Strong Predictor Of Death Research Articles

Predictors of survival in older adults hospitalized with COVID-19.

ObjectiveThis study was designed to investigate clinical characteristics associated with mortality and predictors of survival in older adults hospitalized with COVID-19 with a focus on neurological comorbidities and presenting neurological manifestations.MethodsWe compared clinical characteristics in an age- and gender-matched sample of 75 deceased and 75 recovered patients (MAge = 78) hospitalized with COVID-19 and developed a logistic regression to predict likelihood of survival.ResultsDeceased patients were more like to have dementia, altered mental status (AMS), acute respiratory distress syndrome (ARDS), sepsis, mechanical ventilation, and balance difficulties; higher heart rate, respiratory rate, blood urea nitrogen, creatinine, and absolute neutrophils; lower oxygen saturation and absolute lymphocytes; and shorter length of hospitalization. Logistic regression based on three mortality predictors (ARDS, AMS, and length of hospitalization) correctly predicted 87% of the outcome (89% sensitivity at 85% specificity).ConclusionsDementia and AMS were strong predictors of death in older adults hospitalized with COVID-19. Our findings add to the rapidly growing neurology of COVID-19 literature and underscore the importance of early recognition and the incorporation of a mental status examination into the medical assessment of COVID-19.

Implantable cardioverter-defibrillators in elderly patients: outcome and predictors of mortality.

The implantable cardioverter-defibrillator (ICD) is the therapy of choice for the prevention of sudden cardiac death. The number of elderly patients receiving ICDs is increasing. This study aimed to assess the outcome of patients according to their age at the time of implantation, and to identify variables potentially associated with patient survival. Between June 2009 and December 2019, we retrospectively enrolled all consecutive patients in whom ICD implantation had been performed for primary or secondary prevention at our center. During the study period, 670 patients underwent ICD implantation. We stratified the population into four age-classes: Class 1 (23%) (pts aged less than 60years), Class 2 (28%) (pts aged between 60 and 70years), Class 3 (39%) (pts aged between 70 and 80years) and Class 4 (9%) (pts aged 80years or older). Over a median follow-up of 42months, the rate of deaths in Class 4 was higher than in Classes 1 and 2 (log-rank test, P < 0.01), but was comparable to that in Class 3 (P = 0.407). With increasing age, we observed more complications at the time of implantation and during follow-up. On multivariate analysis, higher NYHA class, creatinine level and CHA2DS2-VASc score were identified as independent predictors of death, while age was not associated with worse prognosis. Higher body mass index, higher NYHA class and CHA2DS2-VASc score were also confirmed as independent predictors of hospitalizations or death due to any cause. This study showed good survival in ICD patients in all age-groups, including those aged ≥80years. The CHA2DS2-VASc score seems to be a stronger predictor of death than age.

Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore.

ABSTRACTBisphosphonates (BP) are the most commonly prescribed effective form of osteoporosis treatment with adverse effects associated with prolonged use such as atypical femoral fractures (AFF). Asians have an elevated risk of AFF at 5 to 6 times those of whites and Hispanics. In this study, we characterize factors associated with AFF and its mortality in a single center in Singapore. We conducted a cohort study of subjects older than 50 years admitted to Changi General Hospital (CGH), Singapore, with fragility subtrochanteric femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria, fractures are classified into atypical and typical subtrochanteric femoral fractures. CGH uses a nationalized electronic health record that allows review of information on patients' demographics, clinical history and previous investigations. Mortality was assessed as of December 31, 2019. Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. A total of 52.2% of AFF occurred with BP exposure of median duration 56.5 (28 to 66) months. Multivariate regression showed that BP exposure was associated with the highest risk of AFF (odds ratio [OR] = 6.65 [2.35–18.9]). AFF patients had higher 5‐year survival (0.85 versus 0.62, p = 0.001) compared with typical subtrochanteric fracture patients. However, after adjusting for variables, the type of subtrochanteric femoral fractures were no longer significantly associated with progression to death, whereas older age, higher mean Charlson comorbidity score, and Malay ethnicity were the strongest predictors of death. AFF constitutes a small proportion of hip and femoral fractures with prolonged BP use being the highest risk factor for its development. There is no evidence of increased mortality or morbidity in patients with AFF compared with the typical subtrochanteric fracture. The fear of AFF should not impede treatment of typical osteoporotic fractures in this population. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Cardiovascular events in cancer patients with bone metastases-A Danish population-based cohort study of 23,113 patients.

