Discharge Reports Research Articles

Streptococcus pneumoniae Infection in Patients with Asplenia: A Spanish Perspective over a 25-Year Period.

Anatomical or functional asplenia constitutes a risk factor for Streptococcus pneumoniae (SP) infection, being more frequent in children and the elderly and in people with multiple comorbidities. We aimed to describe the impact of invasive pneumococcal disease (IPD) on the clinical features and outcomes of patients hospitalized for asplenia in Spain. Discharge reports from the Spanish Minimum Basic Data Set were used to retrospectively analyze hospital discharge data with a diagnosis of asplenia from 1997 to 2021. A total of 132,257 patients with asplenia (splenectomized/non-splenectomized) were identified from the Spanish database. Among the cases, 177 (37.5%) patients with splenectomy and 295 (62.5%) patients without splenectomy developed IPD. The clinical presentations (non-infection vs. infection) did not significantly differ between the two reference groups, except for patients with COPD, rheumatoid disease, AIDS, other neurological disorders, metastatic cancer, and drug abuse. The risk factors for IPD were also more frequently reported in patients without splenectomy (p < 0.001) and with comorbidities (p = 0.005). The study of patients with asplenia provides relevant information about the state of SP infection. This epidemiological tracking can serve to better understand the comorbidities that affect them, the risk factors for the disease, the prediction of antibiotic use, and vaccination in public health, among other factors.

Cross-institution natural language processing for reliable clinical association studies: a methodological exploration

ObjectivesNatural language processing (NLP) of clinical notes in electronic medical records is increasingly used to extract otherwise sparsely available patient characteristics, to assess their association with relevant health outcomes. Manual data curation is resource intensive and NLP methods make these studies more feasible. However, the methodology of using NLP methods reliably in clinical research is understudied. The objective of this study is to investigate how NLP models could be used to extract study variables (specifically exposures) to reliably conduct exposure-outcome association studies. Study Design and SettingIn a convenience sample of patients admitted to the intensive care unit of a US academic health system, multiple association studies are conducted, comparing the association estimates based on NLP-extracted vs. manually extracted exposure variables. The association studies varied in NLP model architecture (Bidirectional Encoder Decoder from Transformers, Long Short-Term Memory), training paradigm (training a new model, fine-tuning an existing external model), extracted exposures (employment status, living status, and substance use), health outcomes (having a do-not-resuscitate/intubate code, length of stay, and in-hospital mortality), missing data handling (multiple imputation vs. complete case analysis), and the application of measurement error correction (via regression calibration). ResultsThe study was conducted on 1,174 participants (median [interquartile range] age, 61 [50, 73] years; 60.6% male). Additionally, up to 500 discharge reports of participants from the same health system and 2,528 reports of participants from an external health system were used to train the NLP models. Substantial differences were found between the associations based on NLP-extracted and manually extracted exposures under all settings. The error in association was only weakly correlated with the overall F1 score of the NLP models. ConclusionAssociations estimated using NLP-extracted exposures should be interpreted with caution. Further research is needed to set conditions for reliable use of NLP in medical association studies.

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads.

Pneumothorax is a well-recognized complication of cardiac implantable electronic device (CIED) insertion. While AP fluoroscopy alone is the most commonly imaging technique for subclavian or axillary access, caudal fluoroscopy (angle 40°) is routinely used at our institution. The caudal view provides additional separation of the first rib and clavicle and may reduce the risk of pneumothorax. We assessed outcomes at our institution of AP and caudal fluoroscopic guided pacing lead insertion. Retrospective cohort study of consecutive patients undergoing transvenous lead insertion for pacemakers, defibrillators, and cardiac resynchronization therapy devices between 2011 and 2023. Both de novo and lead replacement/upgrade procedures were included. Data were extracted from operative, radiology, and discharge reports. All patients underwent postprocedure chest radiography. Three thousand two hundred fifty-two patients underwent insertion of pacing leads between February 2011 and March 2023. Mean age was 71.1 years (range 16-102) and 66.7% were male. Most (n = 2536; 78.0%) procedures used caudal guidance to obtain venous access, while 716 (22.0%) procedures used AP guidance alone. Pneumothoraxes occurred in five (0.2%) patients in the caudal group and five (0.7%) patients in the AP group (p = .03). Subclavian contrast venography was performed less frequently in the caudal group (26.2% vs. 42.7%, p < .01). Caudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.

