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Ko SQ, Kumar SK, Jacob J, Hooi BMY, Soo M, Nashi N, Cruz MTD, Wah YA, Xin WZ, Smitasin N, Lum L, Archuleta S. Technology-enabled virtual ward for COVID management of the elderly and immunocompromised in Singapore: a descriptive cohort. BMC Infect Dis 2023; 23:102. [PMID: 36809977 PMCID: PMC9942066 DOI: 10.1186/s12879-023-08040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To address the hospital bed demand for Delta and Omicron surges in Singapore, the National University Health System (NUHS) developed a COVID Virtual Ward to relieve bed pressures on its three acute hospitals-National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital. To serve a multilingual population, the COVID Virtual Ward featuring protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary. This study aims to evaluate the safety, outcomes and utilisation of the Virtual Ward as a scalable response to COVID-19 surges. METHODS This is a retrospective cohort study of all patients admitted to the COVID Virtual Ward between 23 September to 9 November 2021. Patients were defined as "early discharge" if they were referred from inpatient COVID-19 wards and "admission avoidance" if they were referred directly from primary care or emergency services. Patient demographics, utilisation measures and clinical outcomes were extracted from the electronic health record system. The primary outcomes were escalation to hospital and mortality. Use of the vital signs chatbot was evaluated by examining compliance levels, need for automated reminders and alerts triggered. Patient experience was evaluated using data extracted from a quality improvement feedback form. RESULTS 238 patients were admitted to the COVID Virtual Ward from 23 September to 9 November, of whom 42% were male, 67.6% of Chinese ethnicity. 43.7% were over the age of 70, 20.5% were immunocompromised, and 36.6% were not fully vaccinated. 17.2% of patients were escalated to hospital and 2.1% of patients died. Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC 4C-Mortality Score. There were no missed deteriorations. All patients received teleconsults (median of 5 teleconsults per patient, IQR 3-7). 21.4% of patients received home visits. 77.7% of patients engaged with the vital signs chatbot, with a compliance rate of 84%. All patients would recommend the programme to others in their situation. CONCLUSIONS Virtual Wards are a scalable, safe and patient-centered strategy to care for high risk COVID-19 patients at home. TRIAL REGISTRATION NA.
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Affiliation(s)
- Stephanie Q. Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Shoban Krishna Kumar
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Jonathan Jacob
- Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore, 159964 Singapore
| | - Benjamin M. Y. Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Michelle Soo
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Norshima Nashi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Maria Teresa D. Cruz
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Yeo Ai Wah
- Regional Health Service, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Wong Zhi Xin
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Nares Smitasin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Lionel Lum
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Sophia Archuleta
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
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Sahota A, Tien A, Yao J, Dong E, Herald J, Javaherifar S, Neyer J, Hwang J, Lee R, Fong TL. Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients. Transplantation 2022; 106:2426-2434. [PMID: 36436102 PMCID: PMC9696760 DOI: 10.1097/tp.0000000000004371] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Solid organ transplant recipients (SOTr) are at increased risk for severe disease from coronavirus disease 2019 (COVID-19) compared with non-SOTr. METHODS We performed a retrospective cohort study between March 1, 2020, and March, 30, 2021, in an integrated healthcare system with 4.3 million members aged ≥18 y including 5126 SOTr. Comparisons in COVID-19 mortality, hospitalization, and incidence were made between SOTr and non-SOTr, and between different SOTr organs. Multivariate analysis was performed to identify risk factors for COVID-19 mortality and hospitalization. RESULTS There were 600 SOTr (kidney, liver, heart, and lung) with COVID-19. Per person-year incidence of COVID-19 among SOTr was 10.0% versus 7.6% among non-SOTr (P < 0.0001). Compared with uninfected SOTr, infected SOTr were older (57.1 ± 14.0 versus 45.7 ± 17.9 y, P < 0.001), predominantly Hispanic/Latino (58.8% versus 38.6%, P < 0.0001), hypertensive (77.0% versus 23.8%; P < 0.0001), and diabetic (49.6% versus 13.0%; P = 0.0009). Compared with non-SOTr, infected SOTr had higher hospitalization (39.5% versus 6.0%; P < 0.0001), intensive care unit admission (29.1% versus 15.5%; P < 0.0001), and mortality (14.7% versus 1.8%; P < 0.0001) from COVID-19. Older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.05-1.10), male gender (HR, 1.79; 95% CI, 1.11-2.86), and higher body mass index (HR, 1.04; 95% CI, 1.00-1.09; P = 0.047) were associated with increased mortality from COVID-19, whereas race, diabetes, and number/type of immunosuppressive medications were not. Among the different SOTr, COVID-19 mortality risk was lowest in liver recipients (HR, 0.34; 95% CI, 0.16-0.73) and highest in lung recipients (HR, 1.74; 95% CI, 0.68-4.42). CONCLUSIONS SOTr have higher rates of hospitalization and mortality from COVID-19 compared with the general population. Among the SOTr, the incidence and outcomes were distinct among different transplantation types.
