scholarly journals Predictors of severity and in-hospital mortality in patients with influenza

2021 ◽  
Author(s):  
Mariana Serino ◽  
Nuno Melo ◽  
João Paulo Caldas ◽  
Ana Ferreira ◽  
David Garcia ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Independent Predictor ◽  
Influenza Infection ◽  
Ventilatory Support ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Death ◽  
Reactive Protein ◽  
Increased Risk ◽  
Increase Risk ◽  
Significant Burden

Influenza virus is a common agent of acute respiratoty infections during epidemic periods. It is a major cause of morbidity and mortality and represent a significant burden on the healthcare system. We aimed to evaluate predictors of severity and of in-hospital mortality in patients hospitalized with influenza infection. We performed a retrospective cohort study of hospitalized, laboratory confirmed cases of influenza disease in Centro Hospitalar de São João between October 2016-May 2017 and October 2017-May 2018. The endpoints being analysed were severity and in-hospital mortality. A multivariate logistic regression analysis was used to determine independent predictors of severity and of in-hospital mortality. We studied 221 hospitalized influenza infection cases. Mean age 66±16 years, 57.9% were male, thirty-seven patients (16.7%) died in-hospital and 101 patients (45.7%) met severity criteria. C-reactive protein (CRP) was the only independent predictor of severity as well as the only independent predictor of higher in-hospital mortality in patients admitted due to influenza infection. Multivariate-adjusted CRP OR for severity was 1.10, 95% CI 1.06-1.15 per each 10 mg/L increase in CPR and for in-hospital mortality risk the OR was of 1.05, 95% CI 1.01-1.09, p=0.01, per each 10 mg/L increase. Concluding, in patients’ hospital-admitted due to influenza infection CRP was the only predictor of severity with a 10% increased risk of inotropic support/ventilatory support/prolonged hospitalization needs and a 5% increase risk of in-hospital death per each 10 mg/l increase.

scholarly journals Impact of congenital heart disease on outcomes among pediatric patients hospitalized for influenza infection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Laxmi V. Ghimire ◽  
Fu-Sheng Chou ◽  
Anita J. Moon-Grady
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Influenza Infection ◽  
Ventilatory Support ◽  
Personal Hygiene ◽  
Increased Risk

Abstract Background Young children and those with chronic medical conditions are at risk for complications of influenza including cardiopulmonary compromise. Here we aim to examine risks of mortality, clinical complications in children with congenital heart disease (CHD) hospitalized for influenza. Methods We analyzed data from in-hospital pediatric patients from 2003, 2006, 2009, 2012 and 2016 using the nationally representative Kids Inpatient Database (KID). We included children 1 year and older and used weighted data to compare the incidence of in-hospital mortality and rates of complications such as respiratory failure, acute kidney injury, need for mechanical ventilation, arrhythmias and myocarditis. Results Data from the KID estimated 125,470 children who were admitted with a diagnosis of influenza infection. Out of those, 2174(1.73%) patients had discharge diagnosis of CHD. Children with CHD who required hospitalization for influenza had higher in-hospital mortality (2.0% vs 0.5%), with an adjusted OR (aOR) of 2.8 (95% CI: 1.7–4.5). Additionally, acute respiratory failure and acute kidney failure were more likely among patients with CHD, with aOR of 1.8 (95% CI: 1.5–2.2) and aOR of 2.2 (95% CI: 1.5–3.1), respectively. Similarly, the rate of mechanical ventilatory support was higher in patients with CHD compared to those without, 14.1% vs 5.6%, aOR of 1.9 (95% CI: 1.6–2.3). Median length of hospital stay in children with CHD was longer than those without CHD [4 (IQR: 2–8) days vs. 2 (IQR: 2–4) days]. Outcomes were similar between those with severe vs non-severe CHD. Conclusions Children with CHD who require hospital admission for influenza are at significantly increased risk for in-hospital mortality, morbidities, emphasizing the need to reinforce preventative measures (e.g. vaccination, personal hygiene) in this particularly vulnerable population.