Rehabilitation potential of patients with ischemic heart disease who underwent autovenous coronary artery bypass surgery in the evaluation of rehabilitation treatment effectiveness

To develop a method for RP evaluation in patients with IHD who underwent CABS and to assess its role in predicting the effectiveness of therapeutic activities in the early rehabilitation period. The study consisted of two parts. A method for RP assessment in 118 patients with IHD aged 36-85 years (mean age 62.3±2.0 years) who underwent CABS was developed in the 1st part based on the analysis of hospital discharge reports using mathematical modeling methods. The results of rehabilitation activities were analyzed in the 2nd part of the study in patients who were transferred to the cardiovascular department of the Angara Clinical Resort after the cardiovascular surgery department for the second stage of rehabilitation. The multidisciplinary team evaluated the effectiveness of patients' treatment after the rehabilitation completion using integral indicators characterizing clinical condition of the patient who underwent CABS. A methodological algorithm was created in the 1st part of the study, namely a formalized patient chart was formed, the evidence base was represented by 99 indicators. The values of linear classification functions' coefficients were assigned to certain indicators, according to which the patient was classified into one of four groups: the 1st group - without RP; the 2nd group - with medium RP; the 3rd group - with high RP and the 4th group - with low RP. The values of RP were determined in the second part of the study for predicting the effectiveness of therapeutic measures in the early rehabilitation period (the second stage of medical rehabilitation). It has been found that the greatest effect was observed in subjects of the 3rd group with high RP in the patients' testing after treatment at the health resort. The lesser effect has been noted in patients of the 2nd group and especially of the 4th group. The use of RP assessment method based on mathematical modeling in patients who underwent CABS allows to predict the results of patients' medical rehabilitation at the second stage in the health resort conditions.

Analysis and prediction of readmissions for heart failure in the first year after discharge with INCA score

To determine the readmissions trends and the comorbidities of patients with heart failure that most influence hospital readmission rates. Heart failure (HF) is one of the most prevalent health problems as it causes loss of quality of life and increased health-care costs. Its prevalence increases with age and is a major cause of re-hospitalisation within 30 days after discharge. INCA study had observational and ambispective design, including 4,959 patients from 2000 to 2019, with main diagnosis of HF in Extremadura (Spain). The variables examined were collected from discharge reports. To develop the readmission index, capable of discriminating the population with higher probability of re-hospitalisation, a Competing-risk model was generated. Readmission rate have increased over the period under investigation. The main predictors of readmission were: age, diabetes mellitus, presence of neoplasia, HF without previous hospitalisation, atrial fibrillation, anaemia, previous myocardial infarction, obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). These variables were assigned values with balanced weights, our INCA index showed that the population with values greater than 2 for men and women were more likely to be re-admitted. Previous HF without hospital admission, CKD, and COPD appear to have the greatest effect on readmission. Our index allowed us to identify patients with different risks of readmission.

Rehabilitation for Post-COVID Syndrome covered by the German Pension Insurance in 2021

