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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-7, 01/jan./2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1361637

RESUMO

Aim: to identify which complications and prognosis of diabetic patients, hospitalized, who acquired COVID-19, through a systematic review. Methods: a systematic review based on the PRISMA flowchart, including cohort studies, available in Portuguese, English, Spanish, French, and Mandarin, published from 2019 to 2020, using the PICOS strategy, in the databases: PubMed, Web of Science, Scielo, Lilacs, Scopus and Science Direct, which in addition to the inclusion criteria after questionnaires to assess methodological quality and risk of bias. Results: of the 811 articles researched, 6 were included in this research. These studies showed that patients with COVID-19 and higher DM with worse prognosis, spent more time in the ICU, constantly needed indifference, greater complications when related to other comorbidities, high mortality rate, and glycemic control associated with advanced age directly affected patients. Outcomes even of non-diabetic subjects. Conclusion: this review identified the severity of the pathophysiological association is related to older age and biochemical and inflammatory factors linked to the two pathogens and that these subjects are more prone to specialized hospital care, which, however, result in high rates of hospital mortality.


Objetivo: identificar quais complicações e prognósticos dos pacientes diabéticos, internados, que adquiriram COVID-19, por meio de uma revisão sistemática. Métodos: foi realizada uma revisão sistemática baseada no fluxograma PRISMA, incluindo estudos de coorte, disponíveis em português, inglês, espanhol, francês e mandarim, publicados de 2019 a 2020, utilizando a estratégia PICOS, nas bases de dados: PubMed, Web of Science, Scielo, Lilacs, Scopus e Sciece Direct. Além dos critérios de inclusão passam por questionários para avaliar a qualidade metodológica e risco de viés. Resultados: dos 811 artigos pesquisados, 6 foram incluídos nesta pesquisa. Esses estudos mostraram que pacientes com COVID-19 e DM apresentam pior prognóstico, maior permanência em UTI, necessidade constante de ventilação invasiva, maiores complicações quando relacionadas a outras comorbidades, elevado índice de mortalidade, e o controle glicêmico associado à idade avançada afetavam diretamente os desfechos inclusive de pacientes não diabéticos. Conclusão: esta revisão identificou que a gravidade da associação fisiopatológica está relacionada à idade mais avançada e aos fatores bioquímicos e inflamatórios ligados aos dois patógenos e que esses sujeitos são mais propensos ao atendimento hospitalar especializado, o que, no entanto, resulta em altas taxas de mortalidade hospitalar.


Assuntos
COVID-19 , Estratégias de Saúde , Mortalidade Hospitalar , Diabetes Mellitus , Controle Glicêmico
2.
Surg Infect (Larchmt) ; 23(6): 525-531, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35917385

RESUMO

Background: It is unknown whether having multiple acute care surgery (ACS) procedures performed in one admission confers additional risk. We hypothesized that having multiple procedures (for example, hernia repair plus bowel resection) would be associated with higher mortality. Patients and Methods: We identified all 2017 National Inpatient Sample admissions with ACS procedures including: colon, small bowel/appendix (SB), hernia, adhesiolysis, peptic ulcer procedures, gallbladder, debridement, other laparotomy, other laparoscopy. The total number of procedures for each admission and common dyad (two-procedure) and triad (three-procedure) combinations were identified. Logistic regression estimated the odds of in-hospital mortality for increasing procedure count and specific dyad and triad combinations, using patients with one procedure as the reference. Results: A total of 216,317 ACS patients (median age, 57, interquartile range [IQR], 43-70; 50.6% female) were included; 2.8% died. Patients with multiple procedures were more likely to die than patients with one procedure (7.4% vs. 1.9%). An increasing number of procedures was associated with higher odds of death (two procedures: odds ratio [OR], 3.0; 95% confidence interval [CI], 2.9-3.2] to six or more procedures, OR, 9.5; 95% CI, 4.9-18.5); having more than three procedures was associated with at least fivefold higher odds of death. Specific dyads/triads were associated with particularly high risk of mortality, including ulcer/laparotomy (OR, 15.5; 95% CI, 13.7-17.5) and laparotomy/SB (OR, 8.31; 95% CI, 5.15-13.40). Conclusions: Multiple ACS procedures in one hospitalization confer increased odds of in-hospital mortality. This knowledge enables the ACS providers to better counsel patients by giving more specific expectations regarding mortality based on the number of procedures required or anticipated during an admission.


