1
|
Gardner AJ, Kristensen SR. A multivariable analysis to predict variations in hospital mortality using systems-based factors of healthcare delivery to inform improvements to healthcare design within the English NHS. PLoS One 2024; 19:e0303932. [PMID: 38968314 PMCID: PMC11226030 DOI: 10.1371/journal.pone.0303932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/03/2024] [Indexed: 07/07/2024] Open
Abstract
Over the last decade, the strain on the English National Health Service (NHS) has increased. This has been especially felt by acute hospital trusts where the volume of admissions has steadily increased. Patient outcomes, including inpatient mortality, vary between trusts. The extent to which these differences are explained by systems-based factors, and whether they are avoidable, is unclear. Few studies have investigated these relationships. A systems-based methodology recognises the complexity of influences on healthcare outcomes. Rather than clinical interventions alone, the resources supporting a patient's treatment journey have near-equal importance. This paper first identifies suitable metrics of resource and demand within healthcare delivery from routinely collected, publicly available, hospital-level data. Then it proceeds to use univariate and multivariable linear regression to associate such systems-based factors with standardised mortality. Three sequential cross-sectional analyses were performed, spanning the last decade. The results of the univariate regression analyses show clear relationships between five out of the six selected predictor variables and standardised mortality. When these five predicators are included within a multivariable regression analysis, they reliably explain approximately 36% of the variation in standardised mortality between hospital trusts. Three factors are consistently statistically significant: the number of doctors per hospital bed, bed occupancy, and the percentage of patients who are placed in a bed within four hours after a decision to admit them. Of these, the number of doctors per bed had the strongest effect. Linear regression assumption testing and a robustness analysis indicate the observations have internal validity. However, our empirical strategy cannot determine causality and our findings should not be interpreted as established causal relationships. This study provides hypothesis-generating evidence of significant relationships between systems-based factors of healthcare delivery and standardised mortality. These have relevance to clinicians and policymakers alike. While identifying causal relationships between the predictors is left to the future, it establishes an important paradigm for further research.
Collapse
Affiliation(s)
- Andrew J. Gardner
- Centre for Health Policy, Imperial College London, London, United Kingdom
- William Harvey Research Institute, Critical Care and Perioperative Medicine Research Group, Queen Mary University of London, London, United Kingdom
| | | |
Collapse
|
2
|
Ayyaz FM, Joyner J, Cheetham M, Briggs T, Gray WK. Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England. Ann R Coll Surg Engl 2024. [PMID: 38563060 DOI: 10.1308/rcsann.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
Collapse
Affiliation(s)
- F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Manchester University NHS Foundation Trust, UK
| | - J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Croydon Health Services NHS Trust, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- The Shrewsbury and Telford Hospital NHS Trust, UK
| | - Twr Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Royal National Orthopaedic Hospital NHS Trust, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
| |
Collapse
|
3
|
Ince FM, Alkan Bilik O, Ince H. Evaluating Mortality Predictors in COVID-19 Intensive Care Unit Patients: Insights into Age, Procalcitonin, Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Ferritin Lactate Index. Diagnostics (Basel) 2024; 14:684. [PMID: 38611597 PMCID: PMC11011413 DOI: 10.3390/diagnostics14070684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Numerous studies suggest that alterations in blood parameters, such as changes in platelet, lymphocyte, hemoglobin, eosinophil, and basophil counts; increased neutrophil counts; and elevated neutrophil/lymphocyte and platelet/lymphocyte ratios, signal COVID-19 infection and predict worse outcomes. Leveraging these insights, our study seeks to create a predictive mortality model by assessing age and crucial laboratory markers. MATERIALS AND METHODS Patients were categorized into two groups based on their hospital outcomes: 130 survivors who recovered from their Intensive Care Unit (ICU) stay (Group 1) and 74 who died (Group 2). We then developed a predictive mortality model using patients' age, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), procalcitonin levels, and ferritin lactate (FL) index results. RESULTS A total of 204 patients were included. Patients in Group 2 had a notably higher mean age compared to those in Group 1 (76 ± 11 vs. 66 ± 15 years) (p < 0.001). Using specific cut-off values, our analysis revealed varying effectiveness in predicting COVID-19 mortality: Those aged over 73 years showed 74% sensitivity and 60% specificity, with an area under the curve (AUC) of 0.701. Procalcitonin levels above 0.35 ng/mL balanced true-positive and -negative identifications well, achieving an AUC of 0.752. The FL index, with a threshold of 1228 mg/dL, had 68% sensitivity and 65% specificity with an AUC of 0.707. A PLR higher than 212 resulted in 48% sensitivity and 69% specificity, with an AUC of 0.582. An NLR higher than 5.8 resulted in 55% sensitivity and 63% specificity, with an AUC of 0.640, showcasing diverse predictive accuracies across parameters. The statistical analysis evaluated the effects of age (>73), procalcitonin levels (>0.35), FL > 1228, PLR > 212, and NLR > 5.8 on mortality variables using logistic regression. Ages over 73 significantly increased event odds by 2.1 times (p = 0.05), procalcitonin levels above 0.35 nearly quintupled the odds (OR = 5.6, p < 0.001), high FL index levels more than tripled the odds (OR = 3.5, p = 0.003), a PLR > 212 significantly increased event odds by 3.5 (p = 0.030), and an NLR > 5.8 significantly increased event odds by 1.6 (p = 0.043). CONCLUSIONS Our study highlights significant predictors of mortality in COVID-19 ICU patients, including advanced age, elevated procalcitonin, FL index levels, the PLR, and the NLR.
Collapse
Affiliation(s)
- Fatma Meral Ince
- Infectious Diseases and Clinical Microbiology, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey
| | - Ozge Alkan Bilik
- Medical Microbiology, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey
| | - Hasan Ince
- Internal Medicine, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey;
| |
Collapse
|
4
|
Kolhe NV, Fluck RJ, Taal MW. Regional variation of COVID-19 admissions, acute kidney injury and mortality in England - a national observational study using administrative data. BMC Infect Dis 2024; 24:346. [PMID: 38519921 PMCID: PMC10960376 DOI: 10.1186/s12879-024-09210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND This study explores regional variations in COVID-19 hospitalization rates, in-hospital mortality, and acute kidney injury (AKI) in England. We investigated the influence of population demographic characteristics, viral strain changes, and therapeutic advances on clinical outcomes. METHODS Using hospital episode statistics, we conducted a retrospective cohort study with 749,844 admissions in 337,029 adult patients with laboratory-confirmed COVID-19 infection (March 1, 2020, to March 31, 2021). Multivariable logistic regression identified factors predicting AKI and mortality in COVID-19 hospitalized patients. RESULTS London had the highest number of COVID-19 admissions (131,338, 18%), followed by the North-west region (122,683, 16%). The North-west had the highest population incidence of COVID-19 hospital admissions (21,167 per million population, pmp), while the South-west had the lowest (9,292 admissions pmp). Patients in London were relatively younger (67.0 ± 17.7 years) than those in the East of England (72.2 ± 16.8 years). The shortest length of stay was in the North-east (12.2 ± 14.9 days), while the longest was in the North-west (15.2 ± 17.9 days). All eight regions had higher odds of death compared to London, ranging from OR 1.04 (95% CI 1.00, 1.07) in the South-west to OR 1.24 (95% CI 1.21, 1.28) in the North-west. Older age, Asian ethnicity, emergency admission, transfers from other hospitals, AKI presence, ITU admission, social deprivation, and comorbidity were associated with higher odds of death. AKI incidence was 30.3%, and all regions had lower odds of developing AKI compared to London. Increasing age, mixed and black ethnicity, emergency admission, transfers from other providers, ITU care, and different levels of comorbidity were associated with higher odds of developing AKI. CONCLUSIONS London exhibited higher hospital admission numbers and AKI incidence, but lower odds of death compared to other regions in England. TRIAL REGISTRATION Registered on National Library of Medicine website ( www. CLINICALTRIALS gov ) with registration number NCT04579562 on 8/10/2020.