IntroductionThe incidence of cardiovascular events among cancer patients with bone metastases is poorly understood. We examined rates of cardiovascular events among cancer patients with bone metastases and mortality following such events.MethodsUsing Danish health registries, we identified all Danish cancer patients diagnosed with bone metastases (1994–2013) and followed them from bone metastasis diagnosis. We computed incidence rates (IR) per 100 person‐years and cumulative incidence for first‐time inpatient hospitalization or outpatient clinic visit for cardiovascular events, defined as myocardial infarction, ischemic stroke, or venous thromboembolism (VTE). We also analyzed all‐cause mortality rates including cardiovascular events as time‐varying exposure with adjustment for age, sex, and Charlson Comorbidity Index score. All analyses were performed overall and stratified by cancer type (prostate, breast, lung, and other).ResultsWe included 23,113 cancer patients with bone metastases. The cumulative incidence of cardiovascular events was 1.3% at 30 days, 3.7% at 1 year, and 5.2% at 5 years of follow‐up. The highest IR was observed for VTE, followed by ischemic stroke and myocardial infarction, both overall and by cancer types. Lung cancer patients with bone metastases had the highest incidence of cardiovascular events followed by prostate and breast cancer. Occurrence of any cardiovascular event was a strong predictor of death (5 years following the event, the adjusted hazard ratio was 1.8 [95% confidence interval: 1.7–1.9]).ConclusionCancer patients with bone metastases had a substantial risk of developing cardiovascular events, and these events were associated with a subsequent increased mortality. Our findings underscore the importance of continuous optimized prevention of and care for cardiovascular disease among cancer patients with bone metastases.

Resolving the discrepancies of suicide risk in obsessive-compulsive patients: a review of incidence rates and risk factors of suicide and suicide attempts in OCD

AimsObsessive-Compulsive Disorder (OCD) describes a mental health condition in which affected patients experience persistent obsessions, which may often, but not always result in compulsions, causing major distress and anxiety. Obsessions are defined as intrusive thoughts with a high emotional valence, whereas compulsion are repetitive actions, which demonstrate the attempt to eliminate obsessive thoughts.When speaking of OCD, risk of suicide is rarely a topic of concern. There is still no consensus about whether OCD and suicide are associated. Early schools of clinical sciences propose a low risk of harm, which was taught to most mental health practitioners currently working in health services. Moreover, the World Health Organisation currently classifies OCD as the 11th leading cause of nonfatal burden, indicating that despite the potential for causing significant disabilities, OCD does not pose any serious health risks. Contemporary evidence, however, suggests that the risk for suicide may be underestimated.This literature review aims to cumulate evidence for the risk of suicide in OCD and its associated underlying factors to clarify and resolve the discrepancies that currently exist regarding this topic.MethodTo identify eligible studies, the databases MEDLINE(R), PubMed, and PsycINFO are used. Selected studies provide data on suicide rates, attempts, and risk factors. Grey literature is included in the review to consider results from studies which may not have qualified for publishing. This literature review is conducted according to the PRISMA guidelines.ResultAfter deduplication, 653 studies could be found out of which 15 studies meet the inclusion criteria. Rates of suicide attempts appear to lie between 12% and 27%. Death-to-suicide rates in OCD are shown to range from 0.7% to 1.4%. Associated risk factors for suicide in OCD include, mistrust and unacceptable thoughts, depression, and comorbid substance use disorders. The strongest predictor for death caused by suicide is having a history of previous suicide attempts. Higher education and comorbid anxiety disorders act as protective factors. Lastly, gender differences remain unclear since some studies classify female sex as a protective, and some as a risk factor.ConclusionThis review provides a good overview of the actual risk for suicide in OCD. Current evidence suggests high suicidality in patients with OCD, leading to suicide attempts in affected patients, but not necessarily resulting in death, as the death-to-suicide rates are low. Genetic heritage and comorbidities of further mental health disorders may increase the risk for suicide in OCD.