Assuntos
Laparoscopia , Laparotomia , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Laparoscopia/métodos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Int J Clin Pract ; 2022: 9406499, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35936061

RESUMO

Background: Pneumonia is one of the leading causes of mortality and morbidity worldwide. Microbiology tests play a critical role in the diagnosis of pneumonia. Our study aimed to determine microbiology result reporting times and evaluate their association with outcomes of adult patients (≥18 years) hospitalised with pneumonia. Methods: This is a 3-year (2016-2018) retrospective cohort study in six hospitals in New South Wales, Australia. The study data were obtained by linking hospital and laboratory system databases. Result reporting times including time from admission to the first and the last microbiology test results were determined. The outcome measures were hospital length of stay (LOS) and in-hospital mortality. We fit median and logistic regression to evaluate the association of time-to-first microbiological result with hospital LOS and in-hospital mortality, respectively. Results: A total of 6,298 patients met the inclusion criteria. Of these, 85.3% (n = 5,375) ordered at least one microbiology test. The top 5 microbiology tests were blood culture, urine culture, respiratory polymerase chain reaction (PCR), urine antigen, and sputum culture. The median time-to-first microbiology result was 26 hrs while the median time-to-last test result was 144 hrs. The rate of in-hospital mortality was 5.9% (n = 371). After adjusting for confounders, every 5 hrs increase in the time-to-first microbiology test was associated with an increase of 3.9 hrs in the median hospital LOS [95% Confidence Interval (CI), 3.5 to 4.3; P ≤ 0.001]. There was no association between time-to-first microbiology result and in-hospital mortality (OR 1.01; 95% CI 1.00-1.02; P=0.122). Conclusion: Time-to-first microbiology result reporting was significantly associated with hospital LOS but not with in-hospital mortality. Further research should be conducted to understand if improving result reporting times can reduce the length of hospital stay of patients.


Assuntos
Pneumonia , Adulto , Mortalidade Hospitalar , Humanos , Armazenamento e Recuperação da Informação , Tempo de Internação , Estudos Retrospectivos
4.
BMC Med Inform Decis Mak ; 22(1): 204, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915500

RESUMO

OBJECTIVES: NHS Digital issued new guidance on sepsis coding in April 2017 which was further modified in April 2018. During these timeframes some centres reported increased sepsis associated mortality, whilst others reported reduced mortality, in some cases coincident with specific quality improvement programmes. We hypothesised that changes in reported mortality could not be separated from changes in coding practice. METHODS: Hospital Episode Statistics from the Admitted Patient Care dataset for NHS hospitals in England, from April 2016 to March 2020 were analysed. Admissions of adults with sepsis: an International Classification of Diseases 10 (ICD-10) code associated with the Agency for Healthcare Research and Quality Clinical Classifications Software class 'Septicaemia (except in labour)', were assessed. Patient comorbidities were defined by other ICD-10 codes recorded within the admission episode. RESULTS: 1,081,565 hospital episodes with a coded diagnosis of sepsis were studied. After April 2017 there was a significant increase in admission episodes with sepsis coded as the primary reason for admission. There were significant changes in the case-mix of patients with a primary diagnosis of sepsis after April 2017. An analysis of case-mix, hospital and year treated as random effects, defined a small reduction in sepsis associated mortality across England following the first change in coding guidance. No centre specific improvement in outcome could be separated from these random-effects. CONCLUSION: Changes in sepsis coding practice altered case-mix and case selection, in ways that varied between centres. This was associated with changes in centre-specific sepsis associated mortality, over time. According to the direction of change these may be interpreted either as requiring local investigation for cause or as supporting coincident changes in clinical practice. A whole system analysis showed that centre specific changes in mortality cannot be separated from system-wide changes. Caution is therefore required when interpreting sepsis outcomes in England, particularly when using single centre studies to inform or support guidance or policy.