Collapse
Affiliation(s)
- Nitin V Kolhe
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK.
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Richard J Fluck
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maarten W Taal
- University Hospitals of Derby and Burton NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
5
|
Expression of Concern: An integrated view on society readiness and initial reaction to COVID-19: A study across European countries. PLoS One 2023; 18:e0294386. [PMID: 37943767 PMCID: PMC10635477 DOI: 10.1371/journal.pone.0294386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
|
6
|
Palus DK, Gołębiewska ME, Piątek O, Grudziński K, Majeranowski A, Owczuk R, Kuziemski K, Stefaniak T. Analysing COVID-19 treatment outcomes in dedicated wards at a large university hospital in northern Poland: a result-based observational study. BMJ Open 2023; 13:e066734. [PMID: 37308272 DOI: 10.1136/bmjopen-2022-066734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES Presenting outcomes of patients hospitalised for COVID-19 should be put in context and comparison with other facilities. However, varied methodology applied in published studies can impede or even hinder a reliable comparison. The aim of this study is to share our experience in pandemic management and highlight previously under-reported factors affecting mortality. We present outcomes of COVID-19 treatment in our facility that will allow for an intercentre comparison. We use simple statistical parameters-case fatality ratio (CFR) and length of stay (LOS). SETTING Large clinical hospital in northern Poland serving over 120 000 patients annually. PARTICIPANTS Data were collected from patients hospitalised in COVID-19 general and intensive care unit (ICU) isolation wards from November 2020 to June 2021. The sample consisted of 640 patients-250 (39.1 %) were women and 390 (60.9 %) were men, with a median age of 69 (IQR 59-78) years. RESULTS Values of LOS and CFR were calculated and analysed. Overall CFR for the analysed period was 24.8%, varying from 15.9 % during second quarter 2021 to 34.1% during fourth quarter 2020. The CFR was 23.2% in the general ward and 70.7% in the ICU. All ICU patients required intubation and mechanical ventilation, and 44 (75.9 %) of them developed acute respiratory distress syndrome. The average LOS was 12.6 (±7.5) days. CONCLUSIONS We highlighted the importance of some of the under-reported factors affecting CFR, LOS and thus, mortality. For further multicentre analysis, we recommend broad analysis of factors affecting mortality in COVID-19 using simple and transparent statistical and clinical parameters.
Collapse
Affiliation(s)
- Damian Krystian Palus
- Faculty of Medicine, Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | | | - Olga Piątek
- Faculty of Medicine, Department of Pulmonology and Allergology, Medical University of Gdansk, Gdansk, Poland
- Faculty of Medicine, Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Gdansk, Poland
| | | | - Alan Majeranowski
- Department of Hematology and Transplantology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Department of Cell Biology and Immunology, Intercollegiate Faculty of Biotechnology, University of Gdansk, Medical University of Gdansk, Gdansk, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Kuziemski
- Faculty of Medicine, Department of Pulmonology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Stefaniak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Board of Directors, University Clinical Center of Medical University of Gdansk, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
7
|
Gray WK, Navaratnam AV, Day J, Heyl J, Hardy F, Wheeler A, Eve-Jones S, Briggs TWR. Role of hospital strain in determining outcomes for people hospitalised with COVID-19 in England. Emerg Med J 2023:emermed-2023-213329. [PMID: 37236779 DOI: 10.1136/emermed-2023-213329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes. METHODS This was a retrospective observational study using Hospital Episode Statistics data for England. All unique patients aged ≥18 years in England with a diagnosis of COVID-19 who had a completed (discharged alive or died in hospital) hospital stay with an admission date between 1 July 2020 and 28 February 2021 were included. Bed-strain was calculated as the number of beds occupied by patients with COVID-19 divided by the maximum COVID-19 bed occupancy during the study period. Bed-strain was categorised into quartiles for modelling. In-hospital mortality was the primary outcome of interest and length of stay a secondary outcome. RESULTS There were 253 768 unique hospitalised patients with a diagnosis of COVID-19 during a hospital stay. Patient admissions peaked in January 2021 (n=89 047), although the crude mortality rate peaked slightly earlier in December 2020 (26.4%). After adjustment for covariates, the mortality rate in the lowest and highest quartile of bed-strain was 23.6% and 25.3%, respectively (OR 1.13, 95% CI 1.09 to 1.17). For the lowest and the highest quartile of bed-strain, adjusted mean length of stay was 13.2 days and 11.6 days, respectively in survivors and was 16.5 days and 12.6 days, respectively in patients who died in hospital. CONCLUSIONS High levels of bed-strain were associated with higher in-hospital mortality rates, although the effect was relatively modest and may not fully explain increased mortality rates during winter 2020/21 compared with earlier months. Shorter hospital stay during periods of greater strain may partly reflect changes in patient management over time.
Collapse
Affiliation(s)
- William K Gray
- Getting It Right First Time programme, NHS England, London, UK
| | | | - Jamie Day
- Getting It Right First Time programme, NHS England, London, UK
| | - Johannes Heyl
- Getting It Right First Time programme, NHS England, London, UK
- Department of Physics and Astronomy, University College London, London, UK
| | - Flavien Hardy
- Getting It Right First Time programme, NHS England, London, UK
| | - Andrew Wheeler
- Getting It Right First Time programme, NHS England, London, UK
| | - Sue Eve-Jones
- Getting It Right First Time programme, NHS England, London, UK
| | - Tim W R Briggs
- Getting It Right First Time programme, NHS England, London, UK
- Department of Surgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
| |
Collapse
|
8
|
Wang L, Calzavara A, Baral S, Smylie J, Chan AK, Sander B, Austin PC, Kwong JC, Mishra S. Differential Patterns by Area-Level Social Determinants of Health in Coronavirus Disease 2019 (COVID-19)-Related Mortality and Non-COVID-19 Mortality: A Population-Based Study of 11.8 Million People in Ontario, Canada. Clin Infect Dis 2023; 76:1110-1120. [PMID: 36303410 PMCID: PMC9620355 DOI: 10.1093/cid/ciac850] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Social determinants of health (SDOH) have been associated with coronavirus disease 2019 (COVID-19) outcomes. We examined patterns in COVID-19-related mortality by SDOH and compared these patterns to those for non-COVID-19 mortality. METHODS Residents of Ontario, Canada, aged ≥20 years were followed from 1 March 2020 to 2 March 2021. COVID-19-related death was defined as death within 30 days following or 7 days prior to a positive COVID-19 test. Area-level SDOH from the 2016 census included median household income; proportion with diploma or higher educational attainment; proportion essential workers, racially minoritized groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality, and non-COVID-19 mortality using cause-specific hazard models. RESULTS Of 11 810 255 individuals, we observed 3880 COVID-19-related deaths and 88 107 non-COVID-19 deaths. After accounting for demographics, baseline health, and other area-level SDOH, the following were associated with increased hazards of COVID-19-related death (hazard ratio [95% confidence interval]: lower income (1.30 [1.04-1.62]), lower educational attainment (1.27 [1.07-1.52]), higher proportions essential workers (1.28 [1.05-1.57]), racially minoritized groups (1.42 [1.08-1.87]), apartment buildings (1.25 [1.07-1.46]), and large vs medium household size (1.30 [1.12-1.50]). Areas with higher proportion racially minoritized groups were associated with a lower hazard of non-COVID-19 mortality (0.88 [0.84-0.92]). CONCLUSIONS Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially minoritized groups. Pandemic responses should include strategies to address disproportionate risks and inequitable coverage of preventive interventions associated with SDOH.
