scholarly journals Epidemiological and Clinical Characteristics, and Virologic Features of COVID-19 Patients in Kazakhstan: a Nation-Wide, Retrospective, Cohort Study.

2021 ◽  
Author(s):  
Sergey Yegorov ◽  
Maiya Goremykina ◽  
Raifa Ivanova ◽  
Sara V Good ◽  
Dmitriy Babenko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Severity ◽  
Clinical Laboratory ◽  
Severe Disease ◽  
International Travel ◽  
Older Age ◽  
Radiological Data ◽  
History Of ◽  
Male Sex ◽  
Wbc Count

Background: The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic. Methods: We did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19 in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Univariable and multivariable logistic regression was used to assess factors associated with disease severity and death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients without a recent history of international travel. Findings: Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24-50) and 484 (45%) were male. On admission, 683 (64%) participants had mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 deaths (1.87%) were reported at study exit. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1.05, 95% CI 1.03-1.07, per year increase; p<0.001), the presence of comorbidities (2.13, 95% CI 1.07-4.23; p<0.031) and elevated white blood cell count (WBC, 1.14, 95% CI 1.01-1.28; p<0.032) on admission, while older age (1.09, 95% CI 1.06-1.12, per year increase; p<0.001) and male sex (5.97, 95% CI 1.95-18.32; p<0.002) were associated with increased odds of death. The Kazakhstan SARS-CoV-2 isolates grouped into seven distinct lineages O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10. Interpretation: Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification, likely predating the declaration of state emergency. Continuous epidemiologic and genomic surveillance may be critical for a better understanding of the regional COVID-19 dynamics.

scholarly journals Human Genetic Polymorphisms Associated with Susceptibility to COVID-19 Infection and Response to Treatment

2021 ◽  
Author(s):  
Necla Benlier ◽  
Nevhiz Gundogdu ◽  
Mehtap Ozkur
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Response To Treatment ◽  
Specific Gene ◽  
The Novel ◽  
Susceptibility To Infection ◽  
Global Pandemic ◽  
History Of ◽  
Male Sex ◽  
Diabetes And Obesity

Clinicians and researchers observing the natural history of endemic and epidemic infections have always been fascinated by the vagaries of these diseases, in terms of both the changing nature of the disease severity and phenotype over time and the variable susceptibility of hosts within exposed populations. SARS-CoV-2, the virus that causes COVID-19 and is believed to originate from bats, quickly transformed into a global pandemic. The pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been posing great threats to the global health in many aspects. Currently, there are no proven effective vaccines or therapeutic agents against the virus. Comprehensive understanding of the biology of SARS-CoV-2 and its interaction with hosts is fundamentally important in the fight against SARS-CoV-2. Advanced age, male sex, and comorbidities such as hypertension and cardiovascular disease as well as diabetes and obesity have been identified as risk factors for more severe COVID-19. However, which and to what extent specific genetic factors may account for the predisposition of individuals to develop severe disease or to contract the infection remains elusive. The increasing availability of data from COVID-19 patient populations is allowing for potential associations to be established between specific gene loci and disease severity, susceptibility to infection, and response to current/future drugs.

scholarly journals Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study

2020 ◽  
Author(s):  
Songqiao Liu ◽  
Huanyuan Luo ◽  
Yuancheng Wang ◽  
Luis E. Cuevas ◽  
Duolao Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Severity ◽  
Critically Ill ◽  
Lymphocyte Count ◽  
Clinical Laboratory ◽  
White Blood Cells ◽  
Jiangsu Province ◽  
Factors Associated ◽  
Reactive Protein ◽  
Radiological Data

Abstract Background: Coronavirus Disease-2019 (COVID-19) has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation.Methods: Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected at from admission. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation.Results: A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not to a cluster of cases in family/community), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO2), and higher CT image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (109/L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51).Conclusions: Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19.

scholarly journals Remote history of VTE is associated with severe COVID‐19 in middle and older age: UK Biobank cohort study

2021 ◽  
Author(s):  
Jana J Anderson ◽  
Frederick K Ho ◽  
Claire L Niedzwiedz ◽  
S. Vittal Katikireddi ◽  
Carlos Celis‐Morales ◽  
...  
Keyword(s):  
Cohort Study ◽  
Older Age ◽  
Uk Biobank ◽  
History Of

Implications of Hidradenitis Suppurativa Phenotypes in Cardiovascular Risk and Treatment Decisions: A Retrospective Cohort Study

Dermatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Carlos Cuenca-Barrales ◽  
Trinidad Montero-Vilchez ◽  
Luis Salvador-Rodríguez ◽  
Manuel Sánchez-Díaz ◽  
Salvador Arias-Santiago ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Risk ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Therapeutic Approach ◽  
Retrospective Cohort ◽  
Hidradenitis Suppurativa ◽  
Severe Disease ◽  
Treatment Decisions ◽  
Lesion Pattern

<b><i>Background:</i></b> New integrative hidradenitis suppurativa (HS) lesion pattern phenotypes have been proposed, an inflammatory phenotype (IP) and a follicular phenotype (FP). They are characterized by different lesion patterns, symptoms, and risks of disease progression. <b><i>Objectives:</i></b> To evaluate whether lesion pattern phenotypes (1) have a different cardiovascular risk factor profile, and (2) are associated with a different therapeutic approach in the setting of an HS clinic. <b><i>Methods:</i></b> A retrospective cohort study was conducted on 233 patients with HS. They were classified according to lesion pattern phenotype criteria. Data regarding cardiovascular risk factors and treatment decisions were gathered. <b><i>Results:</i></b> One hundred and seventeen HS patients (50.21%) were classified as FP and 112 (48.07%) as IP. IP was associated with more severe disease and greater impairment of quality of life. Regardless of disease severity, patients with IP may have a higher cardiovascular risk, assessed according to higher C-reactive protein (CRP) levels (12.75 vs. 5.89, <i>p</i> = 0.059). The lesion pattern phenotype also influenced treatment decisions regardless of disease severity. Patients with IP were more likely to be treated with systemic corticosteroids and adalimumab, showing that lesion pattern phenotypes are associated with different therapeutic approaches. <b><i>Conclusions:</i></b> IP is associated with higher CRP values, suggesting a greater cardiovascular risk in these patients and also a different therapeutic approach. This information could help guide dermatologists in the management of HS patients and help to determine future treatment recommendations.

scholarly journals Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Nyan Lynn Tun ◽  
Waqas Haque ◽  
Marie Gilbert Majella ◽  
Ranjith Kumar Sivakumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
English Language ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Data Extraction ◽  
Meta Analysis ◽  
Severe Disease ◽  
Factors Associated ◽  
Risk Of Mortality

Background: Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods: We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results: Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45; 95%CI 1.23,1.71), dyspnea (RR 2.55; 95%CI 1.88,2.46), diabetes (RR 1.59; 95%CI 1.41,1.78), hypertension (RR 1.90; 95%CI 1.69,2.15). Congestive heart failure (OR 4.76; 95%CI 1.34,16.97), hilar lymphadenopathy (OR 8.34; 95%CI 2.57,27.08), bilateral lung involvement (OR 4.86; 95%CI 3.19,7.39) and reticular pattern (OR 5.54; 95%CI 1.24,24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion: Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

scholarly journals The first consecutive 5000 patients with Coronavirus Disease 2019 from Qatar; a nation-wide cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ali S. Omrani ◽  
Muna A. Almaslamani ◽  
Joanne Daghfal ◽  
Rand A. Alattar ◽  
Mohamed Elgara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Older Age ◽  
Icu Admission ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Male Sex

Abstract Background There are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). Methods This was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. The primary outcome was all-cause mortality at 60 days after COVID-19 diagnosis. In addition, we explored risk factors for admission to ICU. Results Included patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28–43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8–68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022–1.061 per year increase; P < 0.001], male sex (aOR 4.375, 95% CI 1.964–9.744; P < 0.001), diabetes (aOR 1.698, 95% CI 1.050–2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596–8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027–1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. Conclusions In a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease.

scholarly journals Clinical Characteristics of Patients Infected With the Novel 2019 Coronavirus (SARS-Cov-2) in Guangzhou, China

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Yaping Wang ◽  
Baolin Liao ◽  
Yan Guo ◽  
Feng Li ◽  
Chunliang Lei ◽  
...  
Keyword(s):  
Incubation Period ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Analysis ◽  
Albumin Level ◽  
Older Age ◽  
The Novel ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Male Sex

