1
|
Mirofsky M, Boietti B, Cirelli D, Rodriguez C, Bibolini J, Young P, Cámera L, Pollan JA, Sanchez Thomas D, Valdez P, Huespe IA. Vaccination impact: mortality and time shift to COVID-19 maximum severity in hospitalized patients. An Argentine multicenter registry. Medicina (B Aires) 2024; 84:19-28. [PMID: 38271929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION The COVID-19 vaccine became an effective instrument to prevent severe SARS-CoV-2 infections. However, 5% of vaccinated patients will have moderate or severe disease. OBJECTIVE to compare mortality and days between the symptom onset to the peak disease severity, in vaccinated vs. unvaccinated COVID-19 hospitalized patients. METHODS Retrospective observational study in 36 hospitals in Argentina. COVID-19 adults admitted to general wards between January 1, 2021, and May 31, 2022 were included. Days between symptoms onset to peak of severity were compared between vaccinated vs. unvaccinated patients with Cox regression, adjusted by Propensity Score Matching (PSM). Results in patients with one and two doses were also compared. RESULTS A total of 3663 patients were included (3001 [81.9%] unvaccinated and 662 [18%] vaccinated). Time from symptom onset to peak severity was 7 days (IQR 4-12) vs. 7 days (IQR 4-11) in unvaccinated and vaccinated. In crude Cox regression analysis and matched population, no significant differences were observed. Regarding mortality, a Risk Ratio (RR) of 1.51 (IC95% 1.29-1.77) was observed in vaccinated patients, but in the PSM cohort, the RR was 0.73 (IC95% 0.60-0.88). RR in patients with one COVID-19 vaccine dose in PSM adjusted population was 0.7 (IC95% 0.45-1.03), and with two doses 0.6 (IC95% 0.46-0.79). DISCUSSION The time elapsed between the onset of COVID-19 symptoms to the highest severity was similar in vaccinated and unvaccinated patients. However, hospitalized vaccinated patients had a lower risk of mortality than unvaccinated patients.
Collapse
Affiliation(s)
- Matias Mirofsky
- Hospital Municipal de Agudos Dr. Leonidas Lucero, Bahía Blanca, Buenos Aires, Argentina. E-mail:
| | | | | | | | - Julian Bibolini
- Hospital Alta Complejidad Pte. Juan D. Perón, Formosa, Argentina
| | - Pablo Young
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Luis Cámera
- Hospital Italiano de Buenos Aires, CABA, Argentina
| | | | | | | | | |
Collapse
|
2
|
Huespe IA, Echeverri J, Khalid A, Carboni Bisso I, Musso CG, Surani S, Bansal V, Kashyap R. Clinical Research With Large Language Models Generated Writing-Clinical Research with AI-assisted Writing (CRAW) Study. Crit Care Explor 2023; 5:e0975. [PMID: 37795455 PMCID: PMC10547240 DOI: 10.1097/cce.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
IMPORTANCE The scientific community debates Generative Pre-trained Transformer (GPT)-3.5's article quality, authorship merit, originality, and ethical use in scientific writing. OBJECTIVES Assess GPT-3.5's ability to craft the background section of critical care clinical research questions compared to medical researchers with H-indices of 22 and 13. DESIGN Observational cross-sectional study. SETTING Researchers from 20 countries from six continents evaluated the backgrounds. PARTICIPANTS Researchers with a Scopus index greater than 1 were included. MAIN OUTCOMES AND MEASURES In this study, we generated a background section of a critical care clinical research question on "acute kidney injury in sepsis" using three different methods: researcher with H-index greater than 20, researcher with H-index greater than 10, and GPT-3.5. The three background sections were presented in a blinded survey to researchers with an H-index range between 1 and 96. First, the researchers evaluated the main components of the background using a 5-point Likert scale. Second, they were asked to identify which background was written by humans only or with large language model-generated tools. RESULTS A total of 80 researchers completed the survey. The median H-index was 3 (interquartile range, 1-7.25) and most (36%) researchers were from the Critical Care specialty. When compared with researchers with an H-index of 22 and 13, GPT-3.5 was marked high on the Likert scale ranking on main background components (median 4.5 vs. 3.82 vs. 3.6 vs. 4.5, respectively; p < 0.001). The sensitivity and specificity to detect researchers writing versus GPT-3.5 writing were poor, 22.4% and 57.6%, respectively. CONCLUSIONS AND RELEVANCE GPT-3.5 could create background research content indistinguishable from the writing of a medical researcher. It was marked higher compared with medical researchers with an H-index of 22 and 13 in writing the background section of a critical care clinical research question.
