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Leatherman JW, Prekker ME, Kummer RL, Maurer JL, Beacom EJ, Ahiskali AS, Shapiro RS. Ventilatory Parameters Measured After One Week of Mechanical Ventilation and Survival in COVID-19-Related ARDS. Respir Care 2023; 68:44-51. [PMID: 36318980 PMCID: PMC9993523 DOI: 10.4187/respcare.10029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ventilatory parameters measured soon after initiation of mechanical ventilation have limited ability to predict outcome of COVID-19-related ARDS. We hypothesized that ventilatory parameters measured after one week of mechanical ventilation might differ between survivors and non-survivors. METHODS One hundred twenty-seven subjects with COVID-related ARDS had gas exchange and lung mechanics assessed on the day of intubation and one week later. The main parameters of interest were PaO2 /FIO2 , ventilatory ratio (VR), respiratory system compliance (CRS), and a composite score that was calculated as (PaO2 /FIO2 /100) × CRS/VR. The primary outcome was death in the ICU. RESULTS Of the 127 subjects, 42 (33%) died in the ICU and 85 (67%) were successfully extubated. On the day of intubation, PaO2 /FIO2 , CRS, and composite score of survivors and non-survivors were similar, but survivors had a lower VR. At one week, as compared to survivors, non-survivors had a significantly higher VR (2.04 ± 0.76 vs 1.60 ± 0.43, P < .001), lower CRS (27.4 ± 6.4 mL/cm H2O vs 32.4 ± 9.3 mL/cm H2O, P = .002), and lower composite score (20.6 ± 11.9 vs 34.5 ± 18.6, P < .001), with no statistically significant difference in PaO2 /FIO2 (137 ± 49 vs 155 ± 48, P = .08). CONCLUSIONS In subjects with COVID ARDS, parameters that reflect dead space (VR), lung mechanics (CRS), and a combined score that included PaO2 /FIO2 , VR, and CRS differed between survivors and non-survivors after one week of mechanical ventilation but with considerable overlap of values between survivors and non-survivors.
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Affiliation(s)
- James W Leatherman
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota.
| | - Matthew E Prekker
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota
| | - Rebecca L Kummer
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - John L Maurer
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Evan J Beacom
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Aileen S Ahiskali
- Department of Pharmacy, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Robert S Shapiro
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota
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Amin R, Sohrabi MR, Zali AR, Hannani K. Five consecutive epidemiological waves of COVID-19: a population-based cross-sectional study on characteristics, policies, and health outcome. BMC Infect Dis 2022; 22:906. [PMID: 36471283 PMCID: PMC9721063 DOI: 10.1186/s12879-022-07909-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND This study was conducted with the intension of providing a more detailed view about the dynamics of COVID-19 pandemic. To this aim, characteristics, implemented public health measures, and health outcome of COVID-19 patients during five consecutive waves of the disease were assessed. METHODS This study was a population-based cross-sectional analysis of data on adult patients who were diagnosed with COVID-19 during five waves of the disease in Iran. Chi-squared test, One-way ANOVA, and Logistic Regression analysis were applied. A detailed literature review on implemented public health policies was performed by studying published documents and official websites responsible for conveying information about COVID-19. RESULTS Data on 328,410 adult patients was analyzed. Main findings indicated that the probability of dying with COVID-19 has increased as the pandemic wore on, showing its highest odd during the third wave (odds ratio: 1.34, CI: 1.283-1.395) and has gradually decreased during the next two waves. The same pattern was observed in the proportion of patients requiring ICU admission (P < 0.001). First wave presented mainly with respiratory symptoms, gastrointestinal complaints were added during the second wave, neurological manifestations with peripheral involvement replaced the gastrointestinal complaints during the third wave, and central nervous system manifestations were added during the fourth and fifth waves. A significant difference in mean age of patients was revealed between the five waves (P < 0.001). Moreover, results showed a significant difference between men and women infected with COVID-19, with men having higher rates of the disease at the beginning. However, as the pandemic progressed the proportion of women gradually increased, and ultimately more women were diagnosed with COVID-19 during the fifth wave. Our observations pointed to the probability that complete lockdowns were the key measures that helped to mitigate the virus spread during the first twenty months of the pandemic in the country. CONCLUSION A changing pattern in demographic characteristics, clinical manifestations, and severity of the disease has been revealed as the pandemic unfolded. Reviewing COVID-19-related public health interventions highlighted the importance of immunization and early implementation of restrictive measures as effective strategies for reducing the acute burden of the disease.