Collapse
Affiliation(s)
- Linwei Wang
- MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janet Smylie
- MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Well Living House, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Beate Sander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Correspondence: S. Mishra, MAP-Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, University of Toronto, 209 Victoria St, Toronto, ON, Canada, M5B 1T8 ()
| |
Collapse
|
9
|
Mukherjee A, Kumar G, Turuk A, Bhalla A, Bingi TC, Bhardwaj P, Baruah TD, Mukherjee S, Talukdar A, Ray Y, John M, Khambholja JR, Patel AH, Bhuniya S, Joshi R, Menon GR, Sahu D, Rao VV, Bhargava B, Panda S. Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection. QJM 2023; 116:47-56. [PMID: 36053197 PMCID: PMC9494346 DOI: 10.1093/qjmed/hcac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). METHODS NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. RESULTS Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6-7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4-0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3-0.7)] were protected from in-hospital mortality. CONCLUSIONS WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.
Collapse
Affiliation(s)
| | | | - Alka Turuk
- Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Pankaj Bhardwaj
- All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Subhasis Mukherjee
- College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | | | - Yogiraj Ray
- Infectious Disease And Beliaghata Hospital, Kolkata, West Bengal, India
| | - Mary John
- Christian Medical College, Ludhiana, Punjab, India
| | | | | | - Sourin Bhuniya
- All India Institute Of Medical Sciences, Bhubaneswar, India
| | - Rajnish Joshi
- All India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Geetha R Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Vishnu Vardhan Rao
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | | | | | - NCRC Study team
MishraPuspendraMCANational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaPanchalYashminPGDISADNational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaSharmaLokesh KumarPhDIndian Council of Medical Research, New Delhi, IndiaAgarwalAnupMBBSMedstar Health, Baltimore, Maryland, United States of AmericaPuriG DMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSuriVikasMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSinglaKaranMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaMesipoguRajaraoMDGandhi Medical College, Telangana, IndiaAedulaVinaya SekharMDGandhi Medical College, Telangana, IndiaMohiuddinMohammed AyazMDGandhi Medical College, Telangana, IndiaKumarDeepakMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaSaurabhSumanMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaMisraSanjeevMChAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaKannaujePankaj KumarMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaKumarAjitMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaShuklaArvindPhDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaPalAmitavaMDCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaChakrabortyShreetamaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaDuttaMoumitaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaMondalTanushreeMDMedical College, Kolkata, West Bengal, IndiaChakravortySarmisthaMScMedical College, Kolkata, West Bengal, IndiaBhattacharjeeBoudhyanMDMedical College, Kolkata, West Bengal, IndiaPaulShekhar RanjanDTCDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaMajumderDebojyotiMDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaChatterjeeSubhrangaMBBSInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaAbrahamAbinMDChristian Medical College, Ludhiana, Punjab, IndiaVargheseDivyaMDChristian Medical College, Ludhiana, Punjab, IndiaThomasMariaMDChristian Medical College, Ludhiana, Punjab, IndiaShahNiteshMDCIMS Hospital, Ahmedabad, IndiaPatelMineshMDCIMS Hospital, Ahmedabad, IndiaMadanSurabhiMDCIMS Hospital, Ahmedabad, IndiaDesaiAnitaPhDNational Institute Of Mental Health And Neurosciences, Bangalore, Karnataka, IndiaM LKala YadhavMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaRMadhumathiMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaG SChetnaMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaOjhaU KMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaJhaRavi RanjanShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaKumarAvinashMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaPathakAshishPhDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSharmaAshishMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaPurohitManjuMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSarangiLisaMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaRathMaheshMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaShahArti DDNBDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaKumarLavleshMDDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaPatelPrinceeMBBSDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaDulhaniNaveenMDLate BRK Memorial Medical College, Jagdalpur, Chhattisgarh, IndiaDubeSimmiMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaShrivastavaJyotsnaMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaMittalArvindMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaPatnaikLipilekhaMDInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSahooJagdish PrasadDMInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSharmaSumitaInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaKatyalV KMD, FACCPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaKatyalAshimaMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaYadavNidhiMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaUpadhyayRashmiMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaSaurabhMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaAnuragMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSutharNilay NMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaShahNehal MMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaRajvanshKrutiMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaPurohitHemangMScSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaMohapatraPrasanta RaghabMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaPanigrahiManoj KumarMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaSaigalSaurabhMD, EDICAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaKhuranaAlkeshMDAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaPanchalManishaMDGMERS Medical College Himmatnagar, Gujarat, IndiaAnderpaMayankMDGMERS Medical College Himmatnagar, Gujarat, IndiaPatelDhruvMBBSGMERS Medical College Himmatnagar, Gujarat, IndiaSalgarVeereshMDGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaAlgurSantoshMBBSGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaChoudhuryRatnamalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaRaoMangalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaDNithyaMScSt. Johns Medical College, Bengaluru, Karnataka, IndiaGuptaBal KishanMDS.P.Medical College, Bikaner, Rajasthan, IndiaKumarBhuvaneshMDS.P.Medical College, Bikaner, Rajasthan, IndiaGuptaJigyasaMBBSS.P.Medical College, Bikaner, Rajasthan, IndiaBhandariSudhirMDSMS Medical College, Jaipur, Rajasthan, IndiaAgrawalAbhishekMDSMS Medical College, Jaipur, Rajasthan, IndiaShameemMohammadMD, FRCPJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaFatimaNazishMDJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaPalaStarMDNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaNongpiurVijayDMNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaChatterjiSoumyadipDMTata Medical Centre, Kolkata, West Bengal, IndiaMukherjeeSudiptaFNBTata Medical Centre, Kolkata, West Bengal, IndiaShivnitwarSachin KMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaTripathySrikanthMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaLokhandePrajaktaMPHDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaDanduHimanshuMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaGuptaAmitMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaKumarVivekMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaSharmaNikitaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaVohraRajatMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaPaliwalArchanaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaKumarM PavanMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaRaoA BikshapathiMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaKikonNyanthungPGDPHMDepartment of Health & Family Welfare, Government of Nagaland, Nagaland, IndiaKikonRhondemoMScIHCommunity Health Initiative, Nagaland, IndiaManoharKMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaRajuY SathyanarayanaMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaMadhariaArunMSESI Hospital and Gayatri Hospital, Raipur, Chhattisgarh, IndiaChakravartyJayaMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaChaubeyManaswiMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaBandaruRajiv KumarMDESIC medical College, Sanathnagar, Hyderabad. IndiaMirzaMehdi AliDMESIC medical College, Sanathnagar, Hyderabad. IndiaKatariaSushilaMDMedanta-The Medicity, Gurugram, Haryana, IndiaSharmaPoojaMedanta-The Medicity, Gurugram, Haryana, IndiaGhoshSoumitraMDInstitute of Postgraduate Medical Education & Research, Kolkata, West BengalHazraAvijitMDInstitute of Postgraduate Medical Education & Research, Kolkata, West Bengal
| |
Collapse
|
10
|
Salter B, DeBenedictis B, Spatafora L, Kapralik J, Luo C, Qiu S, Dawson L, Junek M, Pitre T, Jones A, Beauchamp M, Kruisselbrink R, Duong M, Costa AP, Tsang JL, Ho T. Hospitalised COVID-19 outcomes are predicted by hypoxaemia and pneumonia phenotype irrespective of the timing of their emergence. BMJ Open 2022; 12:e062453. [PMID: 36581424 PMCID: PMC9805826 DOI: 10.1136/bmjopen-2022-062453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Despite the known clinical importance of hypoxemia and pneumonia, there is a paucity of evidence for these variables with respect to risk of mortality and short-term outcomes among those hospitalised with COVID-19. OBJECTIVE Describe the prevalence and clinical course of patients hospitalised with COVID-19 based on oxygenation and pneumonia status at presentation and determine the incidence of emergent hypoxaemia or radiographic pneumonia during admission. METHODS A retrospective study was conducted using a Canadian regional registry. Patients were stratified according to hypoxaemia/pneumonia phenotype and prevalence. Clinical parameters were compared between phenotypes using χ2 and one-way Analysis of variance (ANOVA). Cox analysis estimated adjusted Hazard Ratios (HR) for associations between disease outcomes and phenotypes. RESULTS At emergency department (ED) admission, the prevalence of pneumonia and hypoxaemia was 43% and 50%, respectively, and when stratified to phenotypes: 28.2% hypoxaemia+/pneumonia+, 22.2% hypoxaemia+/pneumonia-, 14.5% hypoxaemia-/pneumonia+ and 35.1% hypoxaemia-/pneumonia-. Mortality was 31.1% in the hypoxaemia+/pneumonia- group and 26.3% in the hypoxaemia+/pneumonia+ group. Hypoxaemia with pneumonia and without pneumonia predicted higher probability of death. Hypoxaemia either <24 hours or ≥24 hours after hospitalisation predicted higher mortality and need for home oxygen compared with those without hypoxaemia. Patients with early hypoxaemia had higher probability of Intensive care unit (ICU) admission compared with those with late hypoxaemia. CONCLUSION Mortality in COVID-19 infection is predicted by hypoxaemia with or without pneumonia and was greatest in patients who initially presented with hypoxaemia. The emergence of hypoxaemia was predicted by radiographic pneumonia. Patients with early and emergent hypoxaemia had similar mortality but were less likely to be admitted to ICU. There may be delayed identification of hypoxaemia, which prevents timely escalation of care.