Assuntos
Sepse , Adulto , Comorbidade , Inglaterra/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Classificação Internacional de Doenças , Sepse/diagnóstico
5.
PLoS One ; 17(8): e0271982, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921383

RESUMO

BACKGROUND: Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. OBJECTIVES: Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. METHODS: This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. RESULTS: The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio (OR) 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). CONCLUSIONS: Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk.


Assuntos
Serviços Médicos de Emergência , Síndrome do Desconforto Respiratório , Adulto , Estudos de Coortes , Dispneia , Mortalidade Hospitalar , Hospitais , Humanos , Alta do Paciente , Síndrome do Desconforto Respiratório/diagnóstico , Estudos Retrospectivos
6.
Sci Rep ; 12(1): 13323, 2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922436

RESUMO

In this study we aimed to evaluate the ability of IMPROVE and IMPROVE-DD scores in predicting in-hospital mortality in patients with severe COVID-19. This prospective observational study included adult patients with severe COVID-19 within 12 h from admission. We recorded patients' demographic and laboratory data, Charlson comorbidity index (CCI), SpO2 at room air, acute physiology and chronic health evaluation II (APACHE II), IMPROVE score and IMPROVE-DD score. In-hospital mortality and incidence of clinical worsening (the need for invasive mechanical ventilation, vasopressors, renal replacement therapy) were recorded. Our outcomes included the ability of the IMPROVE and IMPROVE-DD to predict in-hospital mortality and clinical worsening using the area under receiver operating characteristic curve (AUC) analysis. Multivariate analysis was used to detect independent risk factors for the study outcomes. Eighty-nine patients were available for the final analysis. The IMPROVE and IMPROVE-DD score showed the highest ability for predicting in-hospital mortality (AUC [95% confidence intervals {CI}] 0.96 [0.90-0.99] and 0.96 [0.90-0.99], respectively) in comparison to other risk stratification tools (APACHE II, CCI, SpO2). The AUC (95% CI) for IMPROVE and IMPROVE-DD to predict clinical worsening were 0.80 (0.70-0.88) and 0.79 (0.69-0.87), respectively. Using multivariate analysis, IMPROVE-DD and SpO2 were the only predictors for in-hospital mortality and clinical worsening. In patients with severe COVID-19, high IMPROVE and IMOROVE-DD scores showed excellent ability to predict in-hospital mortality and clinical worsening. Independent risk factors for in-hospital mortality and clinical worsening were IMPROVE-DD and SpO2.


Assuntos
COVID-19 , APACHE , Adulto , COVID-19/terapia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos
7.
Eur J Gastroenterol Hepatol ; 34(9): 967-974, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35913780

RESUMO

INTRODUCTION: Liver transplantation (LT) is the only effective treatment for acute-on-chronic liver failure (ACLF), but it is limited by organ availability. This study aims to identify predictive factors of mortality for LT candidates based on parameters measured at the admission into the ICU. METHODS: Sixty-four patients diagnosed with ACLF, admitted consecutively into ICU between 2015 and 2019, were retrospectively enrolled in the study. Data were assessed using univariate and multivariate regression analyses to identify risk factors for inhospital mortality and 1-year mortality. RESULTS: A total of 67% of patients were diagnosed with ACLF grade 3, and 25 and 8% with grades 2 and 1. Thirty percent received LT with a 1-year mortality rate of 16%, whereas for nontransplanted patients it reached 90%. Clinical features were compared according to transplant eligibility. In the univariate analysis model, lung failure (HR, 3.01; 95% CI, 1.48-6.09; P = 0.002), high lactate levels (HR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and CLIF-ACLF score (HR, 1.04; 95% CI, 1.01-1.09; P = 0.026) were independently correlated to increased inhospital mortality. LT reduced mortality risk (HR, 0.16; 95% CI, 0.04-0.72; P = 0.016). CONCLUSION: Lung failure, CLIF-ACLF score and blood lactate levels at admission were the only statistically significant independent predictors of inhospital mortality, more accurate in determining transplant success than ACLF grade.


