scholarly journals No Evidence for Classic Thrombotic Microangiopathy in COVID-19

2021 ◽  
Vol 10 (4) ◽  
pp. 671
Author(s):  
Tanja Falter ◽  
Heidi Rossmann ◽  
Philipp Menge ◽  
Jan Goetje ◽  
Steffen Groenwoldt ◽  
...  
Keyword(s):  
Thrombotic Microangiopathy ◽  
Medical Center ◽  
Laboratory Data ◽  
Systemic Infection ◽  
Study Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Low Blood Pressure ◽  
Almost All ◽  
The University

Background: Coronavirus disease-2019 (COVID-19) triggers systemic infection with involvement of the respiratory tract. There are some patients developing haemostatic abnormalities during their infection with a considerably increased risk of death. Materials and Methods: Patients (n = 85) with SARS-CoV-2 infection attending the University Medical Center, Mainz, from 3 March to 15 May 2020 were retrospectively included in this study. Data regarding demography, clinical features, treatment and laboratory parameters were analyzed. Twenty patients were excluded for assessment of disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) due to lack of laboratory data. Results: COVID-19 patients (n = 65) were investigated, 19 with uncomplicated, 29 with complicated, and 17 with critical course; nine (13.8%) died. Seven patients showed overt DIC according to the ISTH criteria. The fibrinogen levels dropped significantly in these patients, although not below 100 mg/dl. Hallmarks of TMA, such as thrombocytopenia and microangiopathic haemolytic anaemia, were not detected in any of our COVID-19 patients. ADAMTS13 activity was mildly to moderately reduced in 4/22 patients, all having strongly elevated procalcitonin levels. Conclusion: DIC occurred in 7/65 COVID-19 patients but fibrinogen and platelet consumption were compensated in almost all. ADAMTS13 assays excluded TTP and hallmarks of classic TMA were absent in all investigated patients. We hypothesize that the lacking erythrocyte fragmentation and only mild platelet consumption in severe COVID-19 are due to a microangiopathy predominantly localized to the alveolar microcirculation with a low blood pressure gradient.

The Prevalence of Frailty in Cancer Patients and Mortality Prediction With a Novel Frailty Index Based Clinical Algorithm-A Multicenter, Prospective, Observational Study

2020 ◽  
Author(s):  
Xi Jin ◽  
Yue Ren ◽  
Li Shao ◽  
Zengqing Guo ◽  
Chang Wang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Frailty Index ◽  
National Level ◽  
Laboratory Data ◽  
Mortality Prediction ◽  
Prediction Algorithm ◽  
Tumor Type ◽  
Risk Of Death ◽  
Increased Risk ◽  
Chinese Cancer Patients

Abstract Purpose To investigate the prediction capacity and status of frailty in Chinese cancer patients in national level, through establishing a novel prediction algorithm. Methods The percentage of frailty in different ages, provinces and tumor type groups of Chinese cancer patients were revealed. The predictioncapacity of frailty on mortality of Chinese cancer patients was analyzed by FI-LAB that is composed of routine laboratory data from accessible blood test and calculated as the ratio of abnormal factors in 22 variables. Establishment of a novel algorithm MCP(mortality of cancer patients)to predict the five-year mortality in Chinese cancer patients was accomplished and its prediction capacity was tested in the training and validation sets using ROC analysis. ResultsWe found that the increased risk of death in cancer patients can be successfully identified through FI-LAB. The univariable and multivariable Cox regression were used to evaluate the effect of frailty on death. In the 5-year follow-up, 20.6% of the 2959 participants (age = 55.8 ± 11.7 years; 43.5% female) were dead while the mean FI-LAB score in baseline was 0.23 (standard deviation = 0.13; range = 0 to 0.73).Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased risk of death, with a hazard ratio of 12.67 (95% confidence interval CI: 7.19, 22.31) in comparison with those without frailty. In addition, MCP algorithm presented an area under the ROC (AUC) of 0.691 (95% CI: 0.659-0.684) and 0.648 (95% CI: 0.613-0.684) in the training and validation set, respectively. Conclusion Frailty is common in cancer patients and FI-LAB has high prediction capacity on mortality. The MCP algorithm is a good supplement for frailty evaluation and mortality prediction in cancer patients.