The present work is intended to give an overview of rehabilitation of patients with post COVID-19 condition covered by the German Pension Insurance in 2021. Cross-sectional analysis of medical rehabilitation completed in 2021, in which COVID-19 sequelae were coded in first or second place in the uniform discharge report according to the International Statistical Classification of Diseases and Related Health Problems was carried out. The codes U08(.9), U09(.9) and U10(.9) as well as the corresponding codes from 2020 were taken into the evaluation as COVID-19-related diseases. Children's rehabilitation and oncological rehabilitation for pensioners and their relatives were excluded. Statistically, relative and absolute frequencies are given for nominal and ordinal variables, and median and quartiles for continuous, skewed distributed variables. 9,666 rehabilitations with one of the codes mentioned in first or second place remained. 54.8% of the patients were women and 43.2% men. The median age was 54 and 55 years (women/men). In all, 64.4% of the rehabilitations were carried out in the pulmonary medicine department. Owing to somatic indications, almost 50% of these patients in rehabilitation remained in the clinic beyond the regular approval period. The most common other diagnoses were diseases of the respiratory system. In 80.7% of those affected, the treating physicians considered the post-COVID-19 condition-associated symptoms as improved through rehabilitation. Furthermore, employment was subject to social security contributions for 88.0% of these patients, and 30.5% were employed in the fields of health, social affairs, teaching, and education. Of those affected, 63.8% were on sick leave when they were admitted, 63.0% when they were discharged. With regard to performance in the last job or on the general job market, over 90.0% received a prognosis for 6 hours and more. The importance of post-COVID-19 condition in the context of medical rehabilitation increased significantly over the course of 2021. The disease causes long periods of disability. With regard to performance, the available analyses give a positive picture; only 6.5% of those individuals undergoing rehabilitation were assessed as having a reduced capacity to earn of less than 3 hours on the general labor market.

Sixth wave of COVID-19 pandemic: Epidemiological survey in children

Objectives At the beginning of the COVID-19 pandemic, the number of infected children was lower than that of adults. Most cases were transmitted in the family, asymptomatic, and severe cases were rare. In the sixth wave in Japan the number of infected children increased sharply after the Omicron variant had been replaced in December 2021, which had a substantial influence in maintaining social and medical functions. Furthermore, few reports on child death in the country have raised concerns among parents. However, no literature has elucidated the epidemiological characteristics of the Omicron variant in children. In this study, we aimed to clarify them during the sixth wave in Japan.Methods We analyzed the data of 28,086 COVID-19-infected patients those were registered in the Yamashirokita Public Health Center between January 15, 2022 and May 31, 2022. The cumulative incidence and hospitalization rate were compared between the age groups <15 and those >15 years based on the databases compiled by our public health center and the Kyoto prefecture government. In addition, we analyzed the background, length of hospitalization, and clinical symptoms of 24 patients based on active epidemiological investigation, health observations, and discharge reports submitted from medical facilities.Results Of the 52,897 residents <15 years (pediatric population is 12.3%), 15.1% (7,980 cases) were infected, and children accounted for 28.4% of all-age infected patients. Among them, 24 were hospitalized (0.3% of children with COVID-19, 0.04% of the child population). Conversely, of the 377,093 residents aged ≥15 years, 5.3% (20,106 patients) were infected. Among them, 1,088 were hospitalized (5.4% of COVID-19 patients, 0.28% of the adult population). For 24 hospitalized children, 22 (91.6%) had mild cases and 2 (8.3%) had moderate cases, and no severe case was noted based on the criteria of severity in Japan's COVID-19 medical care guidelines. Two patients (8.3%) were hospitalized for treatment of other diseases. The median of hospital stay was 3.5 days, and 20 patients (83.3%) were discharged home during the recuperation period.Conclusions The cumulative incidence of children with COVID-19 in the sixth wave was 15.1%, approximately three times higher than that of the older patients; however, no severe case was observed in children.

A hackathon as a tool to enhance research and practice on electronic health record systems' interoperability for chronic disease management and prevention.

The development of a standardized technical framework for exchanging electronic health records is widely recognized as a challenging endeavor that necessitates appropriate technological, semantic, organizational, and legal interventions to support the continuity of health and care. In this context, this study delineates a pan-European hackathon aimed at evaluating the efforts undertaken by member states of the European Union to develop a European electronic health record exchange format. This format is intended to facilitate secure cross-border healthcare and optimize service delivery to citizens, paving the way toward a unified European health data space. The hackathon was conducted within the scope of the X-eHealth project. Interested parties were initially presented with a representative clinical scenario and a set of specifications pertaining to the European electronic health record exchange format, encompassing Laboratory Results Reports, Medical Imaging and Reports, and Hospital Discharge Reports. In addition, five onboarding webinars and two professional training events were organized to support the participating entities. To ensure a minimum acceptable quality threshold, a set of inclusion criteria for participants was outlined for the interested teams. Eight teams participated in the hackathon, showcasing state-of-the-art applications. These teams utilized technologies such as Health Level Seven-Fast Healthcare Interoperability Resources (HL7 FHIR) and Clinical Document Architecture (CDA), alongside pertinent IHE integration profiles. They demonstrated a range of complementary uses and practices, contributing substantial inputs toward the development of future-proof electronic health record management systems. The execution of the hackathon demonstrated the efficacy of such approaches in uniting teams from diverse backgrounds to develop state-of-the-art applications. The outcomes produced by the event serve as proof-of-concept demonstrators for managing and preventing chronic diseases, delivering value to citizens, companies, and the research community.

Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD

Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk. Prospective cohort study. 3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate to advanced CKD. Demographic and biological data (including eGFR), medication prescriptions. ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype). During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhage (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death and 22 associated with a life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. The risk of acute kidney injury was 2.2% higher and risk of bleeding ADRs was 8% higher for each 1mL/min/1.73m2 lower baseline eGFR. The results cannot be extrapolated to patients who are not being treated by a nephrologist. ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor. Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.

Endomyocardial biopsy practice in non-transplant patients: a nationwide descriptive study

Abstract Background Endomyocardial biopsy (EMB) is an invasive diagnostic tool, mainly used during the follow-up of heart transplant patients (HTx). Its others indications have been established and discussed in position statement paper from international cardiac societies. However the use of EMB in real life remains controversial and differs widely from a center to another. Purpose We carried out a nationwide survey to describe the current use of EMB in non-heart transplant patients. Methods We used the National Hospital Discharge Database (PMSI) that contains diagnostic codes of all hospitalizations. Medical data is coded from different sources (e.g. laboratory reports, discharge reports) according defined terminologies and coding rules. We included all hospitalizations during which EMB (code CCAM DAHF001 – Endocardium or Myocardium Biopsy, transcutaneous vascular access) was performed from January 1st 2019 to December 31th 2020. We excluded all patients with a main or secondary or associated diagnosis of heart transplant. Main diagnosis as well as secondary and associated diagnoses were collected in order to define the medical indication of EMB. We aggregated EMB indications into 8 groups. Results Among 9735 EMB, 914 (9%) were carried out for non-transplant patients during the 2 years of analysis. Among the 212 hospitals with interventional cardiology units, only 53 (25%) carried out EMB in non-transplant patients and 86% of these procedures were carried out in transplant centers. Three hospitals carried out 37% of all non-transplant EMB while 23 centers carried out no more than 5 EMB over the 2-year survey. The figure displays main indications of EMB in non-transplant patients. According to the PMSI database, the 3 main indications of EMB were amyloïdosis (29%), non-ischemic Dilated Cardiomyopathy (28%) and myocarditis (22%). The medical indication could not be specified in 155 (16%) patients. Conclusion In non-transplant patients, EMB is rarely performed in France, only in a few hospitals and with significant disparity in the annual rate of procedures carried out by each. Most EMB were performed because of amyloidosis or dilated cardiomyopathy and myocarditis. Further data about local constraints as well as clinical impact of EMB for each patient would be useful to understand further the role of EMB in real life.EMB indications in non HTx patients

Can we use national registries to predict discharge reports?: An example with the ENVIN and RETRAUCI registries

Can we use national registries to predict discharge reports?: An example with the ENVIN and RETRAUCI registries

Trends for Percutaneous Tracheostomy in Italian Acute Care Setting over a 5-Year Period.