scholarly journals Usefulness of C-reactive protein/albumin ratio as a predictor of new-onset atrial fibrillation in SARS coronavirus-2

2021 ◽  
Author(s):  
Saban Kelesoglu ◽  
Yucel Yilmaz ◽  
Eyup Ozkan ◽  
Bekir Calapkorur ◽  
Zehra B Dursun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Increased Risk ◽  
High Level ◽  
Onset Atrial Fibrillation ◽  
New Onset

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p < 0.001). In the multivariate logistic regression analysis the CAR (odds ratio = 2.879; 95% CI: 1.063–7.793; p = 0.037) was an independent predictor of NOAF. Conclusion: A high level of CAR in blood samples is associated with an increased risk of developing NOAF in SARS-CoV-2.

scholarly journals Can C-Reactive Protein to Albumin Ratio Predict In-Hospital Death Rate Due to COVID-19 in Patients With Hypertension?

Angiology ◽  
2021 ◽  
pp. 000331972110121
Author(s):  
Faysal Saylik ◽  
Tayyar Akbulut ◽  
Safak Kaya
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Hospital Death ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Cutoff Value ◽  
Reactive Protein ◽  
Kaplan Meier

Hypertension is one of the main morbidity and mortality risk factors in patients with coronavirus disease 2019 (COVID-19). We investigated the association between the C-reactive protein (CRP) to albumin ratio (CAR) and in-hospital mortality in patients with hypertensive COVID-19. A total of 176 patients with hypertension diagnosed with COVID-19 were included in this study. The CAR was compared between survivors and nonsurvivors. Logistic regression analysis was used to detect independent predictors of mortality due to COVID-19 in patients with hypertension. A cutoff value of CAR was obtained for predicting in-hospital death in patients with hypertensive COVID-19. Kaplan-Meier analysis was performed for survival analysis in the study population. The CAR values were significantly higher in nonsurvivors than in survivors with hypertension. Moreover, the CAR was an independent predictor of in-hospital death in patients with hypertensive COVID-19, as shown in multivariable logistic regression analysis. Receiver operating characteristic analysis yielded a cutoff value of 20.75 for the CAR for predicting in-hospital death in patients with hypertension. Kaplan-Meier curve analysis showed that patients with hypertensive COVID-19 with a CAR value of ≥20.75 had a higher incidence of in-hospital death. The CAR might be used as an independent predictor of in-hospital mortality in patients with hypertensive COVID-19.

scholarly journals Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Male Gender ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
University Hospitals ◽  
Adverse Cardiovascular Event ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

scholarly journals Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

2021 ◽  
Author(s):  
Laura C Blomaard ◽  
Carolien M J van der Linden ◽  
Jessica M van der Bol ◽  
Steffy W M Jansen ◽  
Harmke A Polinder-Bos ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hospital Mortality ◽  
Oxygen Demand ◽  
Symptom Duration ◽  
Clinical Frailty Scale ◽  
Reactive Protein ◽  
Increased Risk ◽  
Co Morbidity ◽  
Lower Oxygen ◽  
Independent Association

Abstract Background During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.

scholarly journals Hemogram as marker of in-hospital mortality in COVID-19

2021 ◽  
pp. jim-2021-001810
Author(s):  
Alejandro López-Escobar ◽  
Rodrigo Madurga ◽  
José María Castellano ◽  
Santiago Ruiz de Aguiar ◽  
Sara Velázquez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admission ◽  
White Blood Cells ◽  
Rate Of Change ◽  
Hospital Death ◽  
Direct Role ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Rate Of Increase ◽  
Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Nayab Nadeem ◽  
Rehan Saeed ◽  
Donald Haas ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Odds Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

Exposure To ABO Compatible But Non-Group Identical Blood and In-Hospital Mortality