Lung Ultrasound Score as a Predictor of Mortality in Patients With COVID-19.

Background: Lung injury is a common condition among hospitalized patients with coronavirus disease 2019 (COVID-19). However, whether lung ultrasound (LUS) score predicts all-cause mortality in patients with COVID-19 is unknown. The aim of the present study was to explore the predictive value of lung ultrasound score for mortality in patients with COVID-19.Methods: Patients with COVID-19 who underwent lung ultrasound were prospectively enrolled from three hospitals in Wuhan, China between February 2020 and March 2020. Demographic, clinical, and laboratory data were collected from digital patient records. Lung ultrasound scores were analyzed offline by two observers. Primary outcome was in-hospital mortality.Results: Of the 402 patients, 318 (79.1%) had abnormal lung ultrasound. Compared with survivors (n = 360), non-survivors (n = 42) presented with more B2 lines, pleural line abnormalities, pulmonary consolidation, and pleural effusion (all p < 0.05). Moreover, non-survivors had higher global and anterolateral lung ultrasound score than survivors. In the receiver operating characteristic analysis, areas under the curve were 0.936 and 0.913 for global and anterolateral lung ultrasound score, respectively. A cutoff value of 15 for global lung ultrasound score had a sensitivity of 92.9% and specificity of 85.3%, and 9 for anterolateral score had a sensitivity of 88.1% and specificity of 83.3% for prediction of death. Kaplan–Meier analysis showed that both global and anterolateral scores were strong predictors of death (both p < 0.001). Multivariate Cox regression analysis showed that global lung ultrasound score was an independent predictor (hazard ratio, 1.08; 95% confidence interval, 1.01–1.16; p = 0.03) of death together with age, male sex, C-reactive protein, and creatine kinase-myocardial band.Conclusion: Lung ultrasound score as a semiquantitative tool can be easily measured by bedside lung ultrasound. It is a powerful predictor of in-hospital mortality and may play a crucial role in risk stratification of patients with COVID-19.

ИНДЕКС МЫШЕЧНОЙ МАССЫ НА УРОВНЕ ПОЗВОНКА Th12 КАК ПРОГНОСТИЧЕСКИЙ ФАКТОР ЛЕТАЛЬНОГО ИСХОДА У ПАЦИЕНТОВ С ПНЕВМОНИЕЙ, ВЫЗВАННОЙ SARS-COV2

Purpose: To develop a methodology for determining the muscle mass index (MMI) at the level of Th12 based on the computed tomography of the chest; to estimate the impact of MMI on the outcome of the COVID19 patients as a prognostic factor. &#x0D; Material and methods: The medical data and computed tomography of the chest of 247 patients with confirmed pneumonia caused by SARS-Cov2 were used. A technique has been developed for determining MMI based on the cross-sectional area of paraspinal muscles at the level of the Th12 vertebra and the length of the thoracic spine. A correlation analysis of MMI calculated based on the length of the thoracic spine MMI(L) and height MMI(H) was performed. A statistical analysis of the differences of the MMI(L) in the groups of male and female patients with fatal outcome and recovered, as well as younger and older than 65 years were performed. &#x0D; Results: A strong correlation was found between the MMI calculated on the basis of the length of the thoracic spine and height &#x0D; (r = 0.861, p &lt;0.001). The age threshold, which was associated with an increase in the likelihood of death, in men was 60 years (Se 77.3 %, Sp 60.5 %, PPV 51.5 %, NPV 83.1 %, Youden's index 0.378, area under ROC- curve 0.728), in women 65 years old (Se 72.2 %, Sp 68.6 %, PPV 49.1 %, NPV 85.5 %, Youden's index 0.408, the area under the ROC curve 0.734). The odds ratio of death when the age thresholds are exceeded was 5.2 for men (95 % CI: 2.3 – 12.0), for women – 5.7 (95 % CI: 2.4 – 13.4). MMI(L) 3.37cm2/m2 is a threshold value, below which the probability of death in male patients under 60 years increased 26.3 times (95 % CI: 4.8 – 143.0). In female patients, there was no statistically significant threshold value of MMI(L), which would be associated with a higher risk of death. &#x0D; Conclusion: MMI, calculated at the level Th12 on the basis of the length of the thoracic spine, can be reliably used as a tool to estimate sarcopenia associated muscle atrophy, if there is no anthropometric data. The MMI(D) less than 3.37 cm2/m2 is a strong predictor of death in men under 60 years of age. Further work is needed to study the effect of sarcopenia on the severity and outcome of COVID19 in female patients, taking into account comorbid conditions.

