Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

Diabetes Care ◽  
2021 ◽  
pp. dc210604
Author(s):  
Catherine E. Barrett ◽  
Joohyun Park ◽  
Lyudmyla Kompaniyets ◽  
James Baggs ◽  
Yiling J. Cheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
The U.S

scholarly journals Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

2021 ◽  
Author(s):  
Catherine E. Barrett ◽  
Joohyun Park ◽  
Lyudmyla Kompaniyets ◽  
James Baggs ◽  
Yiling J. Cheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Absolute Risk ◽  
Invasive Mechanical Ventilation ◽  
Logistic Models ◽  
Increased Risk

<b>Objective.</b> <p>To assess whether risk of severe outcomes among patients with type 1 diabetes (T1DM) hospitalized for COVID-19 differs from patients without diabetes (DM) or with type 2 diabetes (T2DM). </p> <p><b>Research Design and Methods.</b> </p> <p>Using the Premier Healthcare Special COVID-19 Release Database records of patients discharged after COVID-19 hospitalization from US hospitals from March to November 2020 (N=269,674, after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without DM or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes.</p> <p><b>Results.</b> </p> <p>Compared with patients without DM, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD = 0.21, 95% Confidence Interval [CI]=0.19–0.24; RR=1.49, 95% CI=1.43–1.56) and a 5% higher absolute risk of mortality (RD=0.05, 95% CI=0.03–0.07; RR=1.40, 95% CI=1.24–1.57), adjusting for age, sex, and race or ethnicity. Compared with patients with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD=0.09, 95% CI=0.07–0.12; RR=1.17, 95% CI=1.12–1.22), but no difference in mortality (RD=0.00, 95% CI=-0.02–0.02; RR=1.00, 95% CI=0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD=0.01, 95% CI=-0.01–0.03) and had lower mortality (RD=-0.03, 95% CI=-0.05– -0.01) compared to patients with T2DM.</p> <p><b>Conclusions.</b> </p> Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without DM. Higher ICU/MV risk compared with patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to DM management and the prevention of COVID-19.

scholarly journals Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

2021 ◽  
Author(s):  
Catherine E. Barrett ◽  
Joohyun Park ◽  
Lyudmyla Kompaniyets ◽  
James Baggs ◽  
Yiling J. Cheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Absolute Risk ◽  
Invasive Mechanical Ventilation ◽  
Logistic Models ◽  
Increased Risk

<b>Objective.</b> <p>To assess whether risk of severe outcomes among patients with type 1 diabetes (T1DM) hospitalized for COVID-19 differs from patients without diabetes (DM) or with type 2 diabetes (T2DM). </p> <p><b>Research Design and Methods.</b> </p> <p>Using the Premier Healthcare Special COVID-19 Release Database records of patients discharged after COVID-19 hospitalization from US hospitals from March to November 2020 (N=269,674, after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without DM or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes.</p> <p><b>Results.</b> </p> <p>Compared with patients without DM, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD = 0.21, 95% Confidence Interval [CI]=0.19–0.24; RR=1.49, 95% CI=1.43–1.56) and a 5% higher absolute risk of mortality (RD=0.05, 95% CI=0.03–0.07; RR=1.40, 95% CI=1.24–1.57), adjusting for age, sex, and race or ethnicity. Compared with patients with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD=0.09, 95% CI=0.07–0.12; RR=1.17, 95% CI=1.12–1.22), but no difference in mortality (RD=0.00, 95% CI=-0.02–0.02; RR=1.00, 95% CI=0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD=0.01, 95% CI=-0.01–0.03) and had lower mortality (RD=-0.03, 95% CI=-0.05– -0.01) compared to patients with T2DM.</p> <p><b>Conclusions.</b> </p> Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without DM. Higher ICU/MV risk compared with patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to DM management and the prevention of COVID-19.

Risk Factors for Falls among Hospitalized Trauma Patients

2013 ◽  
Vol 79 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Carlos V. R. Brown ◽  
Sadia Ali ◽  
Romeo Fairley ◽  
Bryan K. Lai ◽  
Justin Arthrell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Fall Prevention ◽  
Male Gender ◽  
Trauma Patients ◽  
Inpatient Falls ◽  
Serious Injury