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Affiliation(s)
- Rozhin Amin
- grid.411600.2Community Medicine Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran ,grid.411600.2Social Determinants of Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran
| | - Mohammad-Reza Sohrabi
- grid.411600.2Community Medicine Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran ,grid.411600.2Social Determinants of Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran
| | - Ali-Reza Zali
- grid.411600.2Functional Neurosurgery Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran
| | - Khatereh Hannani
- grid.411600.2Statistics and Information Technology Management, Shahid Beheshti University of Medical Sciences, Tehran, 19839-63113 Iran
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Kaso AW, Tesema HG, Hareru HE, Kaso T, Ashuro Z, Talemahu AA, Jore ST, Kassa R, Agero G, Hailu A. Health-Related Quality of Life and Associated Factors Among Covid-19 Survivors. Experience from Ethiopian Treatment Centers. Infect Drug Resist 2022; 15:6143-6153. [PMID: 36304968 PMCID: PMC9593469 DOI: 10.2147/idr.s386566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The pandemic of the novel coronavirus (Covid-19), which is extremely stressful and has an adverse effect on people's health-related quality of life (HRQoL), poses a serious threat to global public health. As a result, this study evaluated the health-related quality of life and associated factors among Covid-19 patients who were discharged from Ethiopian treatment centers. Methods We conducted a multi-center, cross-sectional study among 493 Covid-19 survivors who had been discharged from treatment centers between 1st January 2020, and 20th October 2021. We collected respondents' data using validated Amharic version EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients. Differences in HRQOL scores between patient subgroups were tested by Mann-Whitney U or Kruskal-Wallis test, and the multivariable betaMix regression was used to investigate factors associated with HRQOL scores. Results The EQ-5D and VAS median score for Covid-19 survivors was 0.940 (IQR: 0.783-0.966) and 87 (IQR: 70-91) respectively. Overall, married individuals, old-aged, individuals who had low educational status, high monthly income, comorbidities, admitted to the Intensive care Unit, received intranasal oxygen care, and prolonged hospitalization had lower utility scores and EQ-VAS scores compared to their counterparts. In multivariate betaMix regression, respondents' health status at admission, old age, chronic obstructive pulmonary disease, asthma, and hospital length of stay were significantly associated with the lower EQ-5D-Index value and EQ-VAS score. Conclusion We found that Covid-19 infection had a persisting impact on the physical and psychosocial health of Covid-19 survivors. Age, having asthma and chronic obstructive pulmonary disease, having a worsening health state upon admission, and a prolonged hospital length of stay were significantly associated with the lower EQ-5D and EQ-VAS score. Therefore, the cost-effective psychological treatment such as cognitive behaviour therapy should be encouraged after hospitalization to improve the post-Covid-19 depression and fatigue.
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Affiliation(s)
- Abdene Weya Kaso
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia,Correspondence: Abdene Weya Kaso, Email
| | - Hailmariam Getachew Tesema
- Department of Anaesthesiology, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Habtamu Endashaw Hareru
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Taha Kaso
- Department of Surgery, College of Health Science, Arsi University, Asella, Ethiopia
| | - Zemachu Ashuro
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Adugna Asefa Talemahu
- School of Medicine, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Soressa Tafere Jore
- School of Medicine, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Reta Kassa
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Aries P, Huet O, Balicchi J, Mathais Q, Estagnasie C, Martin-Lecamp G, Simon O, Morvan AC, Puech B, Subiros M, Blonde R, Boue Y. Characteristics and outcomes of SARS-COV 2 critically ill patients after emergence of the variant of concern 20H/501Y.V2: A comparative cohort study. Medicine (Baltimore) 2022; 101:e30816. [PMID: 36181037 PMCID: PMC9524525 DOI: 10.1097/md.0000000000030816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are currently no data regarding characteristics of critically ill patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variant of concern (VOC) 20H/501Y.V2. We therefore aimed to describe changes of characteristics in critically ill patients with Covid-19 between the first and the second wave when viral genome sequencing indicated that VOC was largely dominant in Mayotte Island (Indian Ocean). Consecutive patients with Covid-19 and over 18 years admitted in the unique intensive care unit (ICU) of Mayotte during wave 2 were compared with an historical cohort of patients admitted during wave 1. We performed a LR comparing wave 1 and wave 2 as outcomes. To complete analysis, we built a Random Forest model (RF), that is, a machine learning classification tool- using the same variable set as that of the LR. We included 156 patients, 41 (26.3%) and 115 (73.7%) belonging to the first and second waves respectively. Univariate analysis did not find difference in demographic data or in mortality. Our multivariate LR found that patients in wave 2 had less fever (absence of fever aOR 5.23, 95% confidence interval (CI) 1.89-14.48, p = .001) and a lower simplified acute physiology score (SAPS II) (aOR 0.95, 95% CI 0.91-0.99, p = .007) at admission; at 24 hours, the need of invasive mechanical ventilation was higher (aOR 3.49, 95% CI 0.98-12.51, p = .055) and pO2/FiO2 ratio was lower (aOR 0.99, 95 % CI 0.98-0.99, p = .03). Patients in wave 2 had also an increased risk of ventilator-associated pneumonia (VAP) (aOR 4.64, 95% CI 1.54-13.93, p = .006). Occurrence of VAP was also a key variable to classify patients between wave 1 and wave 2 in the variable importance plot of the RF model. Our data suggested that VOC 20H/501Y.V2 could be associated with a higher severity of respiratory failure at admission and a higher risk for developing VAP. We hypothesized that the expected gain in survival brought by recent improvements in critical care management could have been mitigated by increased transmissibility of the new lineage leading to admission of more severe patients. The immunological role of VOC 20H/501Y.V2 in the propensity for VAP requires further investigations.