Background: Tracheostomy is a widespread procedure usually performed with a percutaneous approach for prolonged mechanical ventilation. Little is known about the population-based trends for percutaneous tracheostomies (PT). The aim of this study was to evaluate the order to analyze the characteristics, rates, and costs of PTs performed in Italy from 2009 to 2014. Methods: We analyzed 102,646 PTs performed in Italy between 2009 and 2014. We obtained the data of patients from the section of the discharge report of the Italian Ministry of Health (National Archive for Hospital Discharge Form, Ministry of Health) about age, gender, length of stay (LOS), hospital types, and hospital region for code 541 and 542 for the years 2009, 2010, 2011, 2012, 2013 and 2014. Our additional source of data was the Annual Discharge Reports of the Italian Ministry of Health. Results: In this study, including 102,646 PTs performed from 2009 to 2014, we found that (1) the rates of PTs significantly decreased over time; (2) PTs were mostly performed in patients aged less than 65 years and hospitalized in ICUs for less than 40 days; and (3) the costs of PTs severely decreased over time, with a breakpoint between 2011 and 2012. Conclusions: Percutaneous tracheostomy is still a procedure frequently performed in the setting of acute care. Although percutaneous tracheostomy still results in high medical care reimbursement, it is a safe and cost-saving procedure.

Drug-induced Sudden Death: A Scoping Review.

The risk of sudden cardiac death (SCD) can be increased with the use of drugs. However, it has been described heterogeneously in the literature. This study aims to systematically review epidemiological studies dealing with druginduced sudden death, describe their methodologies, and summarize the results found. A scoping review has been carried out using Medline electronic database. The search was limited up to 2020. Epidemiological studies were included, and case reports or case series were excluded. Out of 3,114 potential articles, 74 were included. Most studies originated from North America (40.5%) or Europe (39.2%). Case-control (47.3%) or cohort (40.5%) studies were the most common designs. The data for outcomes and exposure were retrieved mainly from administrative databases (37.8%) or medical charts/hospital discharge reports (32.4%), but most studies used several sources of information. A composite variable of sudden death or SCD, mainly with ventricular arrhythmia, was the most frequently used endpoint. Only 18.9% of the studies included autopsy results to confirm the death. Psychotropic drugs were the most frequently studied. An increased risk of different outcomes for typical antipsychotics, tricyclic antidepressants, domperidone, and antiepileptics is suggested. The methodologies used were highly heterogeneous, and the results were, in general, not conclusive. An improvement of the methodologies is needed to achieve a conclusion regarding the risk of SCD associated with drug use.

Analysis of the key themes in the healthcare of older people with multimorbidity in Germany: a framework analysis as part of the LoChro trial

ObjectivesMultimorbidity challenges healthcare systems. In Germany, coordination of healthcare for older multimorbid patients remains unstructured.This study aims to identify key themes in the healthcare of these patients and the inter-relationships...

Hospitalization burden and epidemiology of the COVID-19 pandemic in Spain (2020–2021)

BackgroundSpain had some of Europe’s highest incidence and mortality rates for coronavirus disease 2019 (COVID-19). Here we describe the epidemiology and trends in hospitalizations, the number of critical patients, and deaths in Spain in 2020 and 2021.MethodsWe performed a descriptive, retrospective, nationwide study using an administrative database, the Minimum Basic Data Set at Hospitalization, which includes 95–97% of discharge reports for patients hospitalized in Spain in 2020 and 2021. We analyzed the number of hospitalizations, admissions to intensive care units, and deaths and their geographic distribution across regions of Spain.ResultsAs of December 31, 2021, a total of 498,789 patients (1.04% of the entire Spanish population) had needed hospitalization. At least six waves of illness were identified. Men were more prone to hospitalization than women. The median age was 66. A total of 54,340 patients (10.9% of all hospitalizations) had been admitted to the intensive care unit. We identified 71,437 deaths (mortality rate of 14.3% among hospitalized patients). We also observed important differences among regions, with Madrid being the epicenter of hospitalizations and mortality.ConclusionsWe analyzed Spain’s response to COVID-19 and describe here its experiences during the pandemic in terms of hospitalizations, critical illness, and deaths. This research highlights changes over several months and waves and the importance of factors such as vaccination, the predominant variant of the virus, and public health interventions in the rise and fall of the outbreaks.

Legionellosis-Associated Hospitalization in Spain from 2002 to 2021.

