scholarly journals Development and validation of a prognostic model based on comorbidities to predict Covid-19 severity. A population-based study

2020 ◽  
Author(s):  
Francisco Gude-Sampedro ◽  
Carmen Fernández-Merino ◽  
Lucía Ferreiro ◽  
Óscar Lado-Baleato ◽  
Jenifer Espasandín-Domínguez ◽  
...  
Keyword(s):  
Disease Severity ◽  
Risk Model ◽  
Model Performance ◽  
Population Based ◽  
Chronic Obstructive ◽  
Operating Characteristics ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Health Authorities ◽  
Obesity Hypertension

Abstract Background The prognosis of patients with Covid-19 infection is uncertain. We derived and validated a new risk model for predicting progression to disease severity, hospitalization, admission to intensive care unit (ICU) and mortality in patients with Covid-19 infection (Gal-Covid-19 scores). Methods This is a retrospective cohort study of patients with Covid-19 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) in Galicia, Spain. Data were extracted from electronic health records of patients, including age, sex and comorbidities according to International Classification of Primary Care codes (ICPC-2). Logistic regression models were used to estimate the probability of disease severity. Calibration and discrimination were evaluated to assess model performance. Results The incidence of infection was 0.39% (10 454 patients). A total of 2492 patients (23.8%) required hospitalization, 284 (2.7%) were admitted to the ICU and 544 (5.2%) died. The variables included in the models to predict severity included age, gender and chronic comorbidities such as cardiovascular disease, diabetes, obesity, hypertension, chronic obstructive pulmonary disease, asthma, liver disease, chronic kidney disease and haematological cancer. The models demonstrated a fair–good fit for predicting hospitalization {AUC [area under the receiver operating characteristics (ROC) curve] 0.77 [95% confidence interval (CI) 0.76, 0.78]}, admission to ICU [AUC 0.83 (95%CI 0.81, 0.85)] and death [AUC 0.89 (95%CI 0.88, 0.90)]. Conclusions The Gal-Covid-19 scores provide risk estimates for predicting severity in Covid-19 patients. The ability to predict disease severity may help clinicians prioritize high-risk patients and facilitate the decision making of health authorities.

scholarly journals Association between Physical Activity and Comorbidities in Spanish People with Asthma-COPD Overlap

2021 ◽  
Vol 13 (14) ◽  
pp. 7580
Author(s):  
Sheila Sánchez Castillo ◽  
Lee Smith ◽  
Arturo Díaz Suárez ◽  
Guillermo Felipe López Sánchez
Keyword(s):  
Physical Activity ◽  
Short Form ◽  
National Health Survey ◽  
Lumbar Pain ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Adjusted Model ◽  
Activity Questionnaire

Asthma and chronic obstructive pulmonary disease (COPD) are important conditions which often coexist. Higher rates of comorbidities among people with asthma-COPD overlap (ACO) may complicate clinical management. The aim of this study was to determine the prevalence of 30 different comorbidities and to analyze associations between these comorbidities and physical activity (PA) in Spanish people with ACO. Cross-sectional data from the Spanish National Health Survey 2017 were analyzed. A total of 198 Spanish people with ACO aged 15–69 years (60.6% women) were included in this study. PA was measured with the International Physical Activity Questionnaire (IPAQ) short form. Diagnosis of chronic conditions were self-reported. Associations between PA and comorbidities were analyzed using multivariable logistic regression models. The most prevalent comorbidities were chronic allergy (58.1%), chronic lumbar pain (42.4%), chronic cervical pain (38.4%), hypertension (33.3%) and arthrosis (31.8%). A PA level lower than 600 MET·min/week was significantly associated with urinary incontinence (OR = 3.499, 95% CI = 1.369–8.944) and osteoporosis (OR = 3.056, 95% CI = 1.094–8.538) in the final adjusted model. Therefore, the potential influence of PA on reducing the risk of these conditions among people with ACO should be considered, not only because of the health benefits, but also because PA can contribute to a more sustainable world.

scholarly journals Occupational cold exposure is associated with increased reporting of airway symptoms

2021 ◽  
Author(s):  
Albin Stjernbrandt ◽  
Nikolai Stenfors ◽  
Ingrid Liljelind
Keyword(s):  
Cold Exposure ◽  
Leisure Time ◽  
Rating Scales ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Postal Survey ◽  
Chronic Obstructive ◽  
Northern Sweden ◽  
Obstructive Pulmonary Disease ◽  
Airway Symptoms