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Affiliation(s)
- Philippe Aries
- Clermont-Tonnerre Military Teaching Hospital, Brest, France
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
- UFR of Medicine, University of Western Brittany, Brest, France
- *Correspondence: Philippe Aries, Clermont-Tonnerre Military Teaching Hospital, Brest, France (e-mail: )
| | - Olivier Huet
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
- UFR of Medicine, University of Western Brittany, Brest, France
| | - Julien Balicchi
- Regional Health Agency, Centre Kinga, Mamoudzou, Mayotte, France
| | - Quentin Mathais
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte Anne, Toulon, France
| | | | | | - Olivier Simon
- Intensive Care Unit, Hospital of Southern Réunion, University Teaching Hospital of La Réunion, Saint-Pierre, Reunion Island, France
| | - Anne-Cécile Morvan
- Intensive Care Unit, Hospital of Western Réunion, Saint-Paul, Reunion Island, France
| | - Bérénice Puech
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, Reunion Island, France
| | - Marion Subiros
- French Public Health Agency in the Indian Ocean Region, Mamoudzou, Mayotte, France
| | - Renaud Blonde
- Intensive Care Unit, Mayotte Hospital, Mamoudzou, Mayotte, France
| | - Yvonnick Boue
- Intensive Care Unit, Mayotte Hospital, Mamoudzou, Mayotte, France
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Kowalska M, Niewiadomska E. Spatial Variability of COVID-19 Hospitalization in the Silesian Region, Poland. IJERPH 2022; 19:9007. [PMID: 35897378 PMCID: PMC9331287 DOI: 10.3390/ijerph19159007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023]
Abstract
Assessment of regional variation in the COVID-19 epidemic is an important task for the implementation of effective action in public health, especially in densely populated regions. In this descriptive study, the temporal and spatial variability of morbidity and in-hospital mortality of COVID-19 in the Silesian Voivodship (Poland) was analyzed. Secondary epidemiological data of hospitalized patients due to COVID-19 from 1 March to 31 December 2020 and from 1 January to 31 December 2021 were obtained from the regional registry of the Silesian Voivodship Office in Katowice. A year by year (2020 versus 2021) comparative analysis showed a similar course pattern of the COVID-19 pandemic in the Silesian Voivodeship; with the worst situation occurring in the colder months of the year. The percentage of in-hospital mortality remained at a high level, close to 20% during the second year of observation. The risk of death in patients hospitalized due to COVID-19 increased with the number of comorbidities. The highest number of patients was documented in densely inhabited regions with intensive population movement (Częstochowa and border counties). The epidemiological ‘map’ facilitates the generation of hypotheses needed for the explanation of the observed epidemic hazard in one of the most populated regions of Poland.
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Moon RC, Brown H, Rosenthal N. Healthcare Resource Utilization of Patients With COVID-19 Visiting US Hospitals. Value Health 2022; 25:751-760. [PMID: 35183449 PMCID: PMC8849836 DOI: 10.1016/j.jval.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/19/2021] [Accepted: 12/01/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Severe cases of COVID-19 have overwhelmed hospital systems across the nation. This study aimed to describe the healthcare resource utilization of patients with COVID-19 from hospital visit to 30 days after discharge for inpatients and hospital-based outpatients in the United States. METHODS A retrospective cohort study was conducted using Premier Healthcare Database COVID-19 Special Release, a large geographically diverse all-payer hospital administrative database. Adult patients (age ≥ 18 years) were identified by their first, or "index," visit between April 1, 2020, and February 28, 2021, with a principal or secondary discharge diagnosis of COVID-19. RESULTS Of 1 454 780 adult patients with COVID-19, 33% (n = 481 216) were inpatients and 67% (n = 973 564) were outpatients. Among inpatients, mean age was 64.4 years and comorbidities were common. Most patients (80%) originated from home, 10% from another acute care facility, and 95% were admitted through the emergency department. Of these patients, 23% (n = 108 120) were admitted to intensive care unit and 14% (n = 66 706) died during index hospitalization; 44% were discharged home, 15% to nursing or rehabilitation facility, and 12% to home health. Among outpatients, mean age was 48.8 years, 44% were male, and 60% were emergency department outpatients (n = 586 537). During index outpatient visit, 79% were sent home but 10% had another outpatient visit and 4% were hospitalized within 30 days. CONCLUSIONS COVID-19 is associated with high level of healthcare resource utilization and in-hospital mortality. More than one-third of inpatients required post hospital healthcare services. Such information may help healthcare providers better allocate resources for patients with COVID-19 during the pandemic.