Collapse
Affiliation(s)
- Brittany Salter
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Laura Spatafora
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Kapralik
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Candice Luo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven Qiu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Dawson
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mats Junek
- Department of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - MyLinh Duong
- Respirology, McMaster University, Hamilton, Ontario, Canada
| | | | - Jennifer Ly Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, Niagara Health System - Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Terence Ho
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Respirology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
11
|
Cooper DJ, Lear S, Sithole N, Shaw A, Stark H, Ferris M, Bradley J, Maxwell P, Goodfellow I, Weekes MP, Seaman S, Baker S. Demographic, behavioural and occupational risk factors associated with SARS-CoV-2 infection in UK healthcare workers: a retrospective observational study. BMJ Open 2022; 12:e063159. [PMID: 36343994 PMCID: PMC9644078 DOI: 10.1136/bmjopen-2022-063159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection than the general population. This group is pivotal to healthcare system resilience during the COVID-19, and future, pandemics. We investigated demographic, social, behavioural and occupational risk factors for SARS-CoV-2 infection among HCWs. DESIGN/SETTING/PARTICIPANTS HCWs enrolled in a large-scale sero-epidemiological study at a UK university teaching hospital were sent questionnaires spanning a 5-month period from March to July 2020. In a retrospective observational cohort study, univariate logistic regression was used to assess factors associated with SARS-CoV-2 infection. A Least Absolute Shrinkage Selection Operator regression model was used to identify variables to include in a multivariate logistic regression model. RESULTS Among 2258 HCWs, highest ORs associated with SARS-CoV-2 antibody seropositivity on multivariate analysis were having a household member previously testing positive for SARS-CoV-2 antibodies (OR 6.94 (95% CI 4.15 to 11.6); p<0.0001) and being of black ethnicity (6.21 (95% CI 2.69 to 14.3); p<0.0001). Occupational factors associated with a higher risk of seropositivity included working as a physiotherapist (OR 2.78 (95% CI 1.21 to 6.36); p=0.015) and working predominantly in acute medicine (OR 2.72 (95% CI 1.57 to 4.69); p<0.0001) or medical subspecialties (not including infectious diseases) (OR 2.33 (95% CI 1.4 to 3.88); p=0.001). Reporting that adequate personal protective equipment (PPE) was 'rarely' available had an OR of 2.83 (95% CI 1.29 to 6.25; p=0.01). Reporting attending a handover where social distancing was not possible had an OR of 1.39 (95% CI 1.02 to 1.9; p=0.038). CONCLUSIONS The emergence of SARS-CoV-2 variants and potential vaccine escape continue to threaten stability of healthcare systems worldwide, and sustained vigilance against HCW infection remains a priority. Enhanced risk assessments should be considered for HCWs of black ethnicity, physiotherapists and those working in acute medicine or medical subspecialties. Workplace risk reduction measures include ongoing access to high-quality PPE and effective social distancing measures.
Collapse
Affiliation(s)
- Daniel James Cooper
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara Lear
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nyarie Sithole
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley Shaw
- Medical Director's Office, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Stark
- NIHR Bioresource, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark Ferris
- Occupational Health, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bradley
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Patrick Maxwell
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Goodfellow
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Michael P Weekes
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Shaun Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
12
|
Gray WK, Navaratnam AV, Day J, Wendon J, Briggs TWR. COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study. Thorax 2022; 77:1113-1120. [PMID: 34819384 PMCID: PMC8616641 DOI: 10.1136/thoraxjnl-2021-218025] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We aimed to examine the profile of, and outcomes for, all people hospitalised with COVID-19 across the first and second waves of the pandemic in England. METHODS This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1 March 2020 and 31 March 2021 were included. In-hospital mortality was the primary outcome of interest. The second wave was identified as starting on 1 September 2020. Multilevel logistic regression modelling was used to investigate the relationship between mortality and demographic, comorbidity and temporal covariates. RESULTS Over the 13 months, 374 244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 93 701 (25%) died in hospital. Adjusted mortality rates fell from 40%-50% in March 2020 to 11% in August 2020 before rising to 21% in January 2021 and declining steadily to March 2021. Improvements in mortality rates were less apparent in older and comorbid patients. Although mortality rates fell for all ethnic groups from the first to the second wave, declines were less pronounced for Bangladeshi, Indian, Pakistani, other Asian and black African ethnic groups. CONCLUSIONS There was a substantial decline in adjusted mortality rates during the early part of the first wave which was largely maintained during the second wave. The underlying reasons for consistently higher mortality risk in some ethnic groups merits further study.
Collapse
Affiliation(s)
- William K Gray
- Getting It Right First Time, NHS England and NHS Improvement London, London, UK
| | - Annakan V Navaratnam
- Getting It Right First Time, NHS England and NHS Improvement London, London, UK
- Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamie Day
- Getting It Right First Time, NHS England and NHS Improvement London, London, UK
| | - Julia Wendon
- Liver Intensive Care Unit, King's College London, London, UK
| | - Tim W R Briggs
- Getting It Right First Time, NHS England and NHS Improvement London, London, UK
| |
Collapse
|
13
|
Length of hospital stay and survival of hospitalized COVID-19 patients during the second wave of the pandemic: A single centre retrospective study from Slovenia. Zdr Varst 2022; 61:201-208. [DOI: 10.2478/sjph-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
As of writing, there are no publications pertaining to the prediction of COVID-19-related outcomes and length of stay in patients from Slovene hospitals.