Inpatient falls lead to an injury in 30 per cent of cases and serious injury in 5 per cent. Increasing staffing and implementing fall prevention programs can be expensive and require a significant use of resources. We hypothesized that trauma patients have unique risk factors to sustain a fall while hospitalized. This is a retrospective cohort study from 2005 to 2010 of all trauma patients admitted to an urban Level I trauma center. Patients who fell while hospitalized were compared with patients who did not fall to identify risk factors for sustaining an inpatient fall. There were 16,540 trauma patients admitted during the study period and 128 (0.8%) fell while hospitalized. Independent risk factors for a trauma patient to fall while hospitalized included older age (odds ratio [OR], 1.02 [1.01 to 1.03], P < 0.001), male gender (OR, 1.6 [1.0 to 2.4], P = 0.03), blunt mechanism (OR, 5.1 [1.6 to 16.3], P = 0.006), Glasgow Coma Score at admission (OR, 0.59 [0.35 to 0.97], P = 0.04), intensive care unit admission (OR, 2.3 [1.4 to 3.7], P = 0.001), and need for mechanical ventilation (OR, 2.2 [1.2 to 3.9], P = 0.01). Trauma patients who fell while hospitalized sustained an injury in 17 per cent of cases and a serious injury in 5 per cent. Inpatient falls in hospitalized trauma patients are uncommon. Risk factors include older age, male gender, blunt mechanism, lower Glasgow Coma Score, and the need for intensive care unit admission or mechanical ventilation. Trauma patients with these risk factors may require higher staffing ratios and should be enrolled in a formal fall prevention program.

scholarly journals Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic

2020 ◽  
pp. annrheumdis-2020-219279
Author(s):  
Naomi Serling-Boyd ◽  
Kristin M D’Silva ◽  
Tiffany YT Hsu ◽  
Rachel Wallwork ◽  
Xiaoqing Fu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Rheumatic Diseases ◽  
Cox Regression ◽  
Diagnosis Date ◽  
Recent Cohort ◽  
Over Time

ObjectiveIn earlier studies, patients with rheumatic and musculoskeletal disease (RMD) who got infected with COVID-19 had a higher risk of mechanical ventilation than comparators. We sought to determine COVID-19 outcomes among patients with RMD 6 months into the pandemic.MethodsWe conducted a cohort study at Mass General Brigham in Boston, Massachusetts, of patients with RMD matched to up to five comparators by age, sex and COVID-19 diagnosis date (between 30 January 2020 and 16 July 2020) and followed until last encounter or 18 August 2020. COVID-19 outcomes were compared using Cox regression. Risk of mechanical ventilation was compared in an early versus a recent cohort of patients with RMD.ResultsWe identified 143 patients with RMD and with COVID-19 (mean age 60 years; 76% female individuals) and 688 comparators (mean age 59 years; 76% female individuals). There were no significantly higher adjusted risks of hospitalisation (HR: 0.87, 95% CI: 0.68–1.11), intensive care unit admission (HR: 1.27, 95% CI: 0.86–1.86), or mortality (HR: 1.02, 95% CI: 0.53–1.95) in patients with RMD versus comparators. There was a trend towards a higher risk of mechanical ventilation in the RMD cohort versus comparators, although not statistically significant (adjusted HR: 1.51, 95% CI: 0.93–2.44). There was a trend towards improvement in mechanical ventilation risk in the recent versus early RMD cohort (10% vs 19%, adjusted HR: 0.44, 95% CI: 0.17–1.12).ConclusionsPatients with RMD and comparators had similar risks of poor COVID-19 outcomes after adjusting for race, smoking and comorbidities. The higher risk of mechanical ventilation in the early RMD cohort was no longer detected in a recent cohort, suggesting improved management over time.

scholarly journals Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia

2017 ◽  
Vol 218 (2) ◽  
pp. 179-188 ◽  
Author(s):  
Vikki G Nolan ◽  
Sandra R Arnold ◽  
Anna M Bramley ◽  
Krow Ampofo ◽  
Derek J Williams ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Bacterial Infections ◽  
Clinical Characteristics ◽  
Community Acquired Pneumonia ◽  
Virus Infections ◽  
Oxygen Supplementation

Abstract Background Recognition that coinfections are common in children with community-acquired pneumonia (CAP) is increasing, but gaps remain in our understanding of their frequency and importance. Methods We analyzed data from 2219 children hospitalized with CAP and compared demographic and clinical characteristics and outcomes between groups with viruses alone, bacteria alone, or coinfections. We also assessed the frequency of selected pairings of codetected pathogens and their clinical characteristics. Results A total of 576 children (26%) had a coinfection. Children with only virus detected were younger, more likely to be black, and more likely to have comorbidities such as asthma, compared with children infected with typical bacteria alone. Children with virus-bacterium coinfections had a higher frequency of leukocytosis, consolidation on chest radiography, parapneumonic effusions, intensive care unit admission, and need for mechanical ventilation and an increased length of stay, compared with children infected with viruses alone. Virus-virus coinfections were generally comparable to single-virus infections, with the exception of the need for oxygen supplementation, which was higher during the first 24 hours of hospitalization in some virus-virus pairings. Conclusions Coinfections occurred in 26% of children hospitalized for CAP. Children with typical bacterial infections, alone or complicated by a viral infection, have worse outcomes than children infected with a virus alone.

scholarly journals Real-life use of remdesivir in hospitalized patients with COVID-19

2021 ◽  
Author(s):  
Carolina Garcia-Vidal ◽  
Fernanda Meira ◽  
Alberto Cózar-Llistó ◽  
Gerard Dueñas ◽  
Pedro Puerta-Alcalde ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Unit Admission ◽  
Life Experience ◽  
Real Life ◽  
Descriptive Study ◽  
Hospitalized Patients ◽  
Good Safety Profile

Objective. Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. Methods. We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. Results. A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. Conclusion. In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.