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Affiliation(s)
- Rena C Moon
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA
| | - Harold Brown
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA
| | - Ning Rosenthal
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA.
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Singh K, Xin Y, Xiao Y, Quan J, Kim D, Nguyen TPL, Kondal D, Yan X, Li G, Ng CS, Kang H, Nam HM, Mohan S, Yan LL, Shi C, Chen J, Hanh HTH, Mohan V, Kong S, Eggleston K. Impact of the COVID-19 Pandemic on Chronic Disease Care in India, China, Hong Kong, Korea, and Vietnam. Asia Pac J Public Health 2022; 34:392-400. [PMID: 35067078 PMCID: PMC9133173 DOI: 10.1177/10105395211073052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
This study aims to provide evidence on how the COVID-19 pandemic has impacted chronic disease care in diverse settings across Asia. Cross-sectional surveys were conducted to assess the health, social, and economic consequences of the pandemic in India, China, Hong Kong, Korea, and Vietnam using standardized questionnaires. Overall, 5672 participants with chronic conditions were recruited from five countries. The mean age of the participants ranged from 55.9 to 69.3 years. A worsened economic status during the COVID-19 pandemic was reported by 19% to 59% of the study participants. Increased difficulty in accessing care was reported by 8% to 24% of participants, except Vietnam: 1.6%. The worsening of diabetes symptoms was reported by 5.6% to 14.6% of participants, except Vietnam: 3%. In multivariable regression analyses, increasing age, female participants, and worsened economic status were suggestive of increased difficulty in access to care, but these associations mostly did not reach statistical significance. In India and China, rural residence, worsened economic status and self-reported hypertension were statistically significantly associated with increased difficulty in access to care or worsening of diabetes symptoms. These findings suggest that the pandemic disproportionately affected marginalized and rural populations in Asia, negatively affecting population health beyond those directly suffering from COVID-19.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Yiqian Xin
- Global Health Research Center, Duke Kunshan University, Suzhou, China
- School of Health Humanities, Peking University, Beijing, China
| | - Yuyin Xiao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jianchao Quan
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Daejung Kim
- Korea Institute for Health and Social Affairs, Sejong City, Republic of Korea
| | | | - Dimple Kondal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Xinyi Yan
- Centre for Chronic Disease Control, New Delhi, India
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Carmen S. Ng
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Hyolim Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hoang Minh Nam
- Thai Nguyen University of Medicine and Pharmacy, Thái Nguyên, Vietnam
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Suzhou, China
| | - Chenshu Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayin Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Hoa Thi Hong Hanh
- Thai Nguyen University of Medicine and Pharmacy, Thái Nguyên, Vietnam
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Garcia S, Dehghani P, Stanberry L, Grines C, Patel RAG, Nayak KR, Singh A, Htun WW, Kabour A, Ghasemzadeh N, Sanina C, Aragon J, Alraies C, Benziger C, Okeson B, Garberich R, Welt FG, Davidson L, Hafiz AM, Acharya D, Stone J, Mehra A, Amlani S, Mahmud E, Giri J, Yildiz M, Henry TD. Trends in Clinical Characteristics, Management Strategies and Outcomes of STEMI Patients with COVID-19. J Am Coll Cardiol 2022; 79:2236-2244. [PMID: 35390486 PMCID: PMC8978699 DOI: 10.1016/j.jacc.2022.03.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
Background We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic. Objectives The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic. Methods The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021). Results A total of 586 COVID-19–positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients’ characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009). Conclusions Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation. Minneapolis, MN; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, GA and Society for Cardiovascular Angiography and Interventions (SCAI), Washington, DC
| | | | - Keshav R Nayak
- Department of Cardiology Scripps Mercy Hospital, San Diego, CA
| | - Avneet Singh
- North Shore University Hospital & Long Island Jewish Medical Center (NS/LIJ)
| | | | | | - Nima Ghasemzadeh
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Cristina Sanina
- Montefiore Medical Center and Albert Einstein College of Medicine. New York City, NY
| | | | | | | | - Brynn Okeson
- Minneapolis Heart Institute Foundation. Minneapolis, MN
| | | | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC and University of Utah Health Sciences, Salt Lake City, Utah
| | - Laura Davidson
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine. Springfield, IL
| | | | - Jay Stone
- Community Medical Center (RWJ Barnabas Health). Toms River, NJ
| | - Aditya Mehra
- Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Shy Amlani
- William Osler Health System- Brampton, Brampton, Ontario, Canada
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla CA
| | - Jay Giri
- University of Pennsylvania, Philadelphia, PA
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
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9
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Bianconi V, Mannarino MR, Figorilli F, Cosentini E, Batori G, Marini E, Banach M, Sahebkar A, Pirro M. The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19. Expert Rev Mol Diagn 2022; 22:469-478. [PMID: 35260036 PMCID: PMC8935458 DOI: 10.1080/14737159.2022.2052047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels. Research design and methods This study aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin-to-Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed. Results In the population examined (mean age 74 ± 15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for noninvasive ventilation were higher in patients with high FIR (≥29.2, the 75th percentile) than in those with low FIR (<29.2, the 75th percentile) (p < 0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017–2.871, p = 0.043) higher risk of ICU admission/in-hospital death. Conclusions Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.