Objectives
To evaluate the length of regular ward and ICU stays and assess the survival of COVID-19 patients to develop better prediction models to forecast hospital capacity and staffing demands in possible further pandemic peaks.
Methods
In this retrospective, single-site study we analysed the length of stay and survival of all patients, hospitalized due to the novel coronavirus (COVID-19) at the peak of the second wave, between November 18th 2020 and January 27th 2021 at the University Clinic Golnik, Slovenia.
Results
Out of 407 included patients, 59% were male. The median length of stay on regular wards was 7.5 (IQR 5–13) days, and the median ICU length of stay was 6 (IQR 4–11) days. Age, male sex, and ICU stay were significantly associated with a higher risk of death. The probability of dying in 21 days at the regular ward was 14.4% (95% CI [10.9–18%]) and at the ICU it was 43.6% (95% CI [19.3-51.8%]).
Conclusion
The survival of COVID-19 is strongly affected by age, sex, and the fact that a patient had to be admitted to ICU, while the length of hospital bed occupancy is very similar across different demographic groups. Knowing the length of stay and admission rate to ICU is important for proper planning of resources during an epidemic.
Collapse
|
14
|
Bignon E, Monari A. Modeling the Enzymatic Mechanism of the SARS-CoV-2 RNA-Dependent RNA Polymerase by DFT/MM-MD: An Unusual Active Site Leading to High Replication Rates. J Chem Inf Model 2022; 62:4261-4269. [PMID: 35982544 PMCID: PMC9437665 DOI: 10.1021/acs.jcim.2c00802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 12/24/2022]
Abstract
Viral infection relies on the hijacking of cellular machineries to enforce the reproduction of the infecting virus and its subsequent diffusion. In this context, the replication of the viral genome is a key step performed by specific enzymes, i.e., polymerases. The replication of SARS-CoV-2, the causative agent of the COVID-19 pandemics, is based on the duplication of its RNA genome, an action performed by the viral RNA-dependent RNA polymerase. In this contribution, by using highly demanding DFT/MM-MD computations coupled to 2D-umbrella sampling techniques, we have determined the chemical mechanisms leading to the inclusion of a nucleotide in the nascent viral RNA strand. These results highlight the high efficiency of the polymerase, which lowers the activation free energy to less than 10 kcal/mol. Furthermore, the SARS-CoV-2 polymerase active site is slightly different from those usually found in other similar enzymes, and in particular, it lacks the possibility to enforce a proton shuttle via a nearby histidine. Our simulations show that this absence is partially compensated by lysine whose proton assists the reaction, opening up an alternative, but highly efficient, reactive channel. Our results present the first mechanistic resolution of SARS-CoV-2 genome replication at the DFT/MM-MD level and shed light on its unusual enzymatic reactivity paving the way for the future rational design of antivirals targeting emerging RNA viruses.
Collapse
Affiliation(s)
- Emmanuelle Bignon
- Université
de Lorraine and CNRS, LPCT UMR 7019, F-54000 Nancy, France
| | - Antonio Monari
- Université
de Lorraine and CNRS, LPCT UMR 7019, F-54000 Nancy, France
- Université
de Paris, CNRS, ITODYS, F-75006 Paris, France
| |
Collapse
|
15
|
Sasson J, Donlan AN, Ma JZ, Haughey HM, Coleman R, Nayak U, Mathers AJ, Laverdure S, Dewar R, Jackson PEH, Heysell SK, Sturek JM, Petri WA. Safety and Efficacy of Dupilumab for the Treatment of Hospitalized Patients With Moderate to Severe Coronavirus Disease 2019: A Phase 2a Trial. Open Forum Infect Dis 2022; 9:ofac343. [PMID: 35959207 PMCID: PMC9361171 DOI: 10.1093/ofid/ofac343] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background Based on studies implicating the type 2 cytokine interleukin 13 (IL-13) as a potential contributor to critical coronavirus disease 2019 (COVID-19), this trial was designed as an early phase 2 study to assess dupilumab, a monoclonal antibody that blocks IL-13 and interleukin 4 signaling, for treatment of inpatients with COVID-19. Methods We conducted a phase 2a randomized, double-blind, placebo-controlled trial (NCT04920916) to assess the safety and efficacy of dupilumab plus standard of care vs placebo plus standard of care in mitigating respiratory failure and death in those hospitalized with COVID-19. Results Forty eligible subjects were enrolled from June to November of 2021. There was no statistically significant difference in adverse events nor in the primary endpoint of ventilator-free survival at day 28 between study arms. However, for the secondary endpoint of mortality at day 60, there were 2 deaths in the dupilumab group compared with 5 deaths in the placebo group (60-day survival: 89.5% vs 76.2%; adjusted hazard ratio [HR], 0.05 [95% confidence interval {CI}, .004-.72]; P = .03). Among subjects who were not in the intensive care unit (ICU) at randomization, 3 subjects in the dupilumab arm were admitted to the ICU compared to 6 in the placebo arm (17.7% vs 37.5%; adjusted HR, 0.44 [95% CI, .09-2.09]; P = .30). Last, we found evidence of type 2 signaling blockade in the dupilumab group through analysis of immune biomarkers over time. Conclusions Although the primary outcome of day 28 ventilator-free survival was not reached, adverse events were not observed and survival was higher in the dupilumab group by day 60. Clinical Trials Registration NCT04920916.
Collapse
Affiliation(s)
- Jennifer Sasson
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Alexandra N Donlan
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Heather M Haughey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rachael Coleman
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Uma Nayak
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Amy J Mathers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sylvain Laverdure
- Laboratory of Human Retrovirology and Immunoinformatics, Frederick National Laboratory, Frederick, Maryland, USA
| | - Robin Dewar
- Virus Isolation and Serology Laboratory, Frederick National Laboratory, Frederick, Maryland, USA
| | - Patrick E H Jackson
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jeffrey M Sturek
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - William A Petri
- Correspondence: William A. Petri Jr., MD, PhD, University of Virginia, 345 Crispell Drive, Charlottesville, VA 22908-1340, USA ()
| |
Collapse
|
16
|
Abdi S, Nemati S, Nederi Darbaghshahi N, Mohammadi M, Saeedi E, Naji P, Taheri N, Qandian A, Joshang N, Fattahi P, Namdar P, Vand Rajabpour M. Trends of in-Hospital and ICU Mortality in COVID-19 Patients Over the Fourth and Fifth COVID-19 Surges in Iran: A Retrospective Cohort Study from Iran. Int J Qual Health Care 2022; 34:6650059. [PMID: 35880708 PMCID: PMC9384579 DOI: 10.1093/intqhc/mzac063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/26/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
Objective The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran. Design We performed an observational retrospective cohort study. Setting Qazvin Province- Iran during 6 month from April to September 2021. Participants All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province. Intervention No intervention. Main outcome measures The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value < 0.001). Conclusions We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.