Collapse
Affiliation(s)
- Ivan A Huespe
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Carlos G Musso
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Facultad de Ciencias de la Salud, Universidad Simon Bolivar, Barranquilla, Colombia
| | - Salim Surani
- Mayo Clinic, Rochester, MN
- Texas A&M University, College Station, TX
| | | | | |
Collapse
|
3
|
Holc F, Bronenberg Victorica P, Avanzi R, Huespe IA, De Carli P, Boretto JG. Risk of Volar Locking Plate Removal After Distal Radius Fractures: Time-to-Event Analysis. J Hand Surg Am 2023; 48:1011-1017. [PMID: 37578402 DOI: 10.1016/j.jhsa.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The primary purpose of this study was to describe the rate of volar locking plate (VLP) removal after distal radius fracture and how long it takes for the risk of VLP removal to stabilize. The secondary purpose was to describe the reasons for VLP removal and analyze the relationship between it and the Soong index. METHODS This was a single-center retrospective cohort study. Patients aged >18 years with distal radius fracture who underwent VLP fixation were included. Hardware removal, time until VLP removal, and the primary reason for removal were recorded. The implant prominence was measured as described by Soong. We used Kaplan-Meier curves and risk tables to describe the risk of VLP removal and variation over time. Multivariable logistic regression was used to assess the relationship between Soong grade and VLP removal. RESULTS A total of 313 wrists were included. There were 35 cases of VLP removal, with an overall incidence of 11.2% at 15 years of follow-up. The incidence rate was 1.2 per 100 individuals per year for the entire cohort. The risk of VLP removal decreased from 6.2% in the first postoperative year to 1.7% in the second year and 1.4% in the third year. Beyond that, the rate remained <1% per year throughout the follow-up period. The median hardware removal time was 11 months. The main reasons for VLP removal were tenosynovitis, implant-associated pain, and screw protrusion. We found no association between Soong grade and VLP removal. CONCLUSIONS Volar locking plate removal after distal radius fracture was more common in the first year after surgery and remained notable until the third year. Regular monitoring and patient education to assess possible complications related to hardware are important during this period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Fernando Holc
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocio Avanzi
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan A Huespe
- Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo De Carli
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge G Boretto
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
4
|
Klén R, Huespe IA, Gregalio FA, Lalueza Blanco AL, Pedrera Jimenez M, Garcia Barrio N, Valdez PR, Mirofsky MA, Boietti B, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Pollan JA, Gómez-Varela D. Development and validation of COEWS (COVID-19 Early Warning Score) for hospitalized COVID-19 with laboratory features: A multicontinental retrospective study. eLife 2023; 12:e85618. [PMID: 37615346 PMCID: PMC10479961 DOI: 10.7554/elife.85618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023] Open
Abstract
Background The emergence of new SARS-CoV-2 variants with significant immune-evasiveness, the relaxation of measures for reducing the number of infections, the waning of immune protection (particularly in high-risk population groups), and the low uptake of new vaccine boosters, forecast new waves of hospitalizations and admission to intensive care units. There is an urgent need for easily implementable and clinically effective Early Warning Scores (EWSs) that can predict the risk of complications within the next 24-48 hr. Although EWSs have been used in the evaluation of COVID-19 patients, there are several clinical limitations to their use. Moreover, no models have been tested on geographically distinct populations or population groups with varying levels of immune protection. Methods We developed and validated COVID-19 Early Warning Score (COEWS), an EWS that is automatically calculated solely from