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3651-3651
Author(s):  
Richard J Cook ◽  
Nancy Heddle ◽  
Ker-Ai Lee ◽  
Yang Liu ◽  
Rebecca Barty, MLT ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Funding ◽  
Cox Regression ◽  
Type A ◽  
Blood Type ◽  
Hospital Death ◽  
Trauma Patients ◽  
Factors Associated ◽  
Blood Types ◽  
Increased Risk

Abstract Background Transfusions that are ABO compatible but not group identical (mismatched) are given for a variety of reasons including inventory availability, avoiding wastage from outdating, and clinical urgency. A recent observation at our centre suggested that patient outcome was different for those patients that received a transfusion of units with a compatible but mismatched ABO group compared to those receiving ABO group identical blood. Hence, we performed a retrospective hospital registry study to explore the association between mismatched blood and in-hospital mortality in transfused patients. Study Design Our patient/blood utilization database included 35,487 transfused hospitalized patients from 3 acute care academic centres from April 1, 2002 to October 31, 2011. Information on transfused RBCs included duration of storage (days) and ABO type. Patient data included: sex; age; hemoglobin; creatinine; diagnosis; interventions; ABO blood group and hospital discharge status. Factors associated with mismatched blood and in-hospital mortality were examined using generalized estimating equations to account for the potential serial dependence over multiple transfusions. The effect of exposure to ABO mismatched blood on in-hospital death was examined through Cox regression with time-dependent strata defined by: year of first admission; disease group; and the cumulative number of units transfused (≤ 7 days of storage; > 7 days but ≤ 28 days storage; and, >28 days of storage); and, controlling for available baseline and time-varying characteristics. Results 18,843 patients (blood groups A, B and AB), with complete covariates contributed to the analysis. Factors associated with transfusion of mismatched blood included: younger patient age (p<0.0001); lower hemoglobin (p<0.0001); higher creatinine (p<0.0001); intervention during hospitalization (OR=4.6, p<0.0001); and, patient ABO group whereby blood types A and B were much less likely to receive a mismatched unit compared to type AB patients (p<0.0001). There was a statistically significant interaction between patient blood type and the effect of receiving mismatched blood (p=0.034) with type A patients incurring a 79% higher risk of death (RR=1.79, 95% CI: 1.20, 2.67; p=0.0047); other patient blood types did not suggest increased risk. Similar results were observed when suspected trauma patients (≥ 6 units within 24 hours) were excluded from the analysis (Table 1). Conclusion Controlling for known potential confounders through Cox regression yielded evidence of increased risk of in-hospital mortality among blood type A patients receiving group O red cells. This association remained after suspected trauma patients were excluded from the analyses. Further study of the association observed in this study is warranted. Disclosures: Cook: CIHR: Research Funding. Heddle:CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Health Canada: Research Funding. Eikelboom:CIHR: Research Funding.

scholarly journals Predictive Value of Admission D-dimer for Contrast-induced Acute Kidney Injury and Poor Outcomes after Primary Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Kai-Yang Lin ◽  
Han-Chuan Chen ◽  
Hui Jiang ◽  
Sun-Ying Wang ◽  
Hong-mei Chen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Serum Creatinine ◽  
Logistic Regression Analysis ◽  
Predictive Value ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI. Methods We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic(ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure. Results Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 ug/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUC DD =0.729 vs AUC Mehran =0.722; p =0.8298). Multivariate logistic regression analysis indicated that DD >0.69 ug/ml was an independent predictor of CI-AKI (odds ratio[OR]=3.37,95%CI:1.80-6.33, p <0.0001). Furthermore, DD >0.69 ug/ml was associated with an increased risk of long-term mortality during during a mean follow-up period of 16 months(hazard ratio=3.41, 95%CI:1.4-8.03, p =0.005). Conclusion admission DD >0.69 ug/ml is a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.

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