Collapse
Affiliation(s)
- Sepideh Abdi
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Nemati
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nederi Darbaghshahi
- Emergency Medicine Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadi
- Emergency Medicine Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Saeedi
- Biostatistics Group, Health Sciences Department, University of Leicester, Leicester, UK
| | - Parnian Naji
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Taheri
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Qandian
- Communicable disease office, Deputy of Heath, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Narges Joshang
- Communicable disease office, Deputy of Heath, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Pedram Fattahi
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Student Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Peyman Namdar
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mojtaba Vand Rajabpour
- Cancer Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Damiri S, Shojaee A, Dehghani M, Shahali Z, Abbasi S, Daroudi R. National geographical pattern of COVID-19 hospitalization, case fatalities, and associated factors in patients covered by Iran Health Insurance Organization. BMC Public Health 2022; 22:1274. [PMID: 35773657 PMCID: PMC9243909 DOI: 10.1186/s12889-022-13649-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background Understanding the Spatio-temporal distribution and interpersonal comparisons are important tools in etiological studies. This study was conducted to investigate the temporal and geographical distribution of COVID-19 hospitalized patients in the Iran Health Insurance Organization (IHIO) insured population (the second largest social health insurance organization) and the factors affecting their case fatality rate (CFR). Methods In this descriptive-analytical cross-sectional study, the demographic and clinical data of all insured of the IHIO who were hospitalized with COVID-19 in hospitals across the country until March 2021 was extracted from the comprehensive system of handling the inpatient documents of this organization. The Excel 2019 and GeoDA software were used for descriptive reporting and geographical distribution of variables. A multiple logistic regression model was used to estimate the Odds Ratio (OR) of death in patients with COVID-19 using STATA 14 software. Results During the first 14 months of the COVID-19 outbreak in Iran, 0.72% of the IHIO insured (303,887 individuals) were hospitalized with COVID-19. Hospitalization per 100,000 people varied from 192.51 in East Azerbaijan to 1,277.49 in Yazd province. The overall CFR in hospitalized patients was 14%. Tehran and Kohgiluyeh & BoyerAhmad provinces had the highest and lowest CFR with 19.39% and 5.19%, respectively. The highest odds of death were in those over 80 years old people (OR = 9.65), ICU-admitted (OR = 7.49), Hospitalized in governmental hospitals (OR = 2.08), Being a foreign national (OR = 1.45), hospitalized in November (OR = 1.47) and Residence in provinces such as Sistan & Baluchestan (OR = 1.47) and Razavi Khorasan (OR = 1.66) respectively. Furthermore, the odds of death were lower in females (OR = 0.81) than in males. Conclusions A sound understanding of the primary causes of COVID-19 death and severity in different groups can be the basis for developing programs focused on more vulnerable groups in order to manage the crisis more effectively and benefit from resources more efficiently. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13649-0.
Collapse
Affiliation(s)
- Soheila Damiri
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave., Tehran, 1417613191, Iran
| | - Ali Shojaee
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave., Tehran, 1417613191, Iran.,National Center for Health Insurance Research, Tehran, Iran
| | - Mohsen Dehghani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
| | | | | |
Collapse
|
18
|
Bottle A, Faitna P, Brett S, Aylin P. Factors associated with, and variations in, COVID-19 hospital death rates in England's first two waves: observational study. BMJ Open 2022; 12:e060251. [PMID: 35772812 PMCID: PMC9247323 DOI: 10.1136/bmjopen-2021-060251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess patient-level and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England's first two waves after accounting for random variation. To quantify the correlation between hospitals' first and second wave death rates. DESIGN Observational study using administrative data. SETTING Acute non-specialist hospitals in England. PARTICIPANTS All patients admitted with a primary diagnosis of COVID-19. PRIMARY AND SECONDARY OUTCOMES In-hospital death. RESULTS Hospital Episode Statistics (HES) data were extracted for all acute hospitals in England for COVID-19 admissions from March 2020 to March 2021. In wave 1 (March to July 2020), there were 74 484 admissions and 21 883 deaths (crude rate 29.4%); in wave 2 (August 2020 to March 2021), there were 165 642 admissions and 36 040 deaths (21.8%). Wave 2 patients were younger, with more hypertension and obesity but lower rates of other comorbidities. Mortality improved for all ages; in wave 2, it peaked in December 2020 at 24.2% (lower than wave 1's peak) but halved by March 2021. In multiple multilevel modelling combining HES with hospital-level data from Situational Reports, wave 2 and wave 1 variables significantly associated with death were mostly the same. The median odds ratio for wave 1 was just 1.05 and for wave 2 was 1.07. At 99.8% control limits, 3% of hospitals were high and 7% were low funnel plot outliers in wave 1; these figures were 9% and 12% for wave 2. Four hospitals were (low) outliers in both waves. The correlation between hospitals' adjusted mortality rates between waves was 0.45 (p<0.0001). Length of stay was similar in each wave. CONCLUSIONS England's first two COVID-19 waves were similar regarding predictors and moderate interhospital variation. Despite the challenges, variation in death rates and length of stay between hospitals was modest and might be accounted for by unobserved patient factors.
Collapse
Affiliation(s)
- Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Puji Faitna
- School of Public Health, Imperial College London, London, UK
| | - Stephen Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
- Critical Care, Imperial College Healthcare NHS Trust, London, UK
| | - Paul Aylin
- School of Public Health, Imperial College London, London, UK
| |
Collapse
|
19
|
Xia Y, Ma H, Buckeridge DL, Brisson M, Sander B, Chan A, Verma A, Ganser I, Kronfli N, Mishra S, Maheu-Giroux M. Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves. Int J Infect Dis 2022; 121:1-10. [PMID: 35477050 PMCID: PMC9040412 DOI: 10.1016/j.ijid.2022.04.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Epidemics of COVID-19 strained hospital resources. We describe temporal trends in mortality risk and length of stays in hospital and intensive care units (ICUs) among patients with COVID-19 hospitalized through the first three epidemic waves in Canada. Methods We used population-based provincial hospitalization data from the epicenters of Canada's epidemics (Ontario and Québec). Adjusted estimates were obtained using marginal standardization of logistic regression models, accounting for patient-level and hospital-level determinants. Results Using all hospitalizations from Ontario (N = 26,538) and Québec (N = 23,857), we found that unadjusted in-hospital mortality risks peaked at 31% in the first wave and was lowest at the end of the third wave at 6–7%. This general trend remained after adjustments. The odds of in-hospital mortality in the highest patient load quintile were 1.2-fold (95% CI: 1.0–1.4; Ontario) and 1.6-fold (95% CI: 1.3–1.9; Québec) that of the lowest quintile. Mean hospital and ICU length of stays decreased over time but ICU stays were consistently higher in Ontario than Québec. Conclusions In-hospital mortality risks and length of ICU stays declined over time despite changing patient demographics. Continuous population-based monitoring of patient outcomes in an evolving epidemic is necessary for health system preparedness and response.
Collapse
Affiliation(s)
- Yiqing Xia
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marc Brisson
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Beate Sander
- Management and Evaluation (IHPME), Dalla Lana School of Public Health, Institute of Health Policy, University of Toronto; Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network; Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Adrienne Chan
- Management and Evaluation (IHPME), Dalla Lana School of Public Health, Institute of Health Policy, University of Toronto; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aman Verma
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Iris Ganser
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, QC, Canada; Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Management and Evaluation (IHPME), Dalla Lana School of Public Health, Institute of Health Policy, University of Toronto; Institute of Medical Sciences, University of Toronto
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada.
| |
Collapse
|
20
|
Singh P, Mandal A, Singh D, Kumar S, Kumar A, Rakesh A, Ranjan R, Verma M, Rai DK, Bhushan D, Shankar A, Sinha A, Saini R, Saha A, Thovarayi A, Baral AK, Chauhan S, Kumar R, Kakoty P, Modak B, Ranjan A. Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study. Front Oncol 2022; 12:822902. [PMID: 35425707 PMCID: PMC9002137 DOI: 10.3389/fonc.2022.822902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Treatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease. Methods Patients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities. Findings At the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups. Interpretation LDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia. Funding An intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India. Clinical Trial Registration Clinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php.