Legionellosis is a respiratory disease of bacterial and environmental origin that usually presents two distinct clinical entities, "Legionnaires' disease" (LD) and "Pontiac fever". LD is an important cause of hospital-acquired pneumonia (HAP). The objective of this study is to describe the epidemiology of legionellosis-associated hospitalization (L-AH) in Spain from 2002 to 2021 and the burden of hospitalization due to legionellosis. Discharge reports from the Minimum Basic Data Set (MBDS) were used to retrospectively analyze hospital discharge data with a diagnosis of legionellosis, based on the ICD-9-CM and ICD-10-CM diagnosis codes, from 2002 to 2021. 21,300 L-AH occurred throughout the year during 2002-2021. The incidence of hospitalization associated per 100,000 inhabitants by month showed a similar trend for the 2002-2011, 2012-2021, and 2002-2021 periods. In Spain, during 2002-2021, the hospitalization rate (HR) in the autonomous communities ranged from 4.57 (2002-2011) to 0.24 (2012-2021) cases per 100,000 inhabitants. The HR of legionellosis in Spain has substantially increased across the 2002-2021 period, and the estimate is consistent with available European data. It is considered that in-depth epidemiological surveillance studies of legionellosis and improvements in the prevention and control of the disease are required in Spain.

1841-PUB: Diabetes as a Risk Factor of Death in Hospitalized COVID-19 Patients—An Analysis of a National Hospitalization Database from Poland, 2020

Introduction: Diabetes has been linked with poor clinical prognosis of hospitalized COVID-19 patients. In this nationwide database retrospective study we evaluated diabetes as a risk factor of in-hospital death. Methods: We analysed data from discharge reports from 2020 of hospitalized COVID-19 patients sent to the Polish National Health Fund. To assess the risk of in-hospital death attributed to diabetes, several multivariate logistic regression models were used. In each model in-hospital death was estimated with explanatory variables, including diabetes. Models were built either on the whole cohorts or cohorts matched with propensity score matching (PSM). They examined either main effects or included interaction of diabetes with other variables. Results: We included 174,621 patients with COVID-19 infection hospitalized in Poland in 2020. There were 40,168 diabetic patients (DPs), proportion higher than in the general population (23.0% vs. 9.5%, p&amp;lt;0.001). Overall, 17,438 in-hospital deaths were recorded, the mortality was higher in DPs vs. nondiabetics (16.3% vs. 8.1%, p&amp;lt;0.001). Multivariate logistic regressions showed that diabetes was an independent risk factor of death, regardless of sex and age. In the main effect analysis, odds of in-hospital death were higher by 28.3% for DPs than for nondiabetic patients. Similarly, PSM analysis including 101,578 patients, of whom 19,050 had diabetes, showed that the risk of death was higher in DPs regardless of sex and age. Odds of in-hospital death were higher by 34.9% for DPs. The impact of diabetes on COVD-19 in-hospital death differed among age groups and was the highest for patients aged 60-69. Conclusions: This nationwide study confirmed that diabetes was an independent risk of in-hospital death in the course of COVID-19. However, the relative risk attributed to diabetes might be lower than reported earlier from most of other populations and differ significantly across the age groups. Disclosure M. Kania: None. B. Kon: None. K.M. Kaminski: Other Relationship; Roche Pharmaceuticals. J. Hohendorff: Speaker's Bureau; Abbott, Novo Nordisk, Ascensia Diabetes Care, Dexcom, Inc., Bayer Inc. T. Klupa: Speaker's Bureau; Medtronic. Advisory Panel; Abbott Diabetes. Speaker's Bureau; Abbott Diabetes. Advisory Panel; Ascensia Diabetes Care. Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. Advisory Panel; Sanofi, BIOTON S.A. Speaker's Bureau; Boehringer Ingelheim Inc., Servier Laboratories. P.W. Witek: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Medtronic, Novo Nordisk, Sanofi-Aventis Deutschland GmbH, Boehringer-Ingelheim, Roche Diabetes Care, BIOTON S.A., KRKA. M. Malecki: Advisory Panel; Abbott Diabetes. Speaker's Bureau; AstraZeneca, AlfaSigma. Advisory Panel; Novo Nordisk, Lilly, Sanofi. Speaker's Bureau; Merck &amp; Co., Inc. Research Support; Medtronic. Advisory Panel; Dexcom, Inc. Speaker's Bureau; BIOTON S.A., Servier Laboratories, KRKA. Advisory Panel; Bayer Inc. Funding National Centre for Research and Development CRACoV-HHS project (SZPITALE-JEDNOIMIENNE/18/2020)

Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study)

ObjectivesTo validate the diagnoses of acute myocardial infarction (AMI) and stroke recorded in electronic medical records (EMR) and to estimate the population prevalence of both diseases in people aged ≥18...

