Risk factors of mortality among patients hospitalised with COVID-19 in a critical care or hospital care unit: analysis of the French national medicoadministrative database.

OBJECTIVE: To explore mortality risk factors for patients hospitalised with COVID-19 in a critical care unit (CCU) or a hospital care unit (HCU). DESIGN: Retrospective cohort analysis using the French national (Programme de médicalisation des systèmes d'information) database. SETTING: Any public or private hospital in France. PARTICIPANTS: 98 366 patients admitted with COVID-19 for more than 1 day during the first semester of 2020 were included. The underlying conditions were retrieved for all contiguous stays. MAIN OUTCOME MEASURES: In-hospital mortality and associated risk factors were assessed using frailty Cox models. RESULTS: Among the 98 366 patients included, 25 765 (26%) were admitted to a CCU. The median age was 66 (IQR: 55-76) years in CCUs and 74 (IQR: 57-85) years in HCUs. Age was the main risk factor of death in both CCUs and HCUs, with adjusted HRs (aHRs) in CCUs increasing from 1.60 (95% CI 1.35 to 1.88) for 46 to 65 years to 8.17 (95% CI 6.86 to 9.72) for ≥85 years. In HCUs, the aHR associated with age was more than two times higher. The gender was not significantly associated with death, aHR 1.03 (95% CI 0.98 to 1.09, p=0.2693) in CCUs. Most of the underlying chronic conditions were risk factors for death, including malignant neoplasm (CCU: 1.34 (95% CI 1.25 to 1.43); HCU: 1.41 (95% CI 1.35 to 1.47)), cirrhosis without transplant (1.41 (95% CI 1.22 to 1.64); 1.27 (95% CI 1.12 to 1.45)) and dementia (1.30 (95% CI 1.16 to 1.46); 1.07 (95% CI 1.03 to 1.12)). CONCLUSION: This analysis confirms the role of age as the major risk factor of death in patients with COVID-19 irrespective to admission to critical care and therefore supports the current vaccination policies targeting older individuals.

Reliable assessment of the incidence of childhood autoimmune hemolytic anemia.

BACKGROUND: Childhood autoimmune hemolytic anemia (AIHA) is a rare and severe disease characterized by hemolysis and positive direct antiglobulin test (DAT). Few epidemiologic indicators are available for the pediatric population. The objective of our study was to reliably estimate the number of AIHA cases in the French Aquitaine region and the incidence of AIHA in patients under 18 years old. PROCEDURE: In this retrospective study, the capture-recapture method and log-linear model were used for the period 2000-2008 in the Aquitaine region from the following three data sources for the diagnosis of AIHA: the OBS'CEREVANCE database cohort, positive DAT collected from the regional blood bank database, and the French medico-economic information system. RESULTS: A list of 281 different patients was obtained after cross-matching the three databases; 44 AIHA cases were identified in the period 2000-2008; and the total number of cases was estimated to be 48 (95% confidence interval [CI]: 45-55). The calculated incidence of the disease was 0.81/100,000 children under 18 years old per year (95% CI 0.76-0.92). CONCLUSION: Accurate methods are required for estimating the incidence of AIHA in children. Capture-recapture analysis corrects underreporting and provides optimal completeness. This study highlights a possible under diagnosis of this potentially severe disease in various pediatric settings. AIHA incidence may now be compared with the incidences of other hematological diseases and used for clinical or research purposes.

[Impact of pathological review by an expert on the diagnosis and management of patients with cancer in Aquitania]. / Impacts des avis diagnostiques de cancérologie en Aquitaine. Etude quantitative, qualitative et médicoéconomique rétrospective sur une année.

AIMS: The goal of this work was to evaluate the impact of expert pathological second opinion on the diagnosis and management of patients with cancer, in a French region (Aquitaine) and with an economic point of view. MATERIAL AND METHODS: The study was first quantitative, performed retrospectively on all cases of cancer, voluntary sent for a second opinion to an expert pathologist of two centers. Secondly, we restricted the study to lymphoid, melanocytic and soft tissue tumors sent for second opinion. We considered that the expert review had an important diagnostic impact either when the initial pathologist sent the specimen to identify or classify malignant tumor or hesitated between benign and malignant tumor or had no hypothesis, or if there were discordant diagnoses (malignant/benign) between the two pathologists. We considered that the expert review had a high therapeutic impact if the disagreement between initial and expert diagnoses induced a complete modification in therapy. We evaluated the cost of second opinion for the expert centers and the cost of care management. RESULTS: Over the year 2006, the expert centers received 5077 lesions for consultation: 3769 specimens were sent by a pathologist for a second review, 1324 by pathologists of Aquitania and of these, 751 samples were submitted for lymphoid (55%), soft tissues (30%) or melanocytic tumors (15%). There was an important diagnostic impact for 75% of the samples; the impact of the expert review on patient management was considered high for 46% of specimens and the expert pathological diagnosis modified the clinical prognosis for 40% of the specimens. We estimated that for 53 discordant diagnoses (malignant/benign), second opinion allowed an economy of 500,000 euro. CONCLUSION: Expert second opinion is very important not only for diagnosis and management for patient with cancer but also for economic reasons.

[An overview of the 2001-2002 cancer activity in the 30 French Regional and University Hospitals, based on PMSI data]. / Bilan d'activité cancérologique 2001-2002 des centres hospitaliers régionaux et universitaires de France à partir des données du PMSI.

This study is intended to describe the cancer-related hospitalisations in the thirty French University and Regional Hospitals (CHR&U). The analysis is carried out on the years 2001 and 2002 databases and uses a relevant PMSI (Medicalisation Program Information System, the French DRG) data analysis program, which is an adapted version of the DAC (Cancer Activity Description) analysis program. Cases are selected from cancer-related diagnoses and procedures. The results provided have been classified according to paediatric and adult populations, to the organ anatomical localisations and to the different types of care : one-day hospitalisations or hospitalisations of more than one day, medical or surgical care, cares which include chemotherapy, radiation therapy or palliative procedures. Cancer-related hospitalisations amount to almost 25 % of the total CHR&U hospitalisations and add up to over a million stays per year. One-day hospitalisations amount to 25% of the cancer-related stays and essentially consist in radiation therapy (50% within the adult category) and for chemotherapy (30%). 26% of the hospitalisations of more than one day are surgical. This study is a first descriptive analysis of cancer-related hospital activity in CHR&U. The next stage will see this analysis applied to patients, using the anonymous patient identification number contained in the PMSI coding.