ABSTRACT
BACKGROUND: Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy. AIM: We aimed to investigate whether hemoglobin drop was associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19. DESIGN: Retrospective cohort study. METHODS: This retrospective study was conducted by review of the medical records of 6683 patients with laboratory-confirmed COVID-19 hospitalized in the Mount Sinai Health system between 1st March 2020 and 30th March 2021. We compared patients with and without hemoglobin drop >3 g/dl during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as serum creatine change of 0.3 mg/dl increase or 1.5 times baseline. RESULTS: Of the 6683 patients admitted due to COVID-19, 750 (11.2%) patients presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within 2 days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% vs. 20.0%, P < 0.001) as well as AKI (51.4% vs. 23.9%, P < 0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P < 0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P < 0.001). CONCLUSIONS: Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality.
Subject(s)
Acute Kidney Injury , COVID-19 , Hemoglobins , Hospital Mortality , Acute Kidney Injury/mortality , Acute Kidney Injury/virology , COVID-19/blood , COVID-19/diagnosis , COVID-19/mortality , Hemoglobins/analysis , Humans , Incidence , Retrospective Studies , Risk FactorsABSTRACT
Deviations in the processes of healthcare delivery that affect patient outcomes are recognized to have an impact on the cost of hospitalization. Whether deviations that do not affect patient outcome affects cost has not been studied. We have analyzed process of care (POC) events that were reported in a large transplantation service (n = 3,012) in 2005, delineating whether or not there was a health consequence of the event and assessing the impact on hospital resource utilization. Propensity score matching was used to adjust for patient differences. The rate of POC events varied by transplanted organ: from 10.8 per 1000 patient days (kidney) to 17.3 (liver). The probability of a POC event increased with severity of illness. The majority (81.5%) of the POC events had no apparent effect on patients' health (63.6% no effect and 17.9% unknown). POC events were associated with longer length of stay (LOS) and higher costs independent of whether there was a patient health impact. Multiple events during the same hospitalization were associated with the highest impact on LOS and cost. POC events in transplantation occur frequently, more often in sicker patients and, although the majority of POC events do not harm the patient, their effect on resource utilization is significant.
Subject(s)
Delivery of Health Care/economics , Hospitalization/economics , Organ Transplantation/economics , Adolescent , Adult , Child , Costs and Cost Analysis/economics , Female , Humans , Length of Stay/economics , Male , Middle Aged , Severity of Illness IndexABSTRACT
The biological action of xylol isomers as ambient air pollutants was investigated. The maximum single allowable concentrations of orthoxylol (0.3 mg/m3), methaxylol (0.24 mg/m3), papaxylol (0.27 mg/m3) were determined by measuring the odour thresholds of the substances in 122 volunteers. The average daily allowable concentrations of the xylol isomers were found to be 0.4, 0.16, and 0.96 mg/m3, respectively.