Abstract 322: The Mayo Cardiac Intensive Care Unit Admission Risk Score Predicts Resource Utilization During Hospitalization

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Thomas J Breen ◽  
Courtney E Bennett ◽  
Nandan S Anavekar ◽  
Joseph G Murphy ◽  
Malcolm R Bell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Resource Utilization ◽  
Risk Score ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Vasoactive Medications

Background: With the rising cost of critical care and limited availability of critical care resources, improvements are need in the current cardiac intensive care unit (CICU) triage process. We sought to determine whether the Mayo Clinic Intensive Care Unit Admission Risk Score (M-CARS) could be used to predict which CICU patients will require critical care resources. Methods: Adult patients admitted to our CICU from 2007 to 2018 were retrospectively reviewed. The M-CARS was calculated using data from the time of admission. Groups were compared using Wilcoxon test for continuous variables and chi-squared test for categorical variables. Results: We included 12,428 patients with a mean age of 67 ± 15 years (37% females). The mean M-CARS was 2.1 ± 2.1, including 5,890 (47.4%) patients with M-CARS <2 and 644 (5.2%) patients with M-CARS >6. Critical care therapies were frequently used, including mechanical ventilation in 28.0%, vasoactive medications in 25.5%, dialysis in 4.8% and invasive lines in 44.3%. The low-risk cohort with M-CARS <2 was less likely to require invasive or noninvasive mechanical ventilation (8.0% vs. 46.1%), vasoactive medications (10.1% vs. 38.8%), dialysis (1.0% vs. 8.2%) or invasive lines (34.6% vs. 53.0%), as compared to patients with M-CARS ≥2 (all p<0.001). A higher M-CARS was associated with greater use of critical care therapies and longer CICU and hospital length of stay. Conclusions: In addition to predicting hospital mortality, the M-CARS predicts resource utilization during CICU admission and could be used in the triage of critically ill cardiac patients. Patients with M-CARS <2 infrequently require critical care resources and have extremely low mortality, yet account for nearly half of all CICU admissions, suggesting a potential to avoid CICU admission in many patients.

scholarly journals A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection

Diabetologia ◽  
2021 ◽  
Author(s):  
Yue Ruan ◽  
◽  
Robert E. J. Ryder ◽  
Parijat De ◽  
Benjamin C. T. Field ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Primary Outcome ◽  
Microvascular Complications ◽  
Laboratory Data ◽  
Macrovascular Disease ◽  
Risk Of Death ◽  
The Uk

Abstract Aims/hypothesis The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. Methods A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. Results Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55–74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. Conclusions/interpretation In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. In people with Type 1 diabetes and COVID-19 admitted to hospital in the UK, BMI and one or more microvascular complications had a positive association and low serum creatine levels had a negative association with death/admission to intensive care unit after adjusting for age.

scholarly journals Severity of Sleep Apnea and COVID-19 Illness

OTO Open ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 2473974X2110162
Author(s):  
Meryl B. Kravitz ◽  
Elizabeth Yakubova ◽  
Nick Yu ◽  
Steven Y. Park
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Sleep Apnea ◽  
Intensive Care Unit Admission ◽  
Medical Record ◽  
Charlson Comorbidity Index ◽  
Composite Outcome ◽  
Comorbidity Index ◽  
Severe Sleep Apnea

Objective To characterize the relationship between severity of sleep apnea and coronavirus disease 2019 (COVID-19) hospitalization and severe illness. Study Design Retrospective cohort study. Setting Montefiore Health System in the Bronx, New York. Methods The data set consisted of adult patients with an active diagnosis of obstructive sleep apnea in the past 2 years and a positive severe acute respiratory syndrome coronavirus 2 quantitative polymerase chain reaction test at our institution between March 16, 2020, and May 26, 2020. Sleep apnea severity and continuous positive airway pressure compliance data were abstracted from the electronic medical record. The International Classification of Diseases, 10th Revision was used to classify comorbidities. Results A total of 461 patients with sleep apnea tested positive for COVID-19, of whom 149 were excluded for missing data in the electronic medical record. Patients with moderate and severe sleep apnea had higher rates of COVID-19 hospitalization compared to those with mild sleep apnea ( P = .003). This association was reduced when accounting for confounders, most notably the Charlson Comorbidity Index, a measure of comorbid illness burden. Moderate and severe sleep apnea were associated with increased Charlson Comorbidity Indices, compared to mild sleep apnea ( P = .01). Sleep apnea severity was not associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death. Conclusion Sleep apnea severity was associated with the Charlson Comorbidity Index and may be a risk factor for COVID-19 hospitalization. We found no evidence that sleep apnea severity among hospitalized patients was associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death.

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