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Affiliation(s)
- Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Massimo R Mannarino
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Figorilli
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cosentini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Batori
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ettore Marini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital, Medical University of Lodz, Lodz, Poland.,Polish Mothers Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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10
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Jha P, Deshmukh Y, Tumbe C, Suraweera W, Bhowmick A, Sharma S, Novosad P, Fu SH, Newcombe L, Gelband H, Brown P. COVID mortality in India: National survey data and health facility deaths. Science 2022; 375:667-671. [PMID: 34990216 PMCID: PMC9836201 DOI: 10.1126/science.abm5154] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.
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Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Corresponding author.
| | - Yashwant Deshmukh
- Center For Voting Opinions and Trends in Election Research, Noida, Uttar Pradesh, India
| | - Chinmay Tumbe
- Department of Economics, Indian Institute of Management Ahmedabad, Ahmedabad, Gujarat, India
| | - Wilson Suraweera
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul Novosad
- Department of Economics, Dartmouth College, Hanover, NH, USA
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Newcombe
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hellen Gelband
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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11
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Ughi N, Bernasconi DP, Del Gaudio F, Dicuonzo A, Maloberti A, Giannattasio C, Tarsia P, Puoti M, Scaglione F, Beltrami L, Colombo F, Bertuzzi M, Bellone A, Adinolfi A, Valsecchi MG, Epis OM, Rossetti C. Trends in all-cause mortality of hospitalized patients due to SARS-CoV-2 infection from a monocentric cohort in Milan (Lombardy, Italy). J Public Health (Oxf) 2022; 30:1985-1993. [PMID: 35004128 PMCID: PMC8723908 DOI: 10.1007/s10389-021-01675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Robust data on case fatality rate (CFR) among inpatients with COVID-19 are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study quantified the overall CFR and described its trend in a cohort of hospitalized patients with SARS-CoV-2 in Italy. Admission to ICU, death, or discharge were the secondary outcomes. Methods This retrospective study is based on administrative health data and electronic case records of inpatients consecutively admitted to Niguarda Hospital between 21 February and 8 November 2020. Results An overall CFR of 18% was observed. CFR was significantly reduced during the second wave of contagion (1 June to 30 September, 16%) compared with the first wave (21 February to 31 May, 21% p = 0.015). Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was associated with a high risk of mortality in both waves. The incidence of severe disease and the need for ICU admission were lower in the second wave. Conclusion CFR in SARS-CoV-2 inpatients was demonstrated to decrease over time. This reduction may partly reflect the changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to plan an exit strategy in case of future outbreaks. Key messages What is already known on this topic Before the advent of anti-COVID-19 vaccines, a multi-wave pattern of contagion was observed, and this trend conditioned the inpatient case fatality rate (CFR), which varied over time accordingly to the waves of contagion. Only preliminary results on the in-hospital mortality trend are available, along with a partial analysis of its determinants. Consequently, robust data on CFR among inpatients with SARS-CoV-2 infection are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. What this study adds This study shows that the in-hospital mortality in patients with SARS-CoV-2 infection decreases over time. Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was invariably associated with a high risk of mortality during the whole study period (21 February to 8 November 2020), but the incidence of severe disease and the need for ICU admission were lower in the second wave of contagions (1 October to 8 November 2020). This reduction may partly reflect the impact of changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to inform the response to future outbreaks and to plan exit strategy by prioritizing high-risk populations. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-021-01675-y.