Diabetes as a risk factor of death in hospitalized COVID-19 patients - an analysis of a National Hospitalization Database from Poland, 2020.

Diabetes is one of the comorbidities associated with poor prognosis in hospitalized COVID-19 patients. In this nationwide retrospective study, we evaluated the risk of in-hospital death attributed to diabetes. We analyzed data from discharge reports of patients hospitalized with COVID-19 in 2020 as submitted to the Polish National Health Fund. Several multivariate logistic regression models were used. In each model, in-hospital death was estimated with explanatory variables. Models were built either on the whole cohorts or cohorts matched with propensity score matching (PSM). The models examined either the main effects of diabetes itself or the interaction of diabetes with other variables. We included 174,621 patients with COVID-19 who were hospitalized in the year 2020. Among them, there were 40,168 diabetic patients (DPs), and the proportion of DPs in this group was higher than in the general population (23.0% vs. 9.5%, p<0.001). In this group of COVID-19 hospitalizations, 17,438 in-hospital deaths were recorded, and the mortality was higher among DPs than non-diabetics (16.3% vs. 8.1%, p<0.001). Multivariate logistic regressions showed that diabetes was a risk factor of death, regardless of sex and age. In the main effect analysis, odds of in-hospital death were higher by 28.3% for DPs than for non-diabetic patients. Similarly, PSM analysis including 101,578 patients, of whom 19,050 had diabetes, showed that the risk of death was higher in DPs regardless of sex with odds higher by 34.9%. The impact of diabetes differed among age groups and was the highest for patients aged 60-69. This nationwide study confirmed that diabetes was an independent risk factor of in-hospital death in the course of COVID-19 infection. However, the relative risk differed across the age groups.

Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study.

To investigate the prevalence of hypercalcemia (>2.60 mmol/l) and severe hypercalcemia (≥2.80 mmol/l) on admission. Symptoms, causes, course of serum calcium, treatment and outcome of severe hypercalcemia were evaluated and compared to historical data from previous studies. In this retrospective cohort study, all patients presenting to the interdisciplinary emergency department of the Buergerspital Solothurn between 01 January 2017 and 31 December 2020 with measurements of serum calcium were included. Chart reviews were performed for patients with calcium ≥2.80 mmol/l to assess clinical presentation, course of disease and treatment for severe hypercalcemia. Of 31,963 tested patients, 869 patients (2.7%) had hypercalcemia on the admission, of which 161 had severe hypercalcemia. Non-albumin corrected calcium was 3.07 (0.32) while albumin corrected calcium was 3.34 (0.44). Calcium was higher in patients with malignancy-related hypercalcemia (3.18 [0.34] versus 3.00 [0.3], p <0.001). Neuropsychiatric (35%) and gastrointestinal (24%) were the leading symptoms. Malignancy was the most common identifiable cause of hypercalcemia (40%), with lung cancer (20%), multiple myeloma (14%) and renal cell carcinoma (11%) being the main cancer types. 36% of patients with severe hypercalcemia took calcium supplements. Bisphosphonate treatment was an independent predictor of a fall in calcium until day 5 (regression coefficient: -0.404, standard error 0.11, p <0.001). Hypercalcemia was not mentioned in the final discharge report in 38% of cases. Severe hypercalcemia is common and malignancy-related in almost half of the cases. Neuropsychiatric and gastrointestinal symptoms were most prevalent. Awareness of hypercalcemia, particularly in cancer patients and those with known triggering factors, should be raised in order to identify and treat this harmful disorder early.