Assuntos
Insuficiência Hepática Crônica Agudizada , Transplante de Fígado , Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/cirurgia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Lactatos , Cirrose Hepática , Prognóstico , Estudos Retrospectivos
8.
J Korean Med Sci ; 37(30): e234, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35916046

RESUMO

BACKGROUND: Pneumonia, which is the third leading cause of death in South Korea, is continuously increasing with the aging society. The Health Insurance Review and Assessment of South Korea conducted a quality assessment (QA) for improving the outcome of community-acquired pneumonia (CAP). METHODS: We conducted a nationwide cross-sectional study of hospitalized CAP in South Korea. First to third QA data were gathered into a single database. The national health insurance database was merged with the QA database for analyzing the medical claims data. Comorbidities, pneumonia severity, and pneumonia care appropriateness were calculated using Charlson comorbidity index (CCI), CURB-65, and core assessment of CAP scores (CAP scores), respectively. RESULTS: Overall, 54,307 patients were enrolled. The CAP scores significantly improved on QA program implementation (P < 0.001). All the variables demonstrated an association with in-hospital mortality, hospital length of stay (LOS), and 30-day mortality in the univariate analyses. Following the adjustments, higher CCI and CURB-65 scores were associated with higher in-hospital mortality, longer hospital LOS, and higher 30-day mortality. Male sex was associated with higher in-hospital/30-day mortality and shorter hospital LOS. Higher CAP scores were associated with shorter hospital LOS (P < 0.001). Upon QA program implementation, in-hospital mortality (P < 0.001), hospital LOS (P < 0.001), and 30-day mortality (P < 0.001) improved. CONCLUSION: Continuing QA program is effective in improving the clinical outcomes of hospitalized CAP.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Estudos Transversais , Mortalidade Hospitalar , Hospitalização , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
BMC Cardiovasc Disord ; 22(1): 346, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915399

RESUMO

BACKGROUND: In recent years, abnormalities in serum lipids and lipoproteins have been shown to be associated with cardiovascular disease risk. However, their prognostic value for acute type A aortic dissection is unclear. This study analyzed the correlation between triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and in-hospital mortality in patients with AAAD, and aimed to investigate the clinical significance of preoperative blood lipids and lipoproteins on the prognosis of acute type A aortic dissection. METHODS: A total of 361 patients who underwent type A aortic dissection surgery in Fujian Cardiac Medical Center from June 2018 to March 2020 were retrospectively collected. According to the baseline TG/HDL-C ratio, the patients were divided into 3 groups according to the tertile method, the low TG/HDL-C ratio T1 group (< 1.18) and the middle TG/HDL-C ratio T2 group (1.18-1.70). T3 group with high TG/HDL-C ratio (> 1.70). Kaplan-Meier was used for survival analysis, and Cox proportional hazards regression model was used to analyze the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve was used for the diagnostic efficacy. RESULTS: Among the 361 patients in this study, the mean age was 52.4 ± 11.3 years, 73 (20.2%) were female, and 82 (22.7%) died in hospital. Kaplan-Meier curve showed that with the increase of TG/HDL-C ratio, the risk of in-hospital death gradually increased (P < 0.001). Multivariate Cox regression analysis showed that age (HR = 1.031), body mass index (HR = 1.052), hypertension (HR = 3.491), white blood cells (HR = 1.073), TG/HDL-C ratio (HR = 1.604), MODS (HR = 1.652) was positively correlated with in-hospital mortality (P < 0.05). After adjusting for age, sex, and other risk factors, a significant association was found between the TG/HDL-C ratio and in-hospital mortality for acute type A aortic dissection (HR = 1.472, 95% CI, 1.354-3.451, P = 0.019). CONCLUSION: Patients with type A aortic dissection have obvious abnormal blood lipid metabolism, and serum TG/HDL-C levels are positively correlated with in-hospital mortality in patients with AAAD.