Abstract Background The clinical manifestations and factors associated with the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outside of Wuhan are not clearly understood. Methods All laboratory-confirmed cases with SARS-Cov-2 infection who were hospitalized and monitored in Guangzhou Eighth People’s Hospital were recruited from January 20 to February 10. Results A total of 275 patients were included in this study. The median patient age was 49 years, and 63.6% had exposure to Wuhan. The median virus incubation period was 6 days. Fever (70.5%) and dry cough (56.0%) were the most common symptoms. A decreased albumin level was found in 51.3% of patients, lymphopenia in 33.5%, and pneumonia based on chest computed tomography in 86%. Approximately 16% of patients (n = 45) had severe disease, and there were no deaths. Compared with patients with nonsevere disease, those with severe disease were older, had a higher frequency of coexisting conditions and pneumonia, and had a shorter incubation period (all P &lt; .05). There were no differences between patients who likely contacted the virus in Wuhan and those who had no exposure to Wuhan. Multivariate logistic regression analysis indicated that older age, male sex, and decreased albumin level were independently associated with disease severity. Conclusions Most of the patients infected with SARS-CoV-2 in Guangzhou, China are not severe cases and patients with older age, male, and decreased albumin level were more likely to develop into severe ones.

Acute Myelogenous Leukemia in the Elderly. Intensive Induction Chemotherapy Improves Survival

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4002-4002
Author(s):  
Anant Sharma ◽  
Runhua Shi ◽  
Francesco Turturro
Keyword(s):  
Clinical Outcomes ◽  
Induction Chemotherapy ◽  
Median Survival ◽  
The Elderly ◽  
Older Age ◽  
Myelogenous Leukemia ◽  
Risk Of Death ◽  
Elderly Aml ◽  
History Of ◽  
Wbc Count

Abstract Acute Myeloid Leukemia (AML) in the elderly has poor prognoses and carries inferior results with therapy. The purpose of this study was to determine the incidence of elderly AML, examine clinical outcomes with treatment and investigate the impact of intensive induction chemotherapy and other variables such as such as age, leucocytoses, cytogenetics and presence of antecedent hematologic disorder (AHD) on survival, in a cohort of elderly patients with AML treated at our institution. Patients and Methods: The retrospective review included all patients (age&gt;59) treated between January 1999 and February 2008. Patients diagnosed with acute promyelocytic leukemia were excluded. Records were reviewed from time of diagnoses till death or last follow-up. Statistical analyses: Median survival was calculated using Kaplan Meier method and differences in survival between patients treated with intensive chemotherapy and those receiving supportive care were compared using the logrank test which was also used to determine the association between survival and variables such as older age (&lt;69 vs. ≥ 69), leucocytoses (WBC &gt;10k), cytogenetics and history of AHD. Results: Study cohort included 51 patients with age&gt;59. This represented 29% of all AML cases (n=176) treated at our institution. 31(60.78%) were males. Mean age was 68.42 years, range (60–82) with 23 (45.10%) being &gt;69 years of age. History of AHD was observed in 15 (29.41%). Results of cytogenetic studies were available for 29(56.86%) patients of which 11(37.93%) had poor risk cytogenetics with the remainder falling in the intermediate risk group. Elevated WBC count was seen in 25(49.02%). Intensive induction chemotherapy was administered with an anthracycline and cytarabine regimen to 42(82.35%) patients with an induction mortality of 26%. Total of 23 (54.76%) patients achieved first complete remission (CR1). Of those who achieved CR1, 19(82.60%) underwent consolidation. Median survival was 120 days, range (1–2035). By univariate analyses, survival was not affected by older age (p=0.98), poor cytogenetics (p=0.23) or history of AHD (p=0.59), but was affected by induction chemotherapy (p=0.0001), ability to achieve CR1 (p=0.0001) and elevated WBC (p=0.05). In multivariate analyses after adjusting for other variables risk of death was influenced by ability to achieve CR1 (HR 0.146), AHD (HR=2.66) and elevated WBC count (HR=2.48). Conclusion: Elderly AML has poor clinical outcomes. Risk of death is reduced by intensive induction chemotherapy and achievement of CR1. It is increased by history of AHD and elevated WBC at presentation.

scholarly journals 2789. Respiratory Syncytial Disease in Hospitalized Adults: A Retrospective Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S985-S986
Author(s):  
Hannah Nam ◽  
Michael G Ison
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Solid Organ ◽  
Cell Transplant ◽  
Immunocompromised Patients ◽  
Transplant Patients ◽  
History Of