Abstract Objective To determine if exposure to cold environments, during work or leisure time, was associated with increased reporting of airway symptoms in the general population of northern Sweden. Methods Through a population-based postal survey responded to by 12627 subjects, ages 18–70, living in northern Sweden, the occurrence of airway symptoms was investigated. Cold exposure during work or leisure time was self-reported on numerical rating scales. Binary logistic regression was used to determine the statistical association between cold exposure and airway symptoms. Results For currently working subjects (N = 8740), reporting any occupational cold exposure was associated to wheeze (OR 1.3; 95% CI 1.1–1.4); chronic cough (OR 1.2; 95% CI 1.1–1.4); and productive cough (OR 1.3; 95% CI 1.1–1.4), after adjusting for gender, age, body mass index, daily smoking, asthma, and chronic obstructive pulmonary disease. Leisure-time cold exposure was not significantly associated to reporting airway symptoms. Conclusions Occupational cold exposure was an independent predictor of airway symptoms in northern Sweden. Therefore, a structured risk assessment regarding cold exposure could be considered for inclusion in the Swedish workplace legislation.

scholarly journals Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara C. Auld ◽  
Hardy Kornfeld ◽  
Pholo Maenetje ◽  
Mandla Mlotshwa ◽  
William Chase ◽  
...  
Keyword(s):  
Lung Function ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Pulmonary Impairment ◽  
Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

scholarly journals Predictors of chronic opioid therapy in Medicaid beneficiaries with HIV who initiated antiretroviral therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
GYeon Oh ◽  
Emily S. Brouwer ◽  
Erin L. Abner ◽  
David W. Fardo ◽  
Patricia R. Freeman ◽  
...  
Keyword(s):  
Regression Models ◽  
Opioid Therapy ◽  
Chronic Obstructive ◽  
Chronic Opioid Therapy ◽  
Hepatitis C Infection ◽  
Antipsychotic Therapy ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Medicaid Beneficiaries

AbstractThe factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002–2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with COT. In sex-stratified analyses, multiple predictors were shared between male and female beneficiaries; however, chronic obstructive pulmonary disease, liver disease, any malignancy, and antipsychotic therapy were unique to female beneficiaries. Comorbidities and polypharmacy were important predictors of COT in Medicaid beneficiaries with HIV who initiated cART.

Inspiratory muscle strength in chronic obstructive pulmonary disease depending on disease severity

2007 ◽  
Vol 113 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Hans-Joachim Kabitz ◽  
Stephan Walterspacher ◽  
David Walker ◽  
Wolfram Windisch
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Muscle Strength ◽  
Pulmonary Disease ◽  
Disease Severity ◽  
Inspiratory Muscle ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Inspiratory Muscle Strength

Staging criteria for COPD (chronic obstructive pulmonary disease) include symptoms and lung function parameters, but the role of reduced inspiratory muscle strength related to disease severity remains unclear. Therefore the present study tested whether inspiratory muscle strength is reduced in COPD and is related to disease severity according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria and assessed its clinical impact. PImax (maximal inspiratory mouth occlusion pressure), SnPna (sniff nasal pressure) and TwPmo (twitch mouth pressure) following bilateral anterior magnetic phrenic nerve stimulation were assessed in 33 COPD patients (8 GOLD0, 6 GOLDI, 6 GOLDII, 7 GOLDIII and 6 GOLDIV) and in 28 matched controls. Furthermore, all participants performed a standardized 6 min walking test. In comparison with controls, PImax (11.6±2.5 compared with 7.3±3.0 kPa; P<0.001), SnPna (9.7±2.5 compared with 6.9±3.3 kPa; P<0.001) and TwPmo (1.6±0.6 compared with 0.8±0.4 kPa; P<0.001) were markedly lower in COPD patients. TwPmo decreased with increasing COPD stage. TwPmo was correlated with walking distance (r=0.75; P<0.001), dyspnoea (r=−0.61; P<0.001) and blood gas values following exercise (r>0.57; P<0.001). Inspiratory muscle strength, as reliably assessed by TwPmo, decreased with increasing severity of COPD and should be considered as an important factor in rating disease severity and to reflect burden in COPD.

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