Supraventricular arrhythmia in tetralogy of Fallot repair

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Gottsegen National Cardiovascular Center BACKGROUND With aging morbidity related to arrhythmias in adult patients with Tetralogy of Fallot repair (TOFr) is increasing. OBJECTIVE We aimed to analyze the prevalence of supraventricular tachycardia in these patients using our prospective database. METHODS TOFr data were collected from our prospective database conducted since 2010. Supraventricular arrhythmias (intraatrial reentrant tachycardia (IART), atrial fibrillation, AFib) related complications and therapies were documented. RESULTS Among those with TOFr (n = 296, mean age 34 ± 11) supraventricular tachyarrhythmias (SVT) were present in 41 patients (14%), as following: n = 12 AFib, and n = 29 IART. At the univariate analysis predictors of atrial fibrillation and IART were: age at last follow-up (p &amp;lt; 0,0001), age at first repair (p &amp;lt; 0,0001), number of surgeries (p = 0,014), and tricuspid regurgitation (p = 0,013). Supraventricular tachycardia was a strong predictor of death (OR 3.0). Twenty-five patients had radiofrequency ablation, and after a mean follow-up of 61 ± 56 months, the rate of recurrence for SVT was 32 %. In the non-ablated cohort (treated with amiodarone) 73 % recurrence was detected. CONCLUSION Supraventricular arrhythmias are common in TOFr patients and are associated with increased mortality risk, but arrhythmia control with catheter ablation is superior to anti-arrhythmic drug therapy in this patient population.

Predictors of Clinical Outcome After Early Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction.

Despite increasing use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) secondary to ST-segment elevation myocardial infarction (STEMI), a paucity of adequate evidence for this therapy remains. The aim of this single-center clinical registry study was to identify predictors of survival and discern the possible optimal time to initiate VA-ECMO in this cohort. Seventy-nine consecutive patients with CS complicating STEMI who received VA-ECMO support were included in this analysis. The primary endpoint was survival at 6 months after initiation of VA-ECMO. Mean age was 60 ± 11 years. Forty-six patients (58%) were successfully weaned from VA-ECMO and 30 patients (38%) could be discharged. Of these, 23 patients (29% of the overall population) survived up to 6-month follow-up. Multivariate analysis to identify determinants of survival showed no association between the time of CS onset to VA-ECMO start time and 6-month survival (P=.75). Glomerular filtration rate on admission (P<.001), white blood cell count on admission (P≤.01), age (P≤.01), and arterial lactate level 1 and 24 hours after VA-ECMO initiation (P=.01) were the strongest predictors of survival. The timing of VA-ECMO initiation in patients with CS complicating STEMI was not a prognostic factor of survival. Renal function, white blood cell count, age, and lactate level were the strongest predictors of death during 6-month follow-up.

Clinical Variants, Characteristics, and Outcomes Among COVID-19 Patients: A Case Series Analysis at a Tertiary Care Hospital in Karachi, Pakistan.