Collapse
Affiliation(s)
- Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Avik Mandal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Dharmendra Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Subhash Kumar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Patna, India
| | - Amarjeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Amrita Rakesh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rakesh Ranjan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Manika Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Deependra Kumar Rai
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| | - Divendu Bhushan
- Department of General Medicine, All India Institute of Medical Sciences, Patna, India
| | - Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Arkaprava Sinha
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rohit Saini
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Arijit Saha
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Ashwin Thovarayi
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Anindya Kumar Baral
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Samyak Chauhan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rajhans Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Priya Kakoty
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Bithika Modak
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Alok Ranjan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| |
Collapse
|
21
|
Sasson J, Donlan AN, Ma JZ, Haughey HM, Coleman R, Nayak U, Mathers AJ, Laverdure S, Dewar R, Jackson PEH, Heysell SK, Sturek JM, Petri WA. Safety and Efficacy of Dupilumab for the Treatment of Hospitalized Patients with Moderate to Severe COVID 19: A Phase IIa Trial.. [PMID: 35411349 PMCID: PMC8996634 DOI: 10.1101/2022.03.30.22273194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: A profound need remains to develop further therapeutics for treatment of those hospitalized with COVID-19. Based on data implicating the type 2 cytokine interleukin (IL)-13 as a significant factor leading to critical COVID-19, this trial was designed to assess dupilumab, a monoclonal antibody that blocks IL-13 and IL-4 signaling, for treatment of inpatients with COVID-19. Methods: We conducted a phase IIa randomized double-blind placebo-controlled trial to assess the safety and efficacy of dupilumab plus standard of care versus placebo plus standard of care in mitigating respiratory failure and death in those hospitalized with COVID-19. Subjects were followed prospectively for 60 days. The primary endpoint was the proportion of patients alive and free of invasive mechanical ventilation at 28 days. Findings: Forty eligible subjects were enrolled from June to November of 2021. There was no difference in adverse events nor in ventilator free survival at day 28 between study arms. However, for the secondary endpoint of mortality at day 60, subjects randomized to dupilumab had a higher survival rate compared to the placebo group (89.5% vs 76.2%, adjusted HR 0.05, 95% CI: 0.0–0.72, p=0.03). There were fewer subjects admitted to the ICU in the dupilumab group compared to placebo (33.3% vs 66.7%; adjusted HR 0.44, 95% CI: 0.09–2.09, p=0.30). Lastly, we saw downstream evidence of IL-4 and IL-13 signaling blockade in the dupilumab group through analysis of immune biomarkers over time. Interpretation: Dupilumab was well tolerated and improved 60-day survival in patients hospitalized with moderate to severe COVID-19. Trial Registration: This trial is registered with ClinicalTrials.gov, NCT04920916. Funding: Virginia Biosciences Health Research Corporation, PBM C19, Henske Family Foundation, National Institutes of Health, National Cancer Institute
Collapse
|
22
|
Whebell S, Zhang J, Lewis R, Berry M, Ledot S, Retter A, Camporota L. Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study. Intensive Care Med 2022; 48:467-478. [PMID: 35238946 PMCID: PMC8892395 DOI: 10.1007/s00134-022-06645-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
Purpose Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality. Methods A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques. Results 1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre. Conclusion We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06645-w.
Collapse
Affiliation(s)
- Stephen Whebell
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Department of Adult Critical Care, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Joe Zhang
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Rebecca Lewis
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Berry
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephane Ledot
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew Retter
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| |
Collapse
|
23
|
Venous thromboembolism in patients hospitalised with COVID-19 in England. Thromb Res 2022; 213:138-144. [PMID: 35366435 PMCID: PMC8944169 DOI: 10.1016/j.thromres.2022.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background The aim of this study was to detail the incidence of venous thromboembolism (VTE) in patients hospitalised with COVID-19 in England. Methods This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1st March 2020 and 31st March 2021 were included. A recorded diagnosis of VTE during the index stay or during a subsequent admission in the six weeks following discharge was the primary outcome in the main analysis. In secondary analysis, VTE diagnosis was the primary exposure and in-hospital mortality the primary outcome. Results Over the 13 months, 374,244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 17,346 (4.6%) had a recorded diagnosis of VTE. VTE was more commonly recorded in patients aged 40–79 years, males and in patients of Black ethnicity, even after adjusting for covariates. Recorded VTE diagnosis was associated with longer hospital stay and higher adjusted in-hospital mortality (odds ratio 1.35 (95% confidence interval 1.29 to 1.41)). Conclusions VTE was a common complication of hospitalisation with COVID-19 in England. VTE was associated with both increased length of stay and mortality rate.
Collapse
|
24
|
AlRuthia Y, Al-Salloum HF, Almohammed OA, Alqahtani AS, Al-Abdulkarim HA, Alsofayan YM, Almudarra SS, AlQahtani SH, Almutlaq A, Alabdulkareem K, Balkhi B, Almutairi HT, Alanazi AS, Asiri YA. Demographic Characteristics and Status of Vaccinated Individuals with a History of COVID-19 Infection Pre- or Post-Vaccination: A Descriptive Study of a Nationally Representative Sample in Saudi Arabia. Vaccines (Basel) 2022; 10:323. [PMID: 35214781 PMCID: PMC8875240 DOI: 10.3390/vaccines10020323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Saudi Arabia expedited the approval of some COVID-19 vaccines and launched mass vaccination campaigns. The aim of this study was to describe the demographics of vaccinated COVID-19 cases and compare the mortality rates of COVID-19 cases who were infected post-vaccination in Saudi Arabia. METHODS This was a retrospective cohort study. We retrieved data for COVID-19 cases who were infected pre- or post-vaccination and had received at least one injection of the Oxford-AstraZeneca or Pfizer-BioNTech vaccine from 4 December 2020 to 15 October 2021. RESULTS The number of patients who were infected and had received at least one dose of a COVID-19 vaccine was 281,744. Approximately 45% of subjects were infected post-vaccination, and 75% of subjects had received the Pfizer-BioNTech vaccine. Only 0.342% of the patients who were infected post-vaccination died, and 447 patients were admitted to ICUs. Most of the patients who were infected with COVID-19 post-vaccination and were admitted to ICUs (69.84%) had received only one dose of the vaccine (p < 0.0001). The mean time to infection for patients who had received one and two doses of the Oxford-AstraZeneca vaccine were 27 and 8 days longer than their counterparts who had received one and two doses of Pfizer-BioNTech vaccine, respectively. No difference in the odds of mortality between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines was found (OR = 1.121, 95% CI = [0.907-1.386], p-value = 0.291). Patients who had received two doses of the vaccine had significantly lower odds of mortality compared to those who had received one dose (p < 0.0001). CONCLUSIONS Vaccines are vital in combating the COVID-19 pandemic. The results of this study show no difference between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines in the rate of mortality. However, the number of vaccine doses was significantly associated with a lower risk of mortality. Future studies should examine the effectiveness of different COVID-19 vaccines using real-world data and more robust designs.