laboratory parameters that are widely available and affordable. We benchmarked COEWS against the widely used NEWS2. We also evaluated the predictive performance of vaccinated and unvaccinated patients. Results The variables of the COEWS predictive model were selected based on their predictive coefficients and on the wide availability of these laboratory variables. The final model included complete blood count, blood glucose, and oxygen saturation features. To make COEWS more actionable in real clinical situations, we transformed the predictive coefficients of the COEWS model into individual scores for each selected feature. The global score serves as an easy-to-calculate measure indicating the risk of a patient developing the combined outcome of mechanical ventilation or death within the next 48 hr.The discrimination in the external validation cohort was 0.743 (95% confidence interval [CI]: 0.703-0.784) for the COEWS score performed with coefficients and 0.700 (95% CI: 0.654-0.745) for the COEWS performed with scores. The area under the receiver operating characteristic curve (AUROC) was similar in vaccinated and unvaccinated patients. Additionally, we observed that the AUROC of the NEWS2 was 0.677 (95% CI: 0.601-0.752) in vaccinated patients and 0.648 (95% CI: 0.608-0.689) in unvaccinated patients. Conclusions The COEWS score predicts death or MV within the next 48 hr based on routine and widely available laboratory measurements. The extensive external validation, its high performance, its ease of use, and its positive benchmark in comparison with the widely used NEWS2 position COEWS as a new reference tool for assisting clinical decisions and improving patient care in the upcoming pandemic waves. Funding University of Vienna.
Collapse
Affiliation(s)
- Riku Klén
- Turku PET Centre, University of Turku and Turku University HospitalTurkuFinland
| | - Ivan A Huespe
- Italian Hospital of Buenos AiresBuenos AiresArgentina
| | | | - Antonio Lalueza Lalueza Blanco
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | - Miguel Pedrera Jimenez
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | - Noelia Garcia Barrio
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | | | - Matias A Mirofsky
- Hospital Municipal de Agudos Dr Leónidas LuceroBahía BlancaArgentina
| | - Bruno Boietti
- Italian Hospital of Buenos AiresBuenos AiresArgentina
| | - Ricardo Gómez-Huelgas
- Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of MalagaMálagaSpain
| | | | | | | | - David Gómez-Varela
- Division of Pharmacology & Toxicology, Department of Pharmaceutical Sciences, University of ViennaViennaAustria
| |
Collapse
|
5
|
Huespe IA, Ferraris A, Lalueza A, Valdez PR, Peroni ML, Cayetti LA, Mirofsky MA, Boietti B, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Núñez-Cortés JM, Lumbreras C, Ramos-Rincón JM, Barrio NG, Pedrera-Jiménez M, Martin-Escalante MD, Ruiz FR, Onieva-García MÁ, Toso CR, Risk MR, Klén R, Pollán JA, Gómez-Varela D. COVID-19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes. A multicontinental cohort study. J Med Virol 2023; 95:e28786. [PMID: 37212340 DOI: 10.1002/jmv.28786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
The aim of this study was to analyze whether the coronavirus disease 2019 (COVID-19) vaccine reduces mortality in patients with moderate or severe COVID-19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID-19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9-24), compared to 19.5% (95% CI: 19-20) in unvaccinated patients, resulting in a crude odds ratio (OR) of 1.07 (95% CI: 0.89-1.29; p = 0.41). However, after considering the multiple comorbidities in the vaccinated group, the adjusted OR was 0.73 (95% CI: 0.56-0.95; p = 0.02) with a population attributable risk reduction of 4.3% (95% CI: 1-5). The higher risk reduction for mortality was with messenger RNA (mRNA) BNT162b2 (Pfizer) (OR 0.37; 95% CI: 0.23-0.59; p < 0.01), ChAdOx1 nCoV-19 (AstraZeneca) (OR 0.42; 95% CI: 0.20-0.86; p = 0.02), and mRNA-1273 (Moderna) (OR 0.68; 95% CI: 0.41-1.12; p = 0.13), and lower with Gam-COVID-Vac (Sputnik) (OR 0.93; 95% CI: 0.6-1.45; p = 0.76). COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate or severe disease (oxygen therapy).
