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Shaikh OS, Yan P, Rogal S, Butt AA. The impact of COVID-19 on the clinical course and outcome of patients with cirrhosis: An observational study. Health Sci Rep 2024; 7:e2207. [PMID: 38915355 PMCID: PMC11194291 DOI: 10.1002/hsr2.2207] [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: 12/13/2023] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
Background and Aims Severe outcomes of COVID-19 are associated with advancing age and comorbidities. The specific aim of our study was to determine the impact of COVID-19 on the clinical course and outcome of patients with cirrhosis. Methods We retrieved data from VA national repository and identified patients tested for SARS-CoV-2 RNA who had cirrhosis. Each virus positive patient was propensity-matched with virus negative subjects by demographics and comorbidities. Primary endpoint was death within 30 days of COVID-19 diagnosis and secondary endpoint was hospitalization within 14 days. Results Among 1,115,037 individuals tested for SARS-CoV-2 RNA, 31,680 had cirrhosis. Of those patients, 4456 virus positive patients were propensity-matched with 8752 virus negative subjects. In this cohort of 13,208, median age was 67 years and 95% were male. Most had multiple comorbidities. Alcohol use, hepatitis C and MASH were the dominant etiologies of cirrhosis. At baseline, median MELD was 6% and 21% had hepatic decompensation. Advanced age was the most significant determinant of hospitalization and mortality. Comorbidities, alcohol use and MELD increased the likelihood of hospitalization whereas SARS-CoV-2 positivity had lower Day-14 hospitalization hazard. MELD was associated with higher mortality hazard whereas vaccination reduced the hazard of hospitalization and death. SARS-CoV-2 positivity increased the hazard of death at Day-30 by 72% and at Day-90 by 26%. Conclusion Although patients with cirrhosis who developed COVID-19 were less likely to be hospitalized, they were more likely to die within 30 days compared to their virus negative counterparts. Vaccination was effective in reducing both hospitalization and death.
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Affiliation(s)
- Obaid S. Shaikh
- Veterans Affairs Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Peng Yan
- Veterans Affairs Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Shari Rogal
- Veterans Affairs Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Adeel A. Butt
- Veterans Affairs Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Weill Cornell MedicineDohaQatar
- Hamad Medical CorporationDohaQatar
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Xiao X, Xiang S, Xu Q, Li J, Xiao J, Si Y. Comorbidity among inpatients with dementia: a preliminary cross-sectional study in West China. Aging Clin Exp Res 2023; 35:659-667. [PMID: 36754914 PMCID: PMC9908504 DOI: 10.1007/s40520-023-02349-3] [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: 06/02/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To investigate comorbidities among hospitalized patients with dementia. METHOD Data were extracted from the discharge records in our hospital. Comorbidities based on ICD-10 were selected from the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The distributions of these comorbidities were described in dementia inpatients and age- and sex-matched nondementia controls, as well as in inpatients with Alzheimer's disease and vascular dementia. A logistic regression model was applied to identify dementia-specific morbid conditions. RESULTS A total of 3355 patients with dementia were included, with a majority of 1503 (44.8%) having Alzheimer's disease, 395 (11.8%) with vascular dementia, and 441 (13.1%) with mixed dementia. The mean number of comorbidities was 3.8 in dementia patients (vs. 2.9 in controls). The most prevalent comorbidities in inpatients with dementia compared with those without dementia were cerebral vascular disease (73.0% vs. 35.9%), hypertension (62.8% vs. 56.2%), and peripheral vascular disease (53.7% vs. 31.2%). Comorbidities associated with dementia included epilepsy (OR 4.8, 95% CI 3.5-6.8), cerebral vascular disease (OR 4.1, 95% CI 3.7-4.5), depression (OR 4.0, 95% CI 3.2-5.0), uncomplicated diabetes (OR 1.5, 95% CI 1.4-1.7), peripheral vascular disease (OR 1.8, 95% CI 1.6-2.0), rheumatoid arthritis collagen vascular disease (OR 1.7, 95% CI 1.3-2.3), and anemia (OR 1.2, 95% CI 1.04-1.3). Some comorbidities suggested a protective effect against dementia. They were hypertension (OR 0.8, 95% CI 0.7-0.9), COPD (OR 0.6, 95% CI 0.5-0.6), and solid tumor without metastasis (OR 0.4, 95% CI 0.3-0.4). Vascular dementia has more cardiovascular and cerebrovascular comorbidities than Alzheimer's disease. CONCLUSION Patients with dementia coexisted with more comorbidities than those without dementia. Comorbidities (esp. cardio-cerebral vascular risks) in patients with vascular dementia were more than those in patients with AD. Specifically, vascular and circulatory diseases, epilepsy, diabetes and depression increased the risk of dementia.
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Affiliation(s)
- Xiaoqiang Xiao
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shunju Xiang
- Department of Anesthesiology, West China Hospital, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Qingya Xu
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jieying Li
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jun Xiao
- Department of Neuropsychology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China.
- Sichuan Provincial Center for Mental Health, Chengdu, Sichuan, China.
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Yang Si
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, 32# W. Sec 2, 1St Ring Rd., Chengdu, 610072, Sichuan Province, China.
- University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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Schuldt K, Trocchi P, Stang A. Skin Cancer Screening and Medical Treatment Intensity in Patients with Malignant Melanoma and Non-Melanocytic Skin Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:33-39. [PMID: 36471642 PMCID: PMC10043458 DOI: 10.3238/arztebl.m2022.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/28/2022] [Accepted: 10/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND This cohort study concerns the effect of skin cancer screening (SCS) on medical treatment intensity in patients with skin cancer. METHODS Routine data from persons aged 35 to 99 who were insured by the AOK health insurance company were used to identify persons who received a diagnosis of malignant melanoma or a non-melanocytic skin cancer in 2014 or 2015, either through skin cancer screening or without screening. These persons were included in cohort studies. The routine data contained no information on tumor stages or grading. Tumor-associated rates of hospital admission, contact with physicians in outpatient practice, and intensity of surgical treatment were determined; rate ratios (RR) and their 95% confidence intervals (CI) were estimated. RESULTS The cohort studies included 13 633 patients with melanoma (6480 with SCS and 7153 without) and 118 168 patients with non-melanocytic skin cancer (43 308 with screening and 74 860 without). Patients whose melanomas had been detected by screening had a lower medical treatment intensity than unscreened patients (intensity of tumor-associated surgical treatment (RR = 0.79, 95% CI [0.74; 0.85]), hospital contact rate (RR = 0.44, 95% CI: [0.38; 0.50]), contact with physicians in outpatient practice (RR = 0.79, 95% CI: [0.73; 0.85]). Among patients with non-melanocytic skin cancer, the screened patients displayed a lower hospital contact rate (RR = 0.52, 95% CI: [0.49; 0.56]), a higher contact rate in the outpatient sector (RR = 1.11, 95% CI: [1.08; 1.13]), and no difference in surgical treatment intensity (RR = 0.98, 95% CI: [0.96; 1.00]). CONCLUSION SCS is associated with lower medical treatment intensity in the first 12 months after diagnosis in patients with melanoma. Among patients with non-melanocytic skin cancer, those who had been screened had lower hospital contact rates, but there was no observed lowering of other rates reflecting treatment intensity.
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Affiliation(s)
- Katrin Schuldt
- Institute of Medical Informatics, Biometry and Epidemiology University Hospital of Essen; Department of Epidemiology, Boston University School of Public Health, Boston, USA; North Rhine-Westphalia State Cancer Registry, Bochum
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