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Affiliation(s)
- Nicola Ughi
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano--Bicocca, Milan, Italy
| | - Francesca Del Gaudio
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Armanda Dicuonzo
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Maloberti
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Paolo Tarsia
- Division of Pneumology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.,Division of Infectious Disease, Multi-specialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Division of chemical-Clinical and Microbiological Analyses, Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Università degli Studi di Milano, Milan, Italy
| | - Laura Beltrami
- Division of Internal Medicine 1, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Colombo
- Division of Internal Medicine 1, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michaela Bertuzzi
- Division of Quality and Clinical Risk, Continuous Quality Improvement, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Bellone
- Division of Emergency Medicine and Emergency Room, Department of Emergencies and Admissions (DEA), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Adinolfi
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano--Bicocca, Milan, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Claudio Rossetti
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Functional Department for Higher Education, Research, and Development, Interhospital Functional Department of Nuclear Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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12
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Sousa ELD, Gaído SB, Sousa RAD, Cardoso ODO, Matos Neto EMD, Menezes Júnior JMPD, Oliveira BFAD, Aguiar BGA. Perfil de internações e óbitos hospitalares por síndrome respiratória aguda grave causada por COVID-19 no Piauí: estudo descritivo, 2020-2021. Epidemiol Serv Saúde 2022; 31:e2021836. [DOI: 10.1590/s1679-49742022000100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Descrever o perfil e a variação temporal de internações e óbitos hospitalares por síndrome respiratória aguda grave (SRAG) por COVID-19 no Piauí, Brasil, segundo local de internação. Métodos Estudo descritivo sobre dados do Sistema de Informação da Vigilância Epidemiológica da Gripe de 2020 a 2021. Calculou-se a letalidade entre registros hospitalares com desfecho e respectivos intervalos de confiança de 95% (IC95%). Resultados Foram incluídos 12.649 indivíduos majoritariamente do sexo masculino (57,1%), negros (61,2%), com uma ou duas comorbidades (30,5%). No interior, entre registros hospitalares com desfecho, a letalidade para internados (44,1%; IC95% 42,0;46,3), admitidos em unidades de terapia intensiva (82,3%; IC95% 79,7;84,8) e indivíduos submetidos a ventilação mecânica invasiva (96,6%; IC95% 94,9;97,8) foi maior do que na capital do estado. Conclusão O estudo permitiu a caracterização do perfil das internações devidas a SRAG por COVID-19 no Piauí e demonstrou elevada letalidade entre registros hospitalares com desfechos, mantendo-se alta no período estudado, sobretudo no interior.
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Kaso AW, Agero G, Hurisa Z, Kaso T, Ewune HA, Hailu A. Evaluation of health-related quality of life of Covid-19 patients: a hospital-based study in South Central Ethiopia. Health Qual Life Outcomes 2021; 19:268. [PMID: 34930294 PMCID: PMC8685489 DOI: 10.1186/s12955-021-01900-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Covid-19 causes a wide range of symptoms in patients, ranging from mild manifestations to severe disease and death. This study assessed the health-related quality of life (HRQOL) and associated factors of Covid-19 patients using primary data from confirmed cases in South Central Ethiopia. METHODS We employed a facility-based, cross-sectional study design and conducted the study at the Bokoji Hospital Covid-19 treatment centre. A structured questionnaire and the EQ-5D-3L scale were used to collect the data for analysis. The HRQOL results measured by the EQ-5D-3L tool were converted to a health state utility (HSU) using the Zimbabwe tariff. The average health utility index and HSU-visual analogue scale across diverse sociodemographic and clinical characteristics were compared using the Mann-Whitney U test or Kruskal-Wallis test. We employed a multiple linear regression to examine factors associated with HSU values simultaneously. The data were analysed using STATA version 15. RESULTS The overall mean HSU score from the EQ-5D was 0.688 (SD: 0.285), and the median was 0.787 (IQR 0.596, 0.833). The mean HSU from the visual analogue scale score was 0.69 (SD: 0.129), with a median of 0.70 (IQR 0.60, 0.80). Those who received dexamethasone and intranasal oxygen supplement, those with comorbidity, those older than 55 years and those with a hospital stay of more than 15 days had significantly lower HSU scores than their counterparts (p < .001). CONCLUSION Covid-19 substantially impaired the HRQOL of patients in Ethiopia, especially among elderly patients and those with comorbidity. Therefore, clinical follow-up and psychological treatment should be encouraged for these groups. Moreover, the health utility values from this study can be used to evaluate quality adjusted life years for future cost-effectiveness analyses of prevention and treatment interventions against Covid-19.
