Analysis of Age-Specific Predictors of Mortality in Patients with Coronavirus Disease 2019.

AIM: We investigated predictors of mortality, including demographic, clinical, and laboratory parameters, in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. PATIENTS AND METHODS: This retrospective, single-center study included 651 consecutive Turkish adults who had been admitted to the emergency department with a diagnosis of COVID-19. We recorded the demographic, clinical, and laboratory parameters of the patients. The patients were divided into two groups: patients aged ≥65 years and patients aged <65 years. The predictors of mortality for hospitalized COVID-19 patients were evaluated. RESULTS: The study included 651 patients (354 [54.4%] men and 297 [45.6%] women; mean age, 56.40 ± 15.70 years). The most common comorbidities were hypertension (37.6%), diabetes mellitus (28.9%), and coronary artery disease (CAD) (16.1%). The overall mortality rate was 10.6% (n = 69); the mortality rate was higher in men than in women. Advanced age; chronic renal failure (CRF); prolonged activated partial thromboplastin time; high serum neutrophil and platelet counts; high C-reactive protein to albumin (CRP/albumin) ratio; and high levels of albumin, lactate dehydrogenase (LDH), and high-sensitivity troponin I (TnI-hs) were independent predictors of mortality in all age groups. CONCLUSION: Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (COPD), high serum platelet count, high CRP/albumin ratio, and high levels of albumin, TnI-hs, and D-dimer were independent predictors of mortality in patients aged <65 years. Conversely, advanced age, CAD, CRF, and high levels of serum CRP and LDH were independent predictors of mortality in patients aged ≥65 years.

The impact of meteorological factors on the spread of COVID-19.

Background: Clinical studies suggest that warmer climates slow the spread of viral infections. In addition, exposure to cold weakens human immunity. Aim: This study describes the relationship between meteorological indicators, the number of cases, and mortality in patients with confirmed coronavirus disease 2019 (COVID-19). Patients and Methods: This was a retrospective observational study. Adult patients who presented to the emergency department with confirmed COVID-19 were included in the study. Meteorological data [mean temperature, minimum (min) temperature, maximum (max) temperature, relative humidity, and wind speed] for the city of Istanbul were collected from the Istanbul Meteorology 1st Regional Directorate. Results: The study population consisted of 169,058 patients. The highest number of patients were admitted in December (n = 21,610) and the highest number of deaths (n = 46) occurred in November. In a correlation analysis, a statistically significant, negative correlation was found between the number of COVID-19 patients and mean temperature (rho = -0.734, P < 0.001), max temperature (rho = -0.696, P < 0.001) or min temperature (rho = -0.748, P < 0.001). Besides, the total number of patients correlated significantly and positively with the mean relative humidity (rho = 0.399 and P = 0.012). The correlation analysis also showed a significant negative relationship between the mean, maximum, and min temperatures and the number of deaths and mortality. Conclusion: Our results indicate an increased number of COVID-19 cases during the 39-week study period when the mean, max, and min temperatures were consistently low and the mean relative humidity was consistently high.

Bleeding events in the emergency department with warfarin versus novel oral anticoagulants: A five-year analysis.

Background: Although warfarin is the most effective treatment approved to prevent atrial fibrillation-associated stroke, it remains underused in clinical practice due to patient noncompliance. Therefore, novel oral anticoagulants (NOACs) have been developed. Aims: This study aimed to identify bleeding complications in patients who were taking oral anticoagulants and compare the rates of major and minor bleeding events between NOACs and warfarin groups. Patients and Methods: We conducted a retrospective, observational study of warfarin- and NOAC-treated patients who presented to an emergency department between January 2015 and December 2019 with bleeding events. We compared patients with major and minor bleeding in terms of age, gender, comorbid diseases, type of anticoagulant, and site of bleeding. Results: An electronic search yielded 95 (21.9%) cases of patients taking a NOAC (i.e., dabigatran [19], rivaroxaban [45], apixaban [29], or edoxaban [6]) and 354 taking warfarin. There were no significant differences between the warfarin and NOACs groups in the frequency of minor bleeding complications. Similarly, there were no significant differences between the groups in the frequency of major bleeding complications. No significant difference in intracranial bleeding was seen between the NOACs- and warfarin-treated patients, although the incidence of gastrointestinal bleeding was significantly higher in the NOACs (P = 0.102 and P = 0.021, respectively). Conclusion: Our findings indicate that rates of major and minor bleeding complications in patients taking NOACs are similar to those in patients taking warfarin. While warfarin was associated with fewer complications than NOACs in terms of gastrointestinal bleeding, the risk of intracranial bleeding, was similar between the groups.