IntroductionCoronavirus disease 2019 (COVID-19) has become a global threat to public health. The current study investigates alterations in the biological estimates concerning the severity, recovery, mortality, and assessment of treatment-based outcomes.MethodsA case series of 165 COVID-19 patients admitted to OMI Institute (a tertiary care hospital) was conducted between May and August 2020. The data regarding demographic characteristics, comorbid conditions, radiographic abnormalities, biological estimations, symptoms, treatment, disease progression, complications, and outcomes were recorded using a structured questionnaire. Laboratory estimations included complete blood count (CBC), renal and electrolyte profile, liver function tests (LFTs), hematological indices, and inflammatory markers. Chest X-ray, electrocardiogram (ECG), and a high-resolution computed tomography (HRCT) scan were also performed, and data were extracted from the medical records. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0.ResultsOut of the 165 COVID-19 patients, 79.4% recovered and were successfully discharged, while 20.6% of inpatient died. The patients' mean age was 56.03 ± 15.96 years, with a male majority (55.1%). The most common comorbid conditions were diabetes and hypertension; fever and dry cough were among the most frequently reported symptoms. The chest imaging findings among the severe/critical COVID-19 patients showed extensive bilateral patchy opacities. The median laboratory investigations, including neutrophil-to-lymphocyte ratio (NLR) (14.83), C-reactive protein (CRP) (7.4 mg/dl), lactate dehydrogenase (LDH) (786 IU/L), ferritin (1401.15 mcg/ml), and mean oxygen saturation (88.25%), were significantly altered among cases with increased disease severity and those who expired (p<0.05). The proportion of acute respiratory distress syndrome (ARDS) and sepsis development was significantly high among severe/critical COVID-19 patients (p<0.05). Treatment with tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids was deemed to be potentially effective treatment options in terms of reducing COVID-19 severity and chances of recovery. Furthermore, age (OR 1.05; p=0.047), presence of comorbidity (OR 8.471; p=0.004), high NLR, LDH (final outcome) (OR 1.361 and 1.018; p<0.05), and CRP levels (midpoint) (OR 1.631; p=0.05) were identified as the strong predictors of death among COVID-19 patients.ConclusionThe study identified several alterations in the clinical profile of the COVID-19 patients concerning severity during the hospital stay, affecting prognosis. Clinically, tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids were identified as potential therapeutic options for COVID-19 due to their ability to alter disease-associated severity and recovery rate.

Associations of Performance-Based Functional Assessments and Adverse Outcomes in CKD.

The comparative utility of performance-based functional assessments in predicting adverse outcomes in CKD is unknown. To examine their relative utility, we examined three performance-based functional assessments in an observational cohort of patients with CKD. We recruited 350 participants with stage II-V, predialysis CKD. Participants were administered three performance-based functional assessments: Short Physical Performance Battery (SPPB), Modified Mini-Mental Status Exam (M3SE), and Lawton Instrumental Activities of Daily Living (IADL). Scores were dichotomized on the basis of the median and combined into a summary score. Outcomes included 50% GFR reduction, ESKD, and death. We used Cox proportional hazards to assess the association of performance-based functional assessments with outcomes. Compared with high performers, low SPPB performers had the highest adjusted rate of death, ESKD, or 50% reduction in GFR (HR, 1.96; 95% CI, 1.28 to 2.99). Low SPPB had the strongest association with death when adjusted for multiple covariates (HR, 2.43; 95% CI, 1.36 to 4.34). M3SE performance was not associated with any adverse outcome. None of the performance-based functional assessments were associated with ESKD, but a low IADL score was associated with a lower hazard ratio for ESKD or 50% decline GFR (HR, 0.49; 95% CI, 0.24 to 1.00). Low SPPB score was the strongest predictor of death and all adverse outcomes as a composite. Future trials should determine if outcomes for patients with CKD who have poor physical performance and low SPPB scores are improved by targeted interventions. Safe Kidney Care Cohort Study, NCT01407367.