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Affiliation(s)
- Amandeep Sahota
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Andy Tien
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Janis Yao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Elizabeth Dong
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - John Herald
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Sarah Javaherifar
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Jonathan Neyer
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Jennifer Hwang
- Department of Transplant Pulmonology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Roland Lee
- Department of Nephrology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Liver Program, Hoag Digestive Health Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA
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Lumpy Skin Disease Outbreaks in Africa, Europe, and Asia (2005-2022): Multiple Change Point Analysis and Time Series Forecast. Viruses 2022; 14:v14102203. [PMID: 36298758 PMCID: PMC9611638 DOI: 10.3390/v14102203] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
LSD is an important transboundary disease affecting the cattle industry worldwide. The objectives of this study were to determine trends and significant change points, and to forecast the number of LSD outbreak reports in Africa, Europe, and Asia. LSD outbreak report data (January 2005 to January 2022) from the World Organization for Animal Health were analyzed. We determined statistically significant change points in the data using binary segmentation, and forecast the number of LSD reports using auto-regressive moving average (ARIMA) and neural network auto-regressive (NNAR) models. Four significant change points were identified for each continent. The year between the third and fourth change points (2016-2019) in the African data was the period with the highest mean of number of LSD reports. All change points of LSD outbreaks in Europe corresponded with massive outbreaks during 2015-2017. Asia had the highest number of LSD reports in 2019 after the third detected change point in 2018. For the next three years (2022-2024), both ARIMA and NNAR forecast a rise in the number of LSD reports in Africa and a steady number in Europe. However, ARIMA predicts a stable number of outbreaks in Asia, whereas NNAR predicts an increase in 2023-2024. This study provides information that contributes to a better understanding of the epidemiology of LSD.
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Sudhinaraset M, Choi HY, Nwankwo E, De Trinidad Young ME. Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california. BMC Public Health 2022; 22:1558. [PMID: 35974358 PMCID: PMC9379231 DOI: 10.1186/s12889-022-13994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. METHODS This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. RESULTS Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). CONCLUSIONS Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.
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Affiliation(s)
- May Sudhinaraset
- Fielding School of Public Health, Community Health Sciences Jonathan and Karin, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hye Young Choi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ezinne Nwankwo
- Fielding School of Public Health, Community Health Sciences Jonathan and Karin, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, CA, USA
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Kofahi HM, Swedan SF, Khabour OF, Nimer RM. Predictors of COVID-19 severity and hospitalization: A survey-based study from Jordan. INFORMATICS IN MEDICINE UNLOCKED 2022; 31:100994. [PMID: 35722635 PMCID: PMC9192355 DOI: 10.1016/j.imu.2022.100994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 10/26/2022] Open
Abstract
Objectives To explore the possible predictors of severe illness and hospitalization due to COVID-19 among Jordanians. Method The study was cross-sectional, survey-based and was conducted from March to July of 2021. Individuals who had recovered from COVID-19 (n = 2148) were recruited in the study. Participants were categorized according to the severity of COVID-19 infection and hospitalization. The study sample was stratified according to age, gender, body mass index (BMI), comorbidities, family income, smoking status, and ABO blood groups. Risk factors were investigated using the Chi-square test and multivariate logistic regression analyses. Results Severe illness and hospitalization were associated with older age, males, individuals with comorbidities, higher BMI, and lower-income. No significant differences were found in the incidence of severe illness or hospitalization frequency between the ABO groups or between smokers and non-smokers. Multivariate logistic regression analyses predicted male gender, being older than 40, having a BMI of over 30, having 3 or more comorbidities, and low family income as risk factors for severe COVID-19 outcomes. Conclusion Age was the strongest predictor for severe COVID-19 outcome, followed by having 3 or more comorbidities and to a lesser extent male gender and obesity. These results could help target at-risk groups with infection prevention measures including prioritizing primary COVID-19 vaccines, as well as booster doses.
