization related to COVID-19. We also show that advanced age, male sex and a higher number of comorbidities can contribute to worsen the prognosis of the COVID-19 disease.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&amp;lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&amp;lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &amp;lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.