Development and validation of clinical prediction model to estimate the probability of death in hospitalized patients with COVID‐19: Insights from a nationwide database

In the current study, we aimed to develop and validate a model, based on our nationwide centralized coronavirus disease 2019 (COVID‐19) database for predicting death. We conducted an observational study (CORONATION‐TR registry). All patients hospitalized with COVID‐19 in Turkey between March 11 and June 22, 2020 were included. We developed the model and validated both temporal and geographical models. Model performances were assessed by area under the curve‐receiver operating characteristic (AUC‐ROC or c‐index), R 2, and calibration plots. The study population comprised a total of 60,980 hospitalized COVID‐19 patients. Of these patients, 7688 (13%) were transferred to intensive care unit, 4867 patients (8.0%) required mechanical ventilation, and 2682 patients (4.0%) died. Advanced age, increased levels of lactate dehydrogenase, C‐reactive protein, neutrophil–lymphocyte ratio, creatinine, albumine, and D‐dimer levels, and pneumonia on computed tomography, diabetes mellitus, and heart failure status at admission were found to be the strongest predictors of death at 30 days in the multivariable logistic regression model (area under the curve‐receiver operating characteristic = 0.942; 95% confidence interval: 0.939–0.945; R 2 = .457). There were also favorable temporal and geographic validations. We developed and validated the prediction model to identify in‐hospital deaths in all hospitalized COVID‐19 patients. Our model achieved reasonable performances in both temporal and geographic validations.

First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease coronavirus disease 2019 (COVID-19), is a worldwide emergency. Demographic, comorbidity and laboratory determinants of death and of ICU admission were explored in all Danish hospitalised patients.MethodsNational health registries were used to identify all hospitalized patients with a COVID-19 diagnosis. We obtained demographics, Charlson Comorbidity Index (CCI), and laboratory results on admission and explored prognostic factors for death using multivariate Cox proportional hazard regression and competing risk survival analysis.ResultsAmong 2431 hospitalised patients with COVID-19 between February 27 and July 8 (median age 69 years [IQR 53–80], 54.1% males), 359 (14.8%) needed admission to an intensive care unit (ICU) and 455 (18.7%) died within 30 days of follow-up. The seven-day cumulative incidence of ICU admission was lower for females (7.9%) than for males (16.7%), (p < 0.001). Age, high CCI, elevated C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase (LDH), urea, creatinine, lymphopenia, neutrophilia and thrombocytopenia within ±24-h of admission were independently associated with death within the first week in the multivariate analysis. Conditional upon surviving the first week, male sex, age, high CCI, elevated CRP, LDH, creatinine, urea and neutrophil count were independently associated with death within 30 days. Males presented with more pronounced laboratory abnormalities on admission.ConclusionsAdvanced age, male sex, comorbidity, higher levels of systemic inflammation and cell-turnover were independent factors for mortality. Age was the strongest predictor for death, moderate to high level of comorbidity were associated with a nearly two-fold increase in mortality. Mortality was significantly higher in males after surviving the first week.

Composição corporal como fator protetor para mortalidade em pacientes em tratamento dialítico: uma revisão sistemática

The reverse epidemiology in chronic kidney disease associates obesity with an improvement in survival in patients on dialysis. However, many studies are based on body mass index, an anthropometric method that does not differ lean mass and fat mass, generating controversy. Thus, the analysis of body composition is made necessary to check the veracity of obesity as a protective factor in these patients. The goal of this paper was to review articles that deal with body composition as a mortality protective factor in patients on dialysis treatment. It is a systematic review involving 33 articles, with the following descriptors: Dialysis, body composition, anthropometry and mortality. Through the present studies, it can be concluded that both body mass index and body composition are strong predictors of death. However, the protective effect granted to the high body mass index, indicated in reverse epidemiology, is limited to patients with normal or high muscle mass. Patients with high body mass index due to high body fat present a higher risk of mortality. Therefore, because it does not distinguish lean body mass and fat body mass, the body mass index should not be the manly method evaluation of nutritional state used in patients with chronic kidney disease.