scholarly journals Serum Sulfhydryl Groups, Malondialdehyde, Uric Acid, and Bilirubin as Predictors of Adverse Outcome in Heart Failure Patients due to Ischemic or Nonischemic Cardiomyopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Celina Wojciechowska ◽  
Wojciech Jacheć ◽  
Ewa Romuk ◽  
Anna Ciszek ◽  
Patryk Bodnar ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Uric Acid ◽  
Cox Regression ◽  
Laboratory Data ◽  
Sulfhydryl Groups ◽  
Nonischemic Cardiomyopathy ◽  
Oxidative Stress Biomarkers ◽  
Risk Of Death ◽  
Increased Risk

Oxidative stress plays a significant role in the pathogenesis of heart failure (HF). The aim of the study was to investigate the prognostic value of oxidation-reduction (redox) markers in patients with HF due to ischemic and nonischemic cardiomyopathy. The study included 707 patients of HF allocated into two groups depending on ethology: ischemic cardiomyopathy (ICM) ( n = 435 ) and nonischemic cardiomyopathy (nICM) ( n = 272 ), who were followed up for one year. The endpoint occurrence (mortality or heart transplantation) in a 1-year follow-up was similar in the ICM and nICM group. The predictive value of endpoint occurrence of oxidative stress biomarkers such as the serum protein sulfhydryl groups (PSH), malondialdehyde (MDA), uric acid (UA), bilirubin, and MDA/PSH ratio and other clinical and laboratory data were assessed in both groups (ICM and nICM) separately using univariate and multivariate Cox regression analyses. In multivariate analysis, the higher concentrations of UA ( p = 0.015 , HR = 1.024 , 95% CI (1.005-1.044)) and MDA ( p = 0.004 , HR = 2.202 , 95% CI (1.296-3.741)) were significantly associated with adverse prognosis in patients with ICM. Contrastingly, in patients with nICM, we observed that higher bilirubin concentration ( p = 0.026 , HR = 1.034 , 95% CI (1.004-1.064)) and MDA/PSH ratio ( p = 0.034 , HR = 3.360 , 95% CI (1.096-10.302)) were significantly associated with increased risk of death or HT. The results showed the association of different oxidative biomarkers on the unfavorable course of heart failure depending on etiology.

scholarly journals Association of Perioperative Risk Factors and Cumulative Duration of Low Bispectral Index with Intermediate-term Mortality after Cardiac Surgery in the B-Unaware Trial

2010 ◽  
Vol 112 (5) ◽  
pp. 1116-1127 ◽  
Author(s):  
Miklos D. Kertai ◽  
Nirvik Pal ◽  
Ben J. A. Palanca ◽  
Nan Lin ◽  
Sylvia A. Searleman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Bispectral Index ◽  
Cox Regression ◽  
Medical Center ◽  
Discriminative Ability ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Cumulative Duration

Background Current data suggest that mortality after noncardiac surgery may be associated with persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS). This study assessed the relationships among cumulative duration of low BIS (BIS < 45), intermediate-term mortality, and anesthetic dose after cardiac surgery. Methods The authors studied 460 patients (mean age, 63.0 +/- 13.1 yr; 287 men) who underwent cardiac surgery between September 2005 and October 2006 at Washington University Medical Center, St Louis, Missouri. By using multivariable Cox regression analysis, perioperative factors were evaluated for their potential association with intermediate-term all-cause mortality. Results A total of 82 patients (17.8%) died during a median follow-up of 3 yr (interquartile range, 2.7-3.3 yr). Comparing patients who died with those who survived, there was no statistically significant difference in the relationship between end-tidal anesthetic gas concentrations during the anesthetic maintenance phase and the BIS. Cumulative duration of low BIS was independently associated with intermediate-term mortality. The 1.29 adjusted hazard ratio (95% CI, 1.12-1.49) for intermediate-term mortality with cumulative duration of low BIS translated into a 29% increased risk of death for every cumulative hour spent with a BIS less than 45. The final multivariable Cox regression model showed a good discriminative ability (c-index of 0.78). Conclusions This study found an association between cumulative duration of low BIS and mortality in the setting of cardiac surgery. Notably, this association was independent of both volatile anesthetic concentration and duration of anesthesia, suggesting that intermediate-term mortality after cardiac surgery was not causally related to excessive anesthetic dose.