Collapse
Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.A.); (B.B.); (H.T.A.); (Y.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Haya F. Al-Salloum
- Department of Pharmacy, King Khalid University Hospital, King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.A.); (B.B.); (H.T.A.); (Y.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | | | - Hana A. Al-Abdulkarim
- Drug Policy and Economic Center, National Guard Health Affairs, Riyadh 14812, Saudi Arabia;
| | - Yousef M. Alsofayan
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Sami S. Almudarra
- Gulf Center for Disease Prevention and Control, Gulf Health Council, Riyadh 12511, Saudi Arabia;
| | - Sara H. AlQahtani
- Department of Public Health, Ministry of Health, Riyadh 11176, Saudi Arabia;
| | - Abdullah Almutlaq
- Rheumatology Division, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11564, Saudi Arabia;
| | - Khaled Alabdulkareem
- Assisting Deputyship for Primary Health Care, Ministry of Health, Riyadh 11176, Saudi Arabia;
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.A.); (B.B.); (H.T.A.); (Y.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hamoud T. Almutairi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.A.); (B.B.); (H.T.A.); (Y.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah S. Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Skaka 42421, Saudi Arabia;
| | - Yousif A. Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (O.A.A.); (B.B.); (H.T.A.); (Y.A.A.)
| |
Collapse
|
25
|
Sokolski M, Reszka K, Suchocki T, Adamik B, Doroszko A, Drobnik J, Gorka-Dynysiewicz J, Jedrzejczyk M, Kaliszewski K, Kilis-Pstrusinska K, Konopska B, Kopec A, Larysz A, Lis W, Matera-Witkiewicz A, Pawlik-Sobecka L, Rosiek-Biegus M, Sokolska JM, Sokolowski J, Zapolska-Tomasiewicz A, Protasiewicz M, Madziarska K, Jankowska EA. History of Heart Failure in Patients Hospitalized Due to COVID-19: Relevant Factor of In-Hospital Complications and All-Cause Mortality up to Six Months. J Clin Med 2022; 11:jcm11010241. [PMID: 35011982 PMCID: PMC8746048 DOI: 10.3390/jcm11010241] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between March 2020 and May 2021 with laboratory-confirmed COVID-19 were analyzed. The study population was divided into a HF group (patients with a history of HF) and a non-HF group. Results: Out of 2184 patients (65 ± 13 years old, 50% male), 12% had a history of HF. Patients from the HF group were older, more often males, had more comorbidities, more often dyspnea, pulmonary and peripheral congestion, inflammation, and end-organ damage biomarkers. HF patients had longer and more complicated hospital stay, with more frequent acute HF development as compared with non-HF. They had significantly higher mortality assessed in hospital (35% vs. 12%) at three (53% vs. 22%) and six months (72% vs. 47%). Of 76 (4%) patients who developed acute HF, 71% died during hospitalization, 79% at three, and 87% at six months. Conclusions: The history of HF identifies patients with COVID-19 who are at high risk of in-hospital complications and mortality up to six months of follow-up.
Collapse
Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
- Correspondence: ; Tel.: +48-717331112
| | - Konrad Reszka
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Tomasz Suchocki
- Biostatistics Group, Department of Genetics, Wroclaw University of Environmental and Life Sciences, 51-631 Wroclaw, Poland;
| | - Barbara Adamik
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Adrian Doroszko
- Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Jarosław Drobnik
- Gerontology Unit, Public Health Department, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Joanna Gorka-Dynysiewicz
- Department of Pharmaceutical Biochemistry, Division of Pharmaceutical Biochemistry, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Maria Jedrzejczyk
- Department of Nursing and Obstetrics, Division of Internal Medicine Nursing, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Krzysztof Kaliszewski
- Clinical Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | | | - Bogusława Konopska
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Agnieszka Kopec
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland; (A.K.); (M.R.-B.)
| | - Anna Larysz
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
- Clinical Department of Heart Transplantation and Mechanical Circulatory Support, Institute of Heart Disease, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Weronika Lis
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | | | - Lilla Pawlik-Sobecka
- Division of Basic Sciences, Faculty of Health Sciences, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Marta Rosiek-Biegus
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland; (A.K.); (M.R.-B.)
| | - Justyna M. Sokolska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Janusz Sokolowski
- Clinical Department of Emergency Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anna Zapolska-Tomasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Ewa A. Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| |
Collapse
|
26
|
Marza AM, Petrica A, Lungeanu D, Sutoi D, Mocanu A, Petrache I, Mederle OA. Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection. Int J Gen Med 2022; 15:489-500. [PMID: 35046709 PMCID: PMC8760984 DOI: 10.2147/ijgm.s347178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Spontaneous pneumothorax (SP) and spontaneous pneumomediastinum (SPM) have frequently been cited as complications associated with coronavirus disease 2019 (COVID-19) pneumonia, with especially poor prognosis in mechanically ventilated patients. The current literature is controversial regarding the potential risk factors for developing SP or SPM (SP-SPM) in non-ventilated COVID-19 patients. Our research addressed a twofold objective: (a) to investigate the characteristics of patients with SP-SPM (both with and without COVID-19) and compare them to patients with sole COVID-19; (b) to quantify the risk of in-hospital mortality associated with SP-SPM and COVID-19. Patients and Methods A retrospective case–control study was conducted in the emergency departments (ED) of two tertiary hospitals in Timisoara, Romania, over one year (1st April 2020‒31st March 2021; 64,845 records in total) and 70 cases of SP-SPM were identified (both SARS-CoV-2 positives and negatives). The control group comprised COVID-19 patients with no SP-SPM, included at a 2:1 ratio. Logistic regression was employed to quantify the in-hospital mortality risk associated with age, SP-SPM, and COVID-19. Results SP-SPM and COVID-19 were connected with prolonged hospitalization, a higher percentage of intensive care admission, and a higher mortality. SP-SPM increased the odds of death by almost four times in patients of the same age, gender, smoking status, and SARS-CoV-2 infection: OR = 3.758, 95% CI (1.443–9.792). Each additional year of age added 9.4% to the mortality risk: OR = 1.094, 95% CI (1.054–1.135). Conclusion ED physicians should acknowledge these potential risks when attending COVID-19 patients with SP-SPM.
Collapse
Affiliation(s)
- Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
- Correspondence: Alina Petrica Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, RomaniaTel +40744772427 Email
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Diana Lungeanu Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, 300041, Romania Email
| | - Dumitru Sutoi
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Anaesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, 300736, Romania
| | - Alexandra Mocanu
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
| | - Ioan Petrache
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Clinic of Thoracic Surgery, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania
- Emergency Department, Emergency Clinical Municipal Hospital, Timisoara, 300079, Romania
| |
Collapse
|
27
|
Felsenstein S, Reiff AO. A hitchhiker's guide through the COVID-19 galaxy. Clin Immunol 2021; 232:108849. [PMID: 34563684 PMCID: PMC8461017 DOI: 10.1016/j.clim.2021.108849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023]
Abstract
Numerous reviews have summarized the epidemiology, pathophysiology and the various therapeutic aspects of Coronavirus disease 2019 (COVID-19), but a practical guide on "how to treat whom with what and when" based on an understanding of the immunological background of the disease stages remains missing. This review attempts to combine the current knowledge about the immunopathology of COVID-19 with published evidence of available and emerging treatment options. We recognize that the information about COVID-19 and its treatment is rapidly changing, but hope that this guide offers those on the frontline of this pandemic an understanding of the host response in COVID-19 patients and supports their ongoing efforts to select the best treatments tailored to their patient's clinical status.
Collapse
Affiliation(s)
- Susanna Felsenstein
- University of Liverpool, Faculty of Health and Life Sciences, Brownlow Hill, Liverpool, L69 3GB, United Kingdom.
| | - Andreas Otto Reiff
- Arthritis & Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| |
Collapse
|
28
|
Cook TM, Camporota L. Critical care outcomes from COVID-19: patients, interventions, healthcare systems and the need for core datasets. Anaesthesia 2021; 76:1155-1158. [PMID: 34318495 PMCID: PMC8444852 DOI: 10.1111/anae.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Affiliation(s)
- T M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, University of Bristol, UK
| | - L Camporota
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre of Human Applied Physiological Sciences, King's College London, London, UK
| |
Collapse
|