Formal Frailty Scoring to Predict Outcomes in TAVI

Assessment of frailty is important in determining the appropriate management for severe aortic valve disease [1]. Validated frailty scores predict higher risk of mortality and disability after aortic valve procedures [2]. Preoperative frailty assessment is often insufficient, and there is no consensus on which score should be used, with surgical scores such as the STS score being used as a surrogate. The Essential Frailty Score (EFS) can easily be clinically implemented and is the strongest predictor of death and worsening disability [2].

Candida Infective Endocarditis: A Retrospective Study of Patient Characteristics and Risk Factors for Death in 703 United States Cases, 2015-2019.

Background Candida endocarditis is a rare, sometimes fatal complication of candidemia. Past investigations of this condition are limited by small sample sizes. We used the Vizient clinical database to report on characteristics of patients with Candida endocarditis and to examine risk factors for in-hospital mortality.MethodsThis was a multicenter, retrospective cohort study of 703 inpatients admitted to 179 US hospitals between October 2015 and April 2019. We reviewed demographic, diagnostic, medication administration, and procedural data from each patient’s initial encounter. Univariate and multivariate logistic regression analyses were used to identify predictors of in-hospital mortality.ResultsOf 703 patients, 114 (16.2%) died during the index encounter. One hundred fifty-eight (22.5%) underwent an intervention on a cardiac valve. On multivariate analysis, acute and subacute liver failure was the strongest predictor of death (odds ratio [OR], 9.2; 95% confidence interval [CI], 4.8 –17.7). Female sex (OR, 1.9; 95% CI, 1.2–3.0), transfer from an outside medical facility (OR, 1.8; 95% CI, 1.1–2.8), aortic valve pathology (OR, 2.7; 95% CI, 1.5–4.9), hemodialysis (OR, 2.1; 95% CI, 1.1–4.0), cerebrovascular disease (OR, 2.2; 95% CI, 1.2–3.8), neutropenia (OR, 2.5; 95% CI, 1.3–4.8), and alcohol abuse (OR, 2.9; 95% CI, 1.3–6.7) were also associated with death on adjusted analysis, whereas opiate abuse was associated with a lower odds of death (OR, 0.5; 95% CI, 0.2–0.9).ConclusionsWe found that the inpatient mortality rate was 16.2% among patients with Candida endocarditis. Acute and subacute liver failure was associated with a high risk of death, whereas opiate abuse was associated with a lower risk of death.

The first wave of the COVID-19 pandemic in Spain: characterisation of cases and risk factors for severe outcomes, as at 27 April 2020.

BackgroundThe first wave of the coronavirus disease (COVID-19) pandemic spread rapidly in Spain, one of Europe’s most affected countries. A national lockdown was implemented on 15 March 2020.AimTo describe reported cases and the impact of national lockdown, and to identify disease severity risk factors.MethodsNational surveillance data were used to describe PCR-confirmed cases as at 27 April 2020. We compared case characteristics by severity categories (hospitalisation, admission to intensive care unit (ICU), death) and identified severity risk factors using multivariable regression.ResultsThe epidemic peaked on 20 March. Of 218,652 COVID-19 cases, 45.4% were hospitalised, 4.6% were admitted to ICU and 11.9% died. Among those who died, 94.8% had at least one underlying disease. Healthcare workers (HCWs) represented 22.9% of cases. Males were more likely to have severe outcomes than females. Cardiovascular disease was a consistent risk factor. Patients with pneumonia had higher odds of hospitalisation (odds ratio (OR): 26.63; 95% confidence interval (CI): 25.03–28.33). The strongest predictor of death was age ≥ 80 years (OR: 28.4; 95% CI: 19.85–40.78). Among underlying diseases, chronic renal disease had highest odds of death (OR: 1.47; 95% CI: 1.29–1.68).ConclusionsCOVID-19 case numbers began declining 6 days after the national lockdown. The first wave of the COVID-19 pandemic in Spain had a severe impact on elderly people. Patients with cardiovascular or renal conditions were at higher risk for severe outcomes. A high proportion of cases were HCWs. Enhanced surveillance and control measures in these subgroups are crucial during future COVID-19 waves.

Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients With COVID-19: A Multicenter, Retrospective Hospital-Based Analysis.

OBJECTIVEDiabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19.RESEARCH DESIGN AND METHODSWe analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category in mg/dL (≤7.77, 7.83–10, 10.1–13.88, and >13.88 mmol/L; ≤140, 141–180, 181–250, and >250 mg/dL) during days 2–3 in non-ICU patients or on day 2 in ICU patients. We conducted a survival analysis to determine the association between glucose category and hospital mortality.RESULTSOverall, 18.1% (279/1,544) of patients died in the hospital. In non-ICU patients, severe hyperglycemia (blood glucose [BG] >13.88 mmol/L [250 mg/dL]) on days 2–3 was independently associated with high mortality (adjusted hazard ratio [HR] 7.17; 95% CI 2.62–19.62) compared with patients with BG <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR 1.465; 95% CI 0.683–3.143). In patients admitted directly to the ICU, severe hyperglycemia on admission was associated with increased mortality (adjusted HR 3.14; 95% CI 1.44–6.88). This relationship was not significant on day 2 (HR 1.40; 95% CI 0.53–3.69). Hypoglycemia (BG <70 mg/dL) was also associated with increased mortality (odds ratio 2.2; 95% CI 1.35–3.60).CONCLUSIONSBoth hyperglycemia and hypoglycemia were associated with poor outcomes in patients with COVID-19. Admission glucose was a strong predictor of death among patients directly admitted to the ICU. Severe hyperglycemia after admission was a strong predictor of death among non-ICU patients.

Abstract 16632: Clinical Characteristics and In-Hospital Outcomes of Covid-19 Patients With Ecg St Segment Elevation: A System Wide Analysis

Myocardial injury is seen in approximately 20% of COVID-19 patients and ST elevation myocardial infarction may be the presenting clinical manifestation. Recent data suggest that the ST-segment elevation (STE) may be due to myopericarditis. We assessed the clinical characteristics, electrocardiographic patterns, incidence, management and outcomes of COVID-19 pts with STE. Methods: We analyzed 23,406 ECGs (10,018 pts) admitted to 13 New York City area hospitals between March 1 and April 30, 2020. Results: After manual adjudication, 51 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 did not have STE. Baseline clinical characteristics were similar among the three groups, albeit a higher percentage of pts with low ejection fraction in the diffuse STE group. Cardiac catheterization was performed on 10 pts. Three pts did not have obstructive disease. Pts with focal STE were more likely to require inotropes and die during index hospitalization. Kaplan-Meier estimated overall survival rates were 31%, 33% and 6% in patients without STE, focal and diffuse STE, respectively (p &lt; 0.0001) (Figure). By stepwise logistic regression analysis, focal STE was the strongest predictor of death (OR=7.0; CI 3.8-13.0, p&lt;0 .0001) followed by age &gt; 65 years (OR=3.5; CI 3.1-3.9; p&lt;0.0001) and diffuse STE (OR=2.9; CI 1.1-7.2; p&lt;0.0001). Female gender was associated with a decreased risk (OR 0.72; CI, 0.65-0.79; p&lt;0.0001). Conclusions: In this large retrospective analysis of 10,018 COVID-19 pts, we observed that: 1) a very small percentage (0.7%) presented with STE; 2) 70% had focal STE and 30% had diffuse STE; 3) a minority underwent coronary angiography; 4) in-hospital mortality rates were very high for pts with STE, and even more so for those with focal STE (63% vs 46%) and; 5) focal STE was the strongest predictor of in-hospital mortality and female gender was a predictor of survival.

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis.

AimsTo develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis.MethodsA total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression.ResultsThe one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models).ConclusionSimple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty (https://jointcalc.shef.ac.uk). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty.Cite this article: Bone Joint Res 2020;9(11):808–820.