Association of dyspnea, mortality, and resource use in hospitalised patients

2021 ◽  
pp. 1902107
Author(s):  
Jennifer P. Stevens ◽  
Tenzin Dechen ◽  
Richard M. Schwartzstein ◽  
Carl O'Donnell ◽  
Kathy Baker ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Medical Center ◽  
Intensive Care Unit Discharge ◽  
Academic Medical Center ◽  
Severity Of Illness ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

As many as 1 in 10 patients experience dyspnea at hospital admission but the relationship between dyspnea and patient outcomes is unknown. We sought to determine whether dyspnea on admission predicts outcomes.We conducted a retrospective cohort study in a single, academic medical center. We analysed 67 362 consecutive hospital admissions with available data on dyspnea, pain, and outcomes. As part of the Initial Patient Assessment by nurses, patients rated “breathing discomfort” using a 0 to 10 scale, (10=“unbearable”). Patients reported dyspnea at the time of admission and recalled dyspnea experienced in the 24 h prior to admission. Outcomes included in-hospital mortality, 2-year mortality, length of stay, need for rapid response system activation, transfer to the intensive care unit, discharge to extended care, and 7- and 30-day all cause readmission to the same institution.Patients who reported any dyspnea were at an increased risk of death during that hospital stay; the greater the dyspnea, the greater the risk of death (dyspnea=0, 0.8% in-hospital mortality; dyspnea=1–3, 2.5% mortality; dyspnea ≥4, 3.7% mortality, p<0.001). After adjustment for patient comorbidities, demographics, and severity of illness, increasing dyspnea remained associated with inpatient mortality (dyspnea 1–3, aOR 2.1, 95% CI 1.7–2.6; dyspnea ≥4, aOR 3.1, 95% CI 2.4–3.9). Pain did not predict increased mortality. Patients reporting dyspnea also used more hospital resources, were more likely to be readmitted, and were at increased risk of death within 2 years (dyspnea=1–3 adjusted HR 1.5, 95% CI 1.3–1.6; dyspnea ≥4 adjusted HR 1.7, 95% CI 1.5–1.8).We found that dyspnea of any rating was associated with an increased risk of death. Dyspnea can be rapidly collected by nursing staff, which may allow for better monitoring or interventions that could reduce mortality and morbidity.

scholarly journals Risk factors for immune-related adverse events associated with anti-PD-1 pembrolizumab

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yeonghee Eun ◽  
In Young Kim ◽  
Jong-Mu Sun ◽  
Jeeyun Lee ◽  
Hoon-Suk Cha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Medical Center ◽  
Multivariate Regression Analysis ◽  
Study Data ◽  
Endocrine Disorders ◽  
Logistic Regression Models ◽  
Neutrophil Lymphocyte Ratio ◽  
Increased Risk ◽  
Clinically Significant

Abstract We investigated risk factors for immune-related adverse events (irAEs) in patients treated with anti-programmed cell death protein1 antibody pembrolizumab. A retrospective medical record review was performed to identify all patients who received at least one dose of pembrolizumab at Samsung Medical Center, Seoul, Korea between June 2015 and December 2017. Three hundred and ninety-one patients were included in the study. Data were collected on baseline characteristics, treatment details, and adverse events. Univariate and multivariate logistic regression models were used to identify risk factors for irAEs. Sixty-seven (17.1%) patients experienced clinically significant irAEs; most commonly dermatologic disorders, followed by pneumonitis, musculoskeletal disorders, and endocrine disorders. Fourteen patients (3.6%) experienced serious irAEs (grade ≥ 3). Most common serious irAEs were pneumonitis (2.3%). Four deaths were associated with irAEs, all of which were due to pneumonitis. In multivariate regression analysis, a higher body mass index (BMI) and multiple cycles of pembrolizumab were associated with higher risk of irAEs (BMI: odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01–1.16; pembrolizumab cycle: OR 1.15, 95% CI 1.08–1.22). A derived neutrophil-lymphocyte ratio (dNLR) greater than 3 at baseline was correlated with low risk of irAEs (OR 0.37, 95% CI 0.17–0.81). Our study demonstrated that an elevated BMI and higher number of cycles of pembrolizumab were associated with an increased risk of irAEs in patients treated with pembrolizumab. Additionally, increased dNLR at baseline was negatively correlated with the risk of developing irAEs.

