scholarly journals Fatality and risk features for prognosis in COVID-19 according to the care approach – a retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248869
Author(s):  
Mariano Andrés ◽  
Jose-Manuel Leon-Ramirez ◽  
Oscar Moreno-Perez ◽  
José Sánchez-Payá ◽  
Ignacio Gayá ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Troponin T ◽  
Invasive Mechanical Ventilation ◽  
Academic Center ◽  
Care Approach ◽  
Independent Risk Factors ◽  
The Impact

Introduction This study analyzed the impact of a categorized approach, based on patients’ prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain. Methods Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI). Results Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement. Conclusion Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.

scholarly journals Predictors of Infliximab Refractory Intestinal Behçet’s Syndrome: A Retrospective Cohort Study from the Shanghai Behçet’s Syndrome Database

2021 ◽  
Author(s):  
Hua-fang Bao ◽  
Cheng-cheng Hou ◽  
Bo Ye ◽  
Jun Zou ◽  
Dan Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Protective Factor ◽  
Behçet’S Syndrome ◽  
Behçet's Syndrome ◽  
Behcet’S Syndrome ◽  
Independent Risk Factors ◽  
Behcet's Syndrome

ABSTRACT Objectives This retrospective cohort study aimed to find out predictors and early biomarkers of Infliximab (IFX) refractory Intestinal Behçet’s Syndrome (intestinal BS). Methods We collected the baseline clinical characteristics, laboratory parameters and concomitant therapies of intestinal BS patients treated by IFX from the Shanghai Behçet’s syndrome database. After 1-year IFX therapy, intestinal BS patients with non-mucosal healing (NMH, intestinal ulcers detected by colonoscopy) and/or no clinical remission [NCR, scores of the disease activity index for intestinal Behçet’s disease (DAIBD) ≥ 20] was defined as IFX refractory intestinal BS. Multivariate logistic regression analysis was performed to evaluate the predictors for NMH and NCR in IFX refractory intestinal BS. Results In 85 intestinal BS patients, NMH was identified in 29 (34.12%) patients, and NCR was confirmed in 20 (23.53%) patients. ESR (≥ 24mm/h) and fT3 (≤ 3.3pmol/L) were the independent risk factors of NMH in IFX refractory intestinal BS. Drinking alcohol and the fT3/fT4 ratio (≤ 0.24) were independent risk factors, and thalidomide was an independent protective factor, for NCR in intestinal BS patients treated by IFX. Conclusion This study may be applicable for adjusting the therapeutic strategy and sidestepping unnecessary exposure to IFX in intestinal BS patients. Routine assessments of ESR, fT3 and fT3/fT4 ratio are helpful to identify high-risk individuals of IFX refractory intestinal BS. Thalidomide is suggested to be a concomitant therapy with IFX for intestinal BS patients.

scholarly journals High body mass index is a significant risk factor for the progression and prognosis of imported COVID-19: a multicenter, retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huan Cai ◽  
Lisha Yang ◽  
Yingfeng Lu ◽  
Shanyan Zhang ◽  
Chanyuan Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
High Body Mass Index ◽  
Illness Onset ◽  
Independent Risk Factors ◽  
High Bmi

Abstract Background Coronavirus disease 2019(COVID-19) has spread worldwide. The present study aimed to characterize the clinical features and outcomes of imported COVID-19 patients with high body mass index (BMI) and the independent association of BMI with disease severity. Methods In this retrospective cohort study, 455 imported COVID-19 patients were admitted and discharged in Zhejiang province by February 28, 2020. Epidemiological, demographic, clinical, laboratory, radiological, treatment, and outcome data were collected, analyzed and compared between patients with BMI ≥ 24and < 24. Results A total of 268 patients had BMI < 24, and 187 patients had BMI ≥ 24. Those with high BMI were mostly men, had a smoking history, fever, cough, and sputum than those with BMI < 24. A large number of patients with BMI ≥ 24 were diagnosed as severe/critical types. Some biochemical indicators were significantly elevated in patients with BMI ≥ 24. Also, acute liver injury was the most common complication in these patients. The median days from illness onset to severe acute respiratory syndrome coronavirus 2 detection, duration of hospitalization, and days from illness onset to discharge were significantly longer in patients with BMI ≥ 24 than those with BMI < 24. High BMI, exposure to Wuhan, any coexisting medical condition, high temperature, C-reactive protein (CRP), and increased lactate dehydrogenase (LDH) were independent risk factors for severe/critical COVID-19. After adjusting for age, sex and above factors, BMI was still independently associated with progression to severe/critical illness (P = 0.0040). Hemoglobin, alanine aminotransferase (ALT), CRP, and serum creatinine (Scr) were independent risk factors associated with high BMI. Conclusions Contrasted with the imported COVID-19 patients with BMI < 24, high proportion of COVID-19 patients with BMI ≥ 24 in our study, especially those with elevated CRP and LDH, developed to severe type, with longer hospitalization duration and anti-virus course. Thus, high BMI is a risk factor for the progression and prognosis of imported COVID-19.