Inadecuación de ingresos y esencias hospitalarias en grupos relacionados por diagnóstico ineficientes / No disponible

Introducción: El uso inapropiado hospitalario es un aspecto sobre el que se puede actuar en el Sistema Nacional de Salud para lograr una utilización más eficiente de los recursos. El objetivo de este trabajo es describir la inadecuación de ingresos y estancias en grupos relacionados por diagnóstico ineficientes (GRD). Pacientes y Método: Estudio descriptivo. Se seleccionaron del Conjunto Mínimo Básico de Datos del año 2000 del Hospital Universitario de la Princesa los episodios de hospitalización que correspondan a grupos ineficientes en su comparación con el estándar. Se obtuvieron dos muestras independientes, una de ingresos y otra de estancias y se aplica el Appropiateness analizadas fueron: variables de persona y de tiempo, grupos, adecuación de ingresos y de estancia y causas de la inadecuación. Se realizó el análisis descriptivo de la inadecuación sus causas, análisis bivariante y multivariante de regresión logística para identificar factores asociados a la inadecuación. Resultados: El 21,6% (IC95%: 17,3-25,9) de los ingresos resultó inadecuado. Las causas fueron: admisión prematura, 84% (IC95%: 73,7-90,8); requerir cuidados terminales, 8,6% (IC95%: 3,5-16,9) y poder realizar las pruebas en consultas, 7,4% (IC95%: 2,7-15,4). La inadecuación de ingresos fue superior en admisiones programadas en grupos quirúrgicos (p<0,05), siendo el criterio de oportunidad el responsable del 100% de inadecuación de ingresos programados quirúrgicos. Respecto a la estancias, el 28,4% (IC 95%: 26,4-30,5) fueron inadecuadas. Las causas fueron: retraso del estudio, 47,1% (IC95%: 42,8-51,3) y la responsabilidad del médico u hospital, 34,1% (IC95%: 30,2-38,3). La inadecuación resultó mayor en ingresos urgentes, estancias prequirúrgicas y el tercer tercio de estancia (p<0,05). Discusión: La inadecuación de ingresos y estancias en GRD ineficientes ha sido elevada. En grupos quirúrgicos destaca la alta inadecuación de ingresos programados y de estancias prequirúrgicas por admisión prematura. En grupos médicos la inadecuación fue creciente del primer al tercer tercio de estancia. Se encontró gran varibilidad de inadecuación en los GRD evaluados, probablemente relacionada con la complejidad de los mismos (AU)

Background and objective: To achieve a more efficient management of the NHS, one of the areas to analyze is the inappropriateness use of hospital beds. The main goal of this study is to describe the unnecessary hospital admissions an stays on specific diagnosis related groups (DRG) considered inefficient. A descriptive study was carried out. Data source: Minimum Basic Data Set of H. U. de la Princesa on year 2000. Hospital admissions and stays which were no efficient compared with standard were selected. A retrospective Appropriateness Evaluation Protocol was applied on two independent samples. Study variables: person and time, DRG, appropriateness of hosptial admission and stays and causes of unnecessary use. A biviariate analysis on inappropriateness and its causes was carried out followed by a logistic regression model to identify risk factors. Results: 21,6% (CI 95%; 17,3-25,9) of hospital admissions was considered inappropriated. The main causes were: early admissions, 84% (CI 95%: 73,7-90,8); end of life care needed, 8,6% (IC95%: 3,5-16,9) and diagnostic test available on outpatient basis, 7,4% (CI95%: 2,7-15,4). the inappropriateness of hospital admissions and surgical DRG (p<0,05). All the unnecessary surgical planned admissions were related to opportunity reasons. 28,4% (CIU 95%: 26,4-30,5) of hospital stays were longer than they should be. The most frequent causes were: study delays, 47,1% (CI 95%: 42,8-31,3) and doctor in charge or organizational reasons: 34,1% (CU95%: 30,2-38,3). Inappropriateness was higher or urgent admissions, presurgical stays and on the last third on the whole hospital stays (p<0,05). Discussion: Inappropirateness of hospital admissions and stays on DRG considered inefficient was high. On surgical DRG this was mainly related to planned admissions and presurgical stays. On medical DRG there was a growth on inappropriateness form first to final third period of the hospital stay. Betwwen the studied DRG there was a great variability on the degree of inappropriateness, probably related to the complexity of the patientes included (AU)