Assuntos
Aneurisma Dissecante , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , HDL-Colesterol , Feminino , Mortalidade Hospitalar , Humanos , Lipídeos , Lipoproteínas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos
11.
Kidney360 ; 3(7): 1144-1157, 2022 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-35919520

RESUMO

Background: Hypernatremia is a frequently encountered electrolyte disorder in hospitalized patients. Controversies still exist over the relationship between hypernatremia and its outcomes in hospitalized patients. This study examines the relationship of hypernatremia to outcomes among hospitalized patients and the extent to which this relationship varies by kidney function and age. Methods: We conducted an observational study to investigate the association between hypernatremia, eGFR, and age at hospital admission and in-hospital mortality, and discharge dispositions. We analyzed the data of 1.9 million patients extracted from the Cerner Health Facts databases (2000-2018). Adjusted multinomial regression models were used to estimate the relationship of hypernatremia to outcomes of hospitalized patients. Results: Of all hospitalized patients, 3% had serum sodium (Na) >145 mEq/L at hospital admission. Incidence of in-hospital mortality was 12% and 2% in hyper- and normonatremic patients, respectively. The risk of all outcomes increased significantly for Na >155 mEq/L compared with the reference interval of Na=135-145 mEq/L. Odds ratios (95% confidence intervals) for in-hospital mortality and discharge to a hospice or nursing facility were 34.41 (30.59-38.71), 21.14 (17.53-25.5), and 12.21 (10.95-13.61), respectively (all P<0.001). In adjusted models, we found that the association between Na and disposition was modified by eGFR (P<0.001) and by age (P<0.001). Sensitivity analyses were performed using the eGFR equation without race as a covariate, and the inferences did not substantially change. In all hypernatremic groups, patients aged 76-89 and ≥90 had higher odds of in-hospital mortality compared with younger patients (all P<0.001). Conclusions: Hypernatremia was significantly associated with in-hospital mortality and discharge to a hospice or nursing facility. The risk of in-hospital mortality and other outcomes was highest among those with Na >155 mEq/L. This work demonstrates that hypernatremia is an important factor related to discharge disposition and supports the need to study whether protocolized treatment of hypernatremia improves outcomes.


Assuntos
Hipernatremia , Mortalidade Hospitalar , Hospitalização , Humanos , Hipernatremia/epidemiologia , Alta do Paciente , Sódio
13.
PLoS One ; 17(8): e0267505, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925973

RESUMO

OBJECTIVE: To evaluate racial and ethnic differences in mortality among patients hospitalized with coronavirus disease 2019 (COVID-19) after adjusting for baseline characteristics and comorbidities. METHODS: This retrospective cohort study at 13 acute care facilities in the New York City metropolitan area included sequentially hospitalized patients between March 1, 2020, and April 27, 2020. Last day of follow up was July 31, 2020. Patient demographic information, including race/ethnicity and comorbidities, were collected. The primary outcome was in-hospital mortality. RESULTS: A total of 10 869 patients were included in the study (median age, 65 years [interquartile range (IQR) 54-77; range, 18-107 years]; 40.5% female). In adjusted time-to-event analysis, increased age, male sex, insurance type (Medicare and Self-Pay), unknown smoking status, and a higher score on the Charlson Comorbidity Index were significantly associated with higher in-hospital mortality. Adjusted risk of hospital mortality for Black, Asian, Hispanic, multiracial/other, and unknown race/ethnicity patients were similar to risk for White patients. CONCLUSIONS: In a large diverse cohort of patients hospitalized with COVID-19, patients from racial/ethnic minorities experienced similar mortality risk as White patients.