scholarly journals Clinical characteristics and laboratory features of COVID-19 in high altitude areas: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249964
Author(s):  
Hanxiao Chen ◽  
Lang Qin ◽  
Sixian Wu ◽  
Wenming Xu ◽  
Rui Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Lactate Dehydrogenase ◽  
High Altitude ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Sputum Production ◽  
Laboratory Features ◽  
Independent Risk Factors

Coronavirus disease 2019 (COVID-19) is highly contagious and has affected the whole world. We seek to investigate the clinical and laboratory characteristics of COVID-19 patients in the high altitude areas of Sichuan, China. In this retrospective cohort study, a total of 67 patients with laboratory-confirmed SARS-CoV-2 infections in Sichuan’s Ngawa Tibetan and Qiang Autonomous Prefecture were included from February 1, 2020, to March 2, 2020. Their clinical characteristics, as well as radiological and laboratory features, were extracted. Four (6.0%) patients were categorized as severe cases; 39 (58.2%) were non-severe cases, and 24 (35.8%) were asymptomatic cases. A total of 46 (68.7%) patients were associated with cluster infection events in this study. The most common symptoms were cough, sputum production, dyspnea, fatigue or myalgia, and headache. Seven (10.4%) patients showed leucopenia, and 20 (29.9%) patients showed lymphopenia. Lymphocyte counts and neutrophil-to-lymphocyte ratios (NPR) were different between the three groups. In total, 14 (20.9%) patients had thrombocytopenia, and prothrombin times (PT) and fibrinogen levels differed between groups. We also found significant differences in sodium, chloride and calcium levels between the three groups. Antiviral therapy did not lead to obvious adverse events or shortened durations from initial positive to subsequent negative nuclei acid tests. Advanced age, hypertension, high neutrophil count, the neutrophil-to-lymphocyte ratio, fibrinogen and lactate dehydrogenase levels were identified as independent risk factors for symptomatic cases of COVID-19. In conclusion, the symptoms of patients in high altitude areas were mild, and about one third were asymptomatic. We also identified several independent risk factors for symptomatic cases of COVID-19.

scholarly journals Difference in Risk Factors Associated with Acute Respiratory Distress Syndrome and Intubation/Death in Patients with Coronavirus Disease 2019: A Two-hospital Retrospective Cohort Study in Hubei, China

2021 ◽  
Author(s):  
Jing-Lan Mu ◽  
Ming-Zhe Qin ◽  
Hui-Mei Sun ◽  
Bao-Sheng Guo ◽  
Shi-Da Qiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lymphocyte Count ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Male Gender ◽  
Sensitivity Analyses ◽  
Hospital Death ◽  
Abnormal Laboratory