Abstract Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) and lung transplant recipients. Although RSV is responsible for ~177,000 hospitalizations and 14,000 deaths annually, few epidemiologic studies including all adults including those with immunocompromise have been conducted over multiple seasons. Methods A retrospective cohort study of adults admitted to a large academic medical center in Chicago, IL from 2009 to 2018 was conducted in patients with positive RSV PCR. Specific data on clinical presentation, management, and outcomes were collected by manual chart review. Descriptive statistics were calculated, and Pearson’s Chi-Squared test was utilized to assess association between severe disease status and comorbidities. Results A total of 140 patients* were admitted during part of the study period (2016–2018) with positive PCR for RSV. Most patients had otherwise underlying comorbidities prior to admission (lung 44.2%, heart 40.0%, diabetes 20.7%), history of immunocompromise (36.4%, 51) or history of smoking (39.2%, 55). Cough was the most common symptom among all hospitalized adults (90.7%, 127). However, patients with a history of transplant (both HSCT and SOT) more commonly displayed symptoms of fevers at presentation (50%, 10) when compared with non-immunocompromised patients (36.6%, 36). ICU admission occurred in one-third of the hospitalized patients, with no significant difference amongst transplant patients, immunocompromised patients, and non-immunocompromised patients. Need for mechanical ventilation was highest in patients with co-infections. None of the co-morbidities measured were independent risk factors for severe disease. Most patients (78.5%, 110) were discharged home. Among the 12 fatal cases, all were admitted to the ICU with seven (58.3%) requiring mechanical ventilation. Three (25.0%) were immunocompromised while two (16.7%) were HSCT patients, but none were solid-organ transplant patients. *Ongoing data collection. Conclusion RSV patients were diverse in their demographics, treatment, and outcomes. Large percentages of patients had underlying comorbidities such as immunocompromise due to HSCT, lung and heart disease. Disclosures All authors: No reported disclosures.

scholarly journals LO010: Clinical assessment of transient ischemic attack patients for symptomatic carotid disease in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S33-S33
Author(s):  
N. Motamedi ◽  
K. Abdulaziz ◽  
M. Sharma ◽  
J.J. Perry
Keyword(s):  
Carotid Stenosis ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Disease Diagnosis ◽  
Older Age ◽  
Carotid Disease ◽  
Multicenter Cohort Study ◽  
Symptomatic Carotid ◽  
History Of ◽  
Male Sex

Introduction: TIAs precede about 30% of strokes, with 4-10% having a stroke within 90 days of their TIA. In patients with a TIA due to symptomatic carotid disease, diagnosis and treatment within 2 weeks has been shown to have much better outcomes, while delay beyond 12 weeks no longer reduces subsequent stroke risk. The objective of this study was to determine the clinical findings associated with symptomatic critical disease following an ED visit for TIA to indicate patients requiring prompt carotid imaging. Methods: We performed a prospective Canadian multicenter cohort study, at 13 academic sites, of ED patients with TIA or non-disabling stroke from 2006-2014. Treating ED physicians indicate clinical features on standardized data collection forms. Symptomatic carotid disease was carotid stenosis 50-99%, or carotid dissection, adjudicated by stroke neurology to be the etiology of the index event. Patients were followed by medical review and telephone up to 90 days. Univariate analysis was conducted for clinical features associated with patients who were eventually found to have symptomatic carotid disease as a cause for their TIA. Results: The cohort included 305 patients with and 5,277 without symptomatic carotid disease. Positive predictors of symptomatic carotid disease included older age (74.0 yrs vs 68.0 yrs p<0.0001), male sex (62.9% vs 47.9%; p<0.0001), history of weakness (63.3% vs 41.4%; p<0.0001), language disturbance (52.1% vs 40.0%; p<0.0001), weakness on physical exam (25.5% vs 17.1%; p=0.0002), history of hypertension (74.8% vs 59.5%; p<0.0001), and known history of carotid stenosis (18.9% vs 3.1%; p<0.0001). Negative predictors of symptomatic carotid disease included first ever TIA (56.8% vs 68.8%; p<0.0001), history of altered sensation (39.4% vs 45.8%; p=0.0322), lightheadedness (13.0% vs 22.4%; p=0.0002), and vertigo (3.6% vs 12.7%; p<0.0001). Conclusion: TIA patients with older age, male sex, weakness, language disturbance or history of carotid stenosis need to be promptly imaged to assess for symptomatic carotid disease.

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