scholarly journals Optimizing Retrieval of Biospecimens Using the Curated Cancer Clinical Outcomes Database (C3OD)

2019 ◽  
Vol 18 ◽  
pp. 117693511988683
Author(s):  
Dinesh Pal Mudaranthakam ◽  
Elena Shergina ◽  
Michele Park ◽  
Jeffrey Thompson ◽  
David Streeter ◽  
...  
Keyword(s):  
Personalized Medicine ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Laboratory Data ◽  
Molecular Data ◽  
Host Institution ◽  
University Of Kansas ◽  
Pathology Reports ◽  
The University ◽  
And Personalized Medicine

To fully support their role in translational and personalized medicine, biorepositories and biobanks must continue to advance the annotation of their biospecimens with robust clinical and laboratory data. Translational research and personalized medicine require well-documented and up-to-date information, but the infrastructure used to support biorepositories and biobanks can easily be out of sync with the host institution. To assist researchers and provide them with accurate pathological, epidemiological, and bio-molecular data, the Biospecimen Repository Core Facility (BRCF) at the University of Kansas Medical Center (KUMC) merges data from medical records, the tumor registry, and pathology reports using the Curated Cancer Clinical Outcomes Database (C3OD). In this report, we describe the utilization of C3OD to optimally retrieve and dispense biospecimen samples using these 3 data sources and demonstrate how C3OD greatly increases the efficiency of obtaining biospecimen samples for the researchers.

scholarly journals The Association Between Biomarkers and Clinical Outcomes in Novel Coronavirus (COVID-19) Pneumonia in a U.S. Cohort

2020 ◽  
Author(s):  
Shant Ayanian ◽  
Juan Reyes ◽  
Lei Lynn ◽  
Karolyn Teufel
Keyword(s):  
Clinical Outcomes ◽  
Laboratory Data ◽  
Clinical Deterioration ◽  
University Hospital ◽  
Risk Of Death ◽  
Markers Of Inflammation ◽  
Increased Risk ◽  
Icu Transfer ◽  
Novel Coronavirus ◽  
D Dimer

AbstractBackgroundThe global pandemic caused by COVID-19 remains poorly understood by clinicians. Identifying biologic markers associated with prognosis can help clinicians recognize disease severity.ObjectiveTo describe the association between D-dimer, CRP, IL-6, ferritin, LDH, and clinical outcomes in a cohort of COVID-19 patients treated on the inpatient medical service at a university hospital in Washington, DC.DesignIn this retrospective study, we included all adults admitted to the inpatient medicine service at George Washington University Hospital between March 12, 2020 and May 9, 2020 with laboratory confirmed COVID-19. Clinical and laboratory data were extracted from electronic medical records and compared between survivors not requiring ICU transfer, survivors requiring ICU transfer, survivors requiring intubation, and non-survivors.Key Results299 patients were included in our study, of whom 69 required transfer to the ICU, 39 required intubation, and 71 died. Threshold values for IL-6 (≥50 pg/mL), D-dimer (≥3 mcg/mL), ferritin (≥450 ng/mL), CRP (≥100 mg/L), and LDH (1,200 u/L) were found to be statistically significant and independently associated with higher odd of clinical deterioration and death. Hypertension, CVA and heart disease independently had an increased risk of all three outcomes, while CKD had only an increased risk of death. Patient co-morbidities had no effect on the different biomarkers’ significant association with poor patient clinical outcomes, except cancer.ConclusionLaboratory markers of inflammation and coagulopathy can help clinicians identify patients who are at high risk for clinical deterioration, independent of clinically significant medical comorbidities.