Abstract Background: The reviews on the risk factors with ARDS and the worse outcomes concluded lacking robust data of risk factors to prevent COVID-19 and identified an urgent need for large sample and high-quality research in this area, as well as the features of the ARDS.Methods: This retrospective cohort study included 333 COVID-19 inpatients at two hospitals in Hubei of China in 2020. The COVID-19-related ARDS was diagnosed according to the Berlin criteria. The outcomes were ARDS development and the intubation or in-hospital death. The cox proportional hazard ratio (HR) models were employed to determine the significant risk factors. Results: The median number of days from symptom onset to ARDS diagnosis was 11.0 (IQR, 8.0–13.0). Up to 84.1% COVID-19-related ARDS patients demonstrated multiple organ injuries. The mortality rates were 41.9% and 85.7% in moderate and severe ARDS. The survival patients on invasive mechanical ventilation (IMV) had been intubated earlier since ARDS diagnosis than those who had not survived (5.5 median days, IQR 4.0-7.0 days versus 11.5 median days, IQR 6.0-14.0 days, P < 0.001). Males and all abnormal laboratory indices associated with the higher risk of ARDS (P<0.05) but were not linked with the risk of intubation or death (P>0.05). The sensitivity analyses found that lymphocyte count of < 1000 per mm3 at hospital admission were still significantly associated with developing ARDS when adjusting for age and male gender (HR, 4.10; 95% CI, 2.40-7.10), and oxygenation index (OI) ratio < 150 were more likely to predict the intubation/death after age adjustment (HR, 2.50; 95% CI, 1.17-5.30). Conclusion: The SARS-CoV-2-caused ARDS was not the typical ARDS according to Berlin criteria. The alive patients with IMV had been intubated earlier since ARDS diagnosis than those who had not survived. We identified male gender and abnormal laboratory indices associated with the ARDS but were not linked with the intubation/death. Sensitivity analysis concluded lymphocyte count of < 1000 per mm3 could predict ARDS while OI ratio less than 150 could predict intubation/death.

scholarly journals Incidence and risk factors of a severe Clostridium difficile infection: results of a retrospective cohort study at a tertiary care hospital

2019 ◽  
Author(s):  
Claas Baier ◽  
Simone Valentin ◽  
Frank Schwab ◽  
Sandra Steffens ◽  
Ralf-Peter Vonberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Clinic ◽  
Independent Risk Factors

Abstract Background Clostridium difficile infection (CDI) is a relevant healthcare burden worldwide and one of the leading causes for nosocomial diarrhea. Besides mild courses, the development of a severe infection can occur and has a relevant impact on healthcare costs and patient outcome.Methods We conducted a retrospective cohort study over a 4 year-long period to analyze the incidence of CDI and the contributing risk factors for a severe course at a tertiary care clinic. Independent risk factors were determined by a multivariable logistic regression analysis.Results A total of 761 CDI cases were identified in the study period, thereof 612 (80.4%) cases were nosocomially acquired. The mean incidence for a CDI was 0.42 cases per 1000 patient-days. A severe CDI occurred in 131 cases (17.2%). Independent risk factors for a severe course were pulmonary disease, a Charlson comorbidity index >3, and a preceding antibiotic therapy within three months with glycopeptides (vancomycin/teicoplanin) and/or aminoglycosides.Conclusions This study highlights the relevant burden of CDI in hospitals. Moreover, it underscores that specific knowledge of risk factors contributing to severe CDI is crucial to optimize treatment, infection prevention measures and to guide clinical monitoring and therapy strategy.

scholarly journals Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip

2021 ◽  
Author(s):  
Łukasz Pulik ◽  
Krzysztof Romaniuk ◽  
Aleksandra Sibilska ◽  
Andrzej Jedynak ◽  
Ignacy Tołowiński ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Positive Family History ◽  
Developmental Dysplasia ◽  
Risk Calculator ◽  
The Impact ◽  
Dysplasia Of The Hip

Abstract Introduction: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. Not treated DDH leads to disability, gait abnormalities, limb shortening and chronic pain. Our study aims to determine the impact of multiple risk factors on the occurrence of DDH and develop an interactive risk assessment tool.Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of University Hospital. The Graf classification system was used for ultrasonographic universal screening. In total, 4881 infants met the eligibility criteria (n = 9762 hip joints). Hypothesis testing was performed with χ² test and logistic regression.Results: The incidence of DDH was 4.57%. We have proven risk factors of DDH: female gender (OR=7.11), breech position (OR=3.65), Caesarean section (OR=1.43), positive family history in parent (OR=1.92) or sibling (OR=3.84). Preterm delivery decreased the risk (OR=0.17). Logistic regression was used to construct the interactive risk calculator.Conclusion: The DDH risk calculator was built but needs external validation in prospective study before being used in a clinical setting. We confirmed well-known DDH risk factors in the studied population. Our results support the recent hypothesis that preterm infants (37 < week) have lower rate of DDH.Level of Evidence:Retrospective cohort study: Level III

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