Collapse
Affiliation(s)
- Ivan A Huespe
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Augusto Ferraris
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Antonio Lalueza
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Maria L Peroni
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luis A Cayetti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias A Mirofsky
- Hospital Municipal de Agudos "Dr. Leónidas Lucero", Bahía Blanca, Argentina
| | - Bruno Boietti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Gómez-Huelgas
- Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | | | | | | | - Carlos Lumbreras
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Noelia G Barrio
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | - Miguel Pedrera-Jiménez
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | | | | | - Carlos R Toso
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Marcelo R Risk
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), CONICET-HIBA-IUHI, Buenos Aires, Argentina
| | - Riku Klén
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Javier A Pollán
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - David Gómez-Varela
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Klén R, Purohit D, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Núñez-Cortés JM, Lumbreras C, Ramos-Rincón JM, García Barrio N, Pedrera-Jiménez M, Lalueza Blanco A, Martin-Escalante MD, Rivas-Ruiz F, Onieva-García MÁ, Young P, Ramirez JI, Titto Omonte EE, Gross Artega R, Canales Beltrán MT, Valdez PR, Pugliese F, Castagna R, Huespe IA, Boietti B, Pollan JA, Funke N, Leiding B, Gómez-Varela D. Development and evaluation of a machine learning-based in-hospital COVID-19 disease outcome predictor (CODOP): A multicontinental retrospective study. eLife 2022; 11:e75985. [PMID: 35579324 PMCID: PMC9129872 DOI: 10.7554/elife.75985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
New SARS-CoV-2 variants, breakthrough infections, waning immunity, and sub-optimal vaccination rates account for surges of hospitalizations and deaths. There is an urgent need for clinically valuable and generalizable triage tools assisting the allocation of hospital resources, particularly in resource-limited countries. We developed and validate CODOP, a machine learning-based tool for predicting the clinical outcome of hospitalized COVID-19 patients. CODOP was trained, tested and validated with six cohorts encompassing 29223 COVID-19 patients from more than 150 hospitals in Spain, the USA and Latin America during 2020-22. CODOP uses 12 clinical parameters commonly measured at hospital admission for reaching high discriminative ability up to 9 days before clinical resolution (AUROC: 0·90-0·96), it is well calibrated, and it enables an effective dynamic risk stratification during hospitalization. Furthermore, CODOP maintains its predictive ability independently of the virus variant and the vaccination status. To reckon with the fluctuating pressure levels in hospitals during the pandemic, we offer two online CODOP calculators, suited for undertriage or overtriage scenarios, validated with a cohort of patients from 42 hospitals in three Latin American countries (78-100% sensitivity and 89-97% specificity). The performance of CODOP in heterogeneous and geographically disperse patient cohorts and the easiness of use strongly suggest its clinical utility, particularly in resource-limited countries.
Collapse
Affiliation(s)
- Riku Klén
- Turku PET Centre, University of Turku and Turku University HospitalTurkuFinland
| | - Disha Purohit
- Max Planck Institute of Experimental MedicineGöttingenGermany
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA)MálagaSpain
| | | | | | | | - Carlos Lumbreras
- Internal Medicine Department, 12 de Octubre University HospitalMadridSpain
| | - José Manuel Ramos-Rincón
- Internal Medicine Department, General University Hospital of Alicante, Alicante Institute for 22 Health and Biomedical Research (ISABIAL)AlicanteSpain
| | | | | | | | | | | | | | - Pablo Young
- Hospital Británico of Buenos AiresBuenos AiresArgentina
| | | | | | | | | | | | | | | | - Ivan A Huespe
- Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Bruno Boietti
- Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Nico Funke
- Max Planck Institute for Experimental MedicineGöttingenGermany
| | - Benjamin Leiding
- Institute for Software and Systems Engineering at TU ClausthalClausthalGermany
| | - David Gómez-Varela
- Max Planck Institute for Experimental MedicineGöttingenGermany
- Systems Biology of Pain, Division of Pharmacology & Toxicology, Department of Pharmaceutical Sciences, University of ViennaViennaAustria
| |
Collapse
|