Choice of resuscitation fluid

2016 ◽  
Author(s):  
John Myburgh ◽  
Naomi E. Hammond
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Current Evidence ◽  
Common Side Effect ◽  
Risk Of Death ◽  
Increased Risk ◽  
First Choice ◽  
Resuscitation Fluid ◽  
Almost All

Fluid resuscitation is a ubiquitous intervention in critically-ill patients. There is wide variation in practice and emerging evidence that the choice of resuscitation fluid may affect outcome in selected patient populations. It is likely that beneficial or adverse effects relate not only to the physicochemical properties of the fluid but also to the volume (dose) and rate of administration. Interstitial oedema is a common side-effect associated with all fluids and its development is associated with organ dysfunction. Crystalloids should be first-choice resuscitation fluids for almost all patients, with evidence that balanced salt solutions confer any benefit over saline being limited to observational data. Consideration of serum sodium (or osmolality), pH, renal function and coagulation status may affect selection of a specific crystalloid solution. On the balance of evidence, colloids do not confer any clinical advantage over crystalloids and they should be used with caution, if at all. Albumin is contraindicated for the resuscitation of patients with severe traumatic brain injury. Hydroxyethyl starch is associated with increased risk of death and acute kidney injury in critically-ill patients, particularly those with severe sepsis and septic shock. Current evidence does not support the use of other semi-synthetic colloids for resuscitation.

scholarly journals Exploring the geographical distribution of cryptosporidiosis in the cattle population of Southern Ontario, Canada, 2011-2014

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Andrea Nwosu ◽  
Olaf Berke ◽  
David L. Pearl ◽  
Lise A. Trotz-Williams
Keyword(s):  
Animal Health ◽  
Laboratory Data ◽  
Dairy Industry ◽  
Cattle Industry ◽  
Veterinary Clinic ◽  
Southern Ontario ◽  
Increased Risk ◽  
Spatial Scan ◽  
Potential Impact ◽  
The University

Cryptosporidiosis is an infectious disease of relevance to the cattle industry. The southern region of the Canadian province of Ontario is characterised by widespread cattle farming that is a key contributor to the Canadian dairy industry. Given Ontario’s key role in the Canadian dairy industry and the potential impact that cryptosporidiosis can have on cattle operations, identifying areas of increased risk for bovine cryptosporidiosis is important. The primary goal of this study was to explore the distribution of bovine cryptosporidiosis, across the geographical areas served by the 29 Public Health Units (PHUs) of Southern Ontario, in the period 2011-2014. Laboratory data on bovine cryptosporidiosis were collected from the Animal Health Laboratory at the University of Guelph, Canada. Using veterinary clinic locations as a proxy for farm location, choropleth and isopleth maps were produced. Highrisk clusters of bovine cryptosporidiosis were identified using the flexible spatial scan test. Assessment of the potential for spatial misclassification bias resulting from a proxy location variable was conducted. The overall raw farm-level prevalence of bovine cryptosporidiosis was 45% [95% confidence interval, CI: 42%-48%]. A cluster was identified in the central-west region of Southern Ontario (relative risk 1.30 [95% CI: 1.07-1.54, P=0.026]) meaning that cattle in the areas served by the Bruce-Grey-Owen Sound, Huron, Wellington-Dufferin Guelph and Waterloo PHUs were at a higher risk for infection. Given that this area is known for having a high-density of dairy cattle, it should be considered as a target for further surveillance.

A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated With Postoperative Nosocomial Infections

2006 ◽  
Vol 27 (12) ◽  
pp. 1291-1298 ◽  
Author(s):  
Loreen A. Herwaldt ◽  
Joseph J. Cullen ◽  
David Scholz ◽  
Pamela French ◽  
M. Bridget Zimmerman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nosocomial Infection ◽  
Resource Utilization ◽  
Nosocomial Infections ◽  
Medical Center ◽  
Risk Index ◽  
Tertiary Care ◽  
Cost Of Care ◽  
Risk Of Death ◽  
Increased Risk

Objective.We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.Design.The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.Setting.A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.Patients.A total of 3,864 surgical patients.Results.The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.Conclusion.Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.

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