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Affiliation(s)
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Assela, Ethiopia
| | - Zewdu Hurisa
- Department of Internal Medicine, College of Health Science, Arsi University, Assela, Ethiopia
| | - Taha Kaso
- Department of Surgery, College of Health Science, Arsi University, Assela, Ethiopia
| | | | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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14
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Martínez-Vega RA, Jing W, Ortega-Villa AM, Delgado-Cuellar OM, Hernández-Hernández VA, Jan-Gómez JC, Rincón-León HA, Constantino-Santiesteban P, García-Guerra MP, Cetina-Díaz JH, Pérez-Tirado JM, Gómez-Cruz O, Amaya-Larios IY, Ramos-Castañeda J, Jesús SD. Risk Prediction of Death in Inpatient Adults With COVID-19 from Mexico. Res Sq 2021:rs.3.rs-996535. [PMID: 34751267 PMCID: PMC8575141 DOI: 10.21203/rs.3.rs-996535/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is substantial variation in COVID-19 lethality across countries. In addition, in countries with populations with extreme economic inequalities, such as Mexico, there are regional and local differences in risk factors for COVID-19 death. The goal of this study was to test the hypothesis that the risk of death in Mexican COVID-19 patients was associated with the time between symptom onset and hospitalization and/or with the healthcare site. Also, death prognostic models were developed. Methods The study included two COVID-19 inpatient cohorts, one prospective and one retrospective from Chiapas, Mexico. Demographic, clinical and laboratory variables were collected, and the diagnosis of SARS-CoV-2 infection was performed using RT-qPCR in samples collected seven days since symptom onset. The 30-day mortality, since symptom onset, was the outcome, and clinical variables at the first 48 hours of hospitalization were independent factors. Multivariate logistic regression analyses were conducted. Results Of the 392 patients included, 233 died (59.4%). The time between symptom onset and hospitalization, the healthcare site and sex were not related to the 30-day mortality. Three death prognostic models were developed (AUC between 0.726 and 0.807). Age, LDH, AST, and lymphocyte count were included in all models, OSI-WHO Classification (Non-invasive ventilation or high-flow oxygen, and mechanical ventilation with or without organ support/ECMO) and leukocyte count in two models, and diabetes and diarrhea in one model. Conclusion The population evaluated had underlying deteriorated health before COVID-19 compared with regional and country population. The factors that determine the COVID-19 mortality risk in a relatively healthy population are sex, age and comorbidities. However, as this study shows, when populations have underlying poor health, some of these factors lose their associations with mortality risk, and others become more important.
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Affiliation(s)
| | - Wang Jing
- Frederick National Laboratory for Cancer Research
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15
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Strålin K, Wahlström E, Walther S, Bennet-Bark AM, Heurgren M, Lindén T, Holm J, Hanberger H. Mortality in hospitalized COVID-19 patients was associated with the COVID-19 admission rate during the first year of the pandemic in Sweden. Infect Dis (Lond) 2021; 54:145-151. [PMID: 34612774 DOI: 10.1080/23744235.2021.1983643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Studies from the first pandemic wave found associations between COVID-19 hospital load and mortality. Here, we aimed to study if mortality of hospitalized COVID-19 patients was associated with the COVID-19 admission rate during a full year of the pandemic in Sweden. METHOD Observational review of all patients admitted to hospital with COVID-19 in Sweden between March 2020 and February 2021 (n = 42,017). Primary outcome was 60-day all-cause mortality related to number of COVID-19 hospital admissions per month/100,000 inhabitants. Poisson regression was used to estimate the relative risk for death by month of admission, adjusting for pre-existing factors. RESULTS The overall mortality was 17.4%. Excluding March 2020, mortality was clearly correlated to the number of COVID-19 admissions per month (coefficient of correlation ρ=.96; p<.0001). After adjustment for pre-existing factors, the correlation remained significant (ρ=.75, p=.02). Patients admitted in December (high admission rate and high mortality) had more comorbidities and longer hospital stays, and patients treated in intensive care units (ICU) had longer pre-ICU hospital stays and worse respiratory status on ICU admission than those admitted in July to September (low admission rate and low mortality). CONCLUSION Mortality in hospitalized COVID-19 patients was clearly associated with the COVID-19 admission rate. Admission of healthier patients between pandemic waves and delayed ICU care during wave peaks could contribute to this pattern. The study supports measures to flatten-the-curve to reduce the number of COVID-19 patients admitted to hospital.
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Affiliation(s)
- Kristoffer Strålin
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Infectious Diseases Section, National Programme for Evidence-based Healthcare Management: Sweden's Regions in Collaboration, Stockholm, Sweden
| | - Erik Wahlström
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Sten Walther
- Swedish Intensive Care Register, Värmland County Council, Karlstad, Sweden.,Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden.,Department of Health, Medicine, and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna M Bennet-Bark
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Mona Heurgren
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Thomas Lindén
- Department for Knowledge-Based Policy of Health Care, National Board of Health and Welfare, Stockholm, Sweden
| | - Johanna Holm
- Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Håkan Hanberger
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
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16
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Moon RC, Mackey RH, Cao Z, Emont S, Schott LL, Gayle J, Lipkin C, Rosenthal N. Is COVID-19 Less Deadly Now? -- Trends of In-Hospital Mortality Among Hospitalized COVID-19 Patients in the United States. Clin Infect Dis 2021; 74:2238-2242. [PMID: 34534276 PMCID: PMC8522416 DOI: 10.1093/cid/ciab830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Indexed: 01/19/2023] Open
Abstract
After an initial decline from April through June 2020 (from 22.2% to 11.9%), adjusted in-hospital mortality in COVID-19 inpatients peaked twice and was significantly higher than June 2020 for subsequent months except in July and October 2020. Adjusted mortality trends differed across age groups between November 2020 and February 2021.
