Clinical presentation and prognosis of COVID-19 in older adults with hypothyroidism: data from the GeroCovid observational study

BACKGROUND

The prevalence of hypothyroidism among older patients hospitalized for COVID-19 and its association with mortality is unclear. This study aims to investigate the prevalence of hypothyroidism in older COVID-19 inpatients and verify if this comorbidity is associated with a specific pattern of onset symptoms and a worse prognosis.

METHODS

COVID-19 inpatients aged ≥ 60 years, participating in the GeroCovid acute wards cohort, were included. The history of hypothyroidism was derived from medical records and the use of thyroid hormones. Sociodemographic data, comorbidities, symptoms/signs at the disease onset and inflammatory markers at ward admission were compared between people with vs without history of hypothyroidism. The association between hypothyroidism and in-hospital mortality was tested through Cox regression.

RESULTS

Of the 1245 patients included, 8.5% had a history of hypothyroidism. These patients were more likely to present arterial hypertension and obesity compared with those without an history of hypothyroidism. Concerning COVID-19 clinical presentation, patients with hypothyroidism had less frequently low oxygen saturation and anorexia but reported muscle pain and loss of smell more commonly than those without hypothyroidism. Among the inflammatory markers, patients with hypothyroidism had higher lymphocytes values. At Cox regression, hypothyroidism was associated with reduced in-hospital mortality only in the univariable model (HR = 0.66, 95% CI 0.45-0.96, p = 0.03); conversely, no significant result were observed after adjusting for potential confounders (HR = 0.69, 95% CI 0.47-1.03, p = 0.07).

CONCLUSIONS

Hypothyroidism does not seem to substantially influence the prognosis of COVID-19 in older people, although it may be associated with peculiar clinical and biochemical features at the disease onset.

Audit of Childhood Death in a Tertiary Care Center in Niger Delta Region of Nigeria

BACKGROUND

Childhood mortality is a serious public health concern. Periodic assessment of its trend is important in evaluating the pattern and planning intervention strategies.

OBJECTIVE

The study aimed at evaluating the childhood mortality (<18 years) in Delta State University Teaching Hospital, Nigeria.

METHODS

This is a descriptive retrospective study from 1st January, 2016 to 31st December, 2018 using mortality data from the institution.

RESULTS

A total of 1,692 children were admitted during the study period, out of which 203 died, giving a mortality rate of 12%. They were composed of 126 males and 77 females with a mean age of 17.5 months. Neonates, children aged between 28 days and 1 year, between 12 months and 5 years and between 5 years and 18 years accounted for 46.8%, 14.3%, 16.3%, and 22.7% of the cases respectively. Sepsis, prematurity, birth asphyxia, congenital anomalies and bilirubin encephalopathy accounted for 30 (31.6%), 22 (23.2%), 15 (15.8%), 13(13.7%) and 5 (5.3%) of the cases respectively. Septicemia (31.0%) and bronchopneumonia (13.9%) were the leading causes of infant death. Leading causes of under-5 mortality (excluding infants) include burns, malaria, anemia/anemic heart failure, traumatic injury, meningitis and pneumonia, accounting for 18.2%, 18.2%, 12.1%, 12.1%, 9.1% and 9.1% of the cases respectively. Among children 5-18 years, meningitis/encephalitis, malignancies, renal disease, road traffic accident (RTA) and burns accounted for 9(19.6%), 8 (17.4%), 4 (8.7%), 4 (8.7%) and 3 (6.5%) cases respectively.

CONCLUSION

We observed excess of male mortality, with neonates being the most vulnerable. These deaths are attributed to preventable causes. There is need to intensify intervention programmes to reverse this trend.