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Affiliation(s)
- Hassan M Kofahi
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Samer F Swedan
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Refat M Nimer
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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Gómez Vázquez JP, García YE, Schmidt AJ, Martínez-López B, Nuño M. Testing and vaccination to reduce the impact of COVID-19 in nursing homes: an agent-based approach. BMC Infect Dis 2022; 22:477. [PMID: 35590305 PMCID: PMC9117861 DOI: 10.1186/s12879-022-07385-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization. METHODS We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission among resident and staff agents in a nursing home. Interactions between 172 residents and 170 staff based on data from a nursing home in Los Angeles, CA. Scenarios were simulated assuming different levels of non-pharmaceutical interventions, testing frequencies, and vaccine efficacy to reduce transmission. RESULTS Under the hypothetical scenario of widespread SARS-CoV-2 in the community, 3-day testing frequency minimized the attack rate and the time to eradicate an outbreak. Prioritization of vaccine among staff or staff and residents minimized the cumulative number of infections and hospitalization, particularly in the scenario of high probability of an introduction. Reducing the probability of a viral introduction eased the demand on testing and vaccination rate to decrease infections and hospitalizations. CONCLUSIONS Improving frequency of testing from 7-days to 3-days minimized the number of infections and hospitalizations, despite widespread community transmission. Vaccine prioritization of staff provides the best protection strategy when the risk of viral introduction is high.
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Affiliation(s)
- José P. Gómez Vázquez
- Center for Animal Disease Modeling and Surveillance, University of California Davis, Davis, CA USA
| | - Yury E. García
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
| | - Alec J. Schmidt
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, University of California Davis, Davis, CA USA
| | - Miriam Nuño
- Department of Public Health Sciences, University of California Davis, Davis, CA USA
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Nikolla DA, Forehand BR. Do Corticosteroids Reduce Mortality or Progression to Severe Disease for Non-Oxygen Requiring Patients Infected With COVID-19? Ann Emerg Med 2022; 80:314-316. [PMID: 35461721 PMCID: PMC9021012 DOI: 10.1016/j.annemergmed.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Dhimitri A Nikolla
- Department of Emergency Medicine, Allegheny Health Network-Saint Vincent Hospital, Erie, PA
| | - Brett R Forehand
- Department of Emergency Medicine, Allegheny Health Network-Saint Vincent Hospital, Erie, PA
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Varghese J, Lavergne V, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y, Morgan RL. Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2021:ciab953. [PMID: 34791102 PMCID: PMC8767890 DOI: 10.1093/cid/ciab953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Division of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Jamie Varghese
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
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Koutroulos MV, Bakola SA, Kalpakidis S, Avramidou D, Panagaris S, Melissopoulou E, Souleiman H, Partsalidis A, Metaxa E, Feresiadis I, Kampaki E, Papadopoulos V. The MaD-CLINYC score: An easy tool for the prediction of the outcome of hospitalized COVID-19 patients. Hippokratia 2021; 25:119-125. [PMID: 36683905 PMCID: PMC9851139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most outcome-predictive models for COVID-19 patients use hospital admission data, offering a spontaneous mortality risk estimation. We aimed to elaborate on a tool that could be applied repeatedly, thus being more suitable for these patients' rapidly changing clinical course. METHODS In this prospective study, we evaluated 560 samples derived from 156 patients hospitalized for COVID-19 in a single center. Age >61 years, male sex, comorbidities >2, need for intensive care unit admission, lactate dehydrogenase (LDH) >408 U/L, Neutrophil/Lymphocyte Ratio (NLR) >17, C-reactive protein (CRP) >10 mg/dl, and D-dimers >3,200 ng/ml were incorporated in an eight-scale score (MaD-CLINYC) after optimal scaling, ridge regression, and bootstrapping, which was documented to correlate with outcome independently of one or more samples analyzed, day from admission at sampling, and need for delivery. Validation process was performed over 574 samples derived from three centers. RESULTS The developing and the validation cohort Area under Curve (AUC) was 0.90 (95 % Confidence Interval: 0.82-0.98) and 0.91 (0.88-0.94), respectively (p =0.822). A MaD-CLINYC score ≥4 had 75 % sensitivity and 81 % specificity to predict fatal outcome. CONCLUSIONS MaD-CLINYC score is a powerful, feasible, easy-to-use, dynamic tool to assess the risk of the outcome, thus assisting clinicians in close monitoring and timely decisions in COVID-19 hospitalized patients. HIPPOKRATIA 2021, 25 (3):119-125.
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Affiliation(s)
- M V Koutroulos
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - S A Bakola
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - S Kalpakidis
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - D Avramidou
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - S Panagaris
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - E Melissopoulou
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - H Souleiman
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - A Partsalidis
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - E Metaxa
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - I Feresiadis
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - E Kampaki
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
| | - V Papadopoulos
- Department of Internal Medicine, Xanthi General Hospital, Xanthi, Greece
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