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Affiliation(s)
- Rena C Moon
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Rachel H Mackey
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States.,University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Zhun Cao
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Seth Emont
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Laura L Schott
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Julie Gayle
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Craig Lipkin
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
| | - Ning Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, United States
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17
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Zanella A, Florio G, Antonelli M, Bellani G, Berselli A, Bove T, Cabrini L, Carlesso E, Castelli GP, Cecconi M, Citerio G, Coloretti I, Corti D, Dalla Corte F, De Robertis E, Foti G, Fumagalli R, Girardis M, Giudici R, Guiotto L, Langer T, Mirabella L, Pasero D, Protti A, Ranieri MV, Rona R, Scudeller L, Severgnini P, Spadaro S, Stocchetti N, Viganò M, Pesenti A, Grasselli G; COVID-19 Italian ICU Network. Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units. Intensive Care Med 2021. [PMID: 34373952 DOI: 10.1007/s00134-021-06495-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/22/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). METHODS In this retrospective-prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. RESULTS 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55-69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89-175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil-lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. CONCLUSION Daily values or trends over time of parameters associated with acute organ dysfunction, acid-base derangement, coagulation impairment, or systemic inflammation were associated with patient survival.
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Jassat W, Mudara C, Ozougwu L, Tempia S, Blumberg L, Davies MA, Pillay Y, Carter T, Morewane R, Wolmarans M, von Gottberg A, Bhiman JN, Walaza S, Cohen C. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study. Lancet Glob Health 2021; 9:e1216-e1225. [PMID: 34252381 PMCID: PMC8270522 DOI: 10.1016/s2214-109x(21)00289-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Background The first wave of COVID-19 in South Africa peaked in July, 2020, and a larger second wave peaked in January, 2021, in which the SARS-CoV-2 501Y.V2 (Beta) lineage predominated. We aimed to compare in-hospital mortality and other patient characteristics between the first and second waves. Methods In this prospective cohort study, we analysed data from the DATCOV national active surveillance system for COVID-19 admissions to hospital from March 5, 2020, to March 27, 2021. The system contained data from all hospitals in South Africa that have admitted a patient with COVID-19. We used incidence risk for admission to hospital and determined cutoff dates to define five wave periods: pre-wave 1, wave 1, post-wave 1, wave 2, and post-wave 2. We compared the characteristics of patients with COVID-19 who were admitted to hospital in wave 1 and wave 2, and risk factors for in-hospital mortality accounting for wave period using random-effect multivariable logistic regression. Findings Peak rates of COVID-19 cases, admissions, and in-hospital deaths in the second wave exceeded rates in the first wave: COVID-19 cases, 240·4 cases per 100 000 people vs 136·0 cases per 100 000 people; admissions, 27·9 admissions per 100 000 people vs 16·1 admissions per 100 000 people; deaths, 8·3 deaths per 100 000 people vs 3·6 deaths per 100 000 people. The weekly average growth rate in hospital admissions was 20% in wave 1 and 43% in wave 2 (ratio of growth rate in wave 2 compared with wave 1 was 1·19, 95% CI 1·18–1·20). Compared with the first wave, individuals admitted to hospital in the second wave were more likely to be age 40–64 years (adjusted odds ratio [aOR] 1·22, 95% CI 1·14–1·31), and older than 65 years (aOR 1·38, 1·25–1·52), compared with younger than 40 years; of Mixed race (aOR 1·21, 1·06–1·38) compared with White race; and admitted in the public sector (aOR 1·65, 1·41–1·92); and less likely to be Black (aOR 0·53, 0·47–0·60) and Indian (aOR 0·77, 0·66–0·91), compared with White; and have a comorbid condition (aOR 0·60, 0·55–0·67). For multivariable analysis, after adjusting for weekly COVID-19 hospital admissions, there was a 31% increased risk of in-hospital mortality in the second wave (aOR 1·31, 95% CI 1·28–1·35). In-hospital case-fatality risk increased from 17·7% in weeks of low admission (<3500 admissions) to 26·9% in weeks of very high admission (>8000 admissions; aOR 1·24, 1·17–1·32). Interpretation In South Africa, the second wave was associated with higher incidence of COVID-19, more rapid increase in admissions to hospital, and increased in-hospital mortality. Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage. Funding DATCOV as a national surveillance system is funded by the National Institute for Communicable Diseases and the South African National Government.
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Affiliation(s)
- Waasila Jassat
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Caroline Mudara
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lovelyn Ozougwu
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lucille Blumberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mary-Ann Davies
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Terence Carter
- Clinton Health Access Initiative, Pretoria, South Africa
| | | | | | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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