Assuntos
COVID-19 , Mortalidade Hospitalar , Idoso , Etnicidade , Feminino , Mortalidade Hospitalar/etnologia , Hospitalização , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Grupos Raciais , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos , Brancos
14.
Front Immunol ; 13: 874426, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35928822

RESUMO

Background: Several reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19. Methods: Herein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death). Results: In this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients. Conclusions: Since the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications.


Assuntos
Injúria Renal Aguda , COVID-19 , Injúria Renal Aguda/etiologia , COVID-19/complicações , Mortalidade Hospitalar , Humanos , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
15.
J Nepal Health Res Counc ; 20(1): 138-141, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945866

RESUMO

BACKGROUND: There have been very few studies in the literature assessing various scoring systems to predict mortality in patients with hollow viscous perforation. Scoring systems like POSSUM and SAPS II are among the most widely validated risk predictors. Objective of the study was to compare POSSUM and SAPS II in prediction of mortality in patients undergoing surgery for hollow viscus perforation. METHODS: Prospective observational study was conducted at Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal, over a period of 18 months. Ethical approval was obtained from the Institutional Review Board of Institute of Medicine. Informed consent was taken from all the patients. Patients aged less than 16 years, discharged on request and patients in whom no perforation found during surgery were excluded from the study. RESULTS: Among 121 patients enrolled in the study, in-hospital mortality was seen in 19 patients (17.0%). Mean POSSUM score in survivors was 39.7 ± 7.3 and in non-survivors was 52.8 ± 5.8 (p < 0.001). Similarly mean SAPS II score was 16.4 ± 9.7 in survivors and 41.8 ± 6.4 in non-survivors ( p < 0.001). Area under ROC curve was higher for SAPS II (0.964) as compared to POSSUM (0.906) suggesting that SAPS was better. CONCLUSIONS: Both POSSUM and SAPS II provided good discrimination between survivors and non survivors in patients undergoing surgery for hollow viscus perforation. SAPS II showed better sensitivity and specificity than POSSUM in predicting mortality.


Assuntos
Escore Fisiológico Agudo Simplificado , Mortalidade Hospitalar , Humanos , Nepal , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
Ethn Dis ; 32(3): 193-202, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35909638

RESUMO

Background: Race and ethnicity are major considerations in the incidence, management, and long-term outcome of ST-elevation myocardial infarction (STEMI) in the United States, but there is limited existing comparative data. Methods: We assembled a registry in a health system serving Bronx, NY of STEMI patients from 2008-2014 and analyzed differences in presentation, treatment and mortality between Hispanic/Latino (H/L), non-Hispanic Black (NHB) and non-Hispanic White (NHW). Upon discharge post-treatment for STEMI, all patients were followed for a median of 4.4 years (interquartile range 2.5, 6.0). Out of 966 STEMI patients, mean age was 61 years, 46% were H/L and 65% were male. H/Ls and NHBs had a higher prevalence of hypertension and diabetes mellitus than their NHW counterparts, coinciding with a lower socioeconomic status (SES). Results: The number of critically diseased vessels found at cardiac catheterization and mean troponin levels did not vary by race-ethnicity; neither did the adjusted hazard ratios (HR) for death. However, age-sex adjusted rates of general hospital readmission were higher in NHBs vs NHWs (HR 1.30, P=.03). Age-sex adjusted cardiovascular readmissions rates were higher in H/Ls than NHWs (HR 1.42, P=.03). Age-sex adjusted heart failure readmissions were increased for both H/Ls (HR 2.14, P=.01) and NHBs (HR 2.12, P=.02) over NHWs. Conclusions: Among STEMI patients, a higher prevalence of modifiable cardiovascular risk factors and a lower SES was seen among NHBs and H/Ls compared to NHWs. Despite similar coronary disease severity and in-hospital death, NHBs and H/Ls had a greater risk of general, cardiovascular and heart failure readmissions post-STEMI compared to NHWs.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio com Supradesnível do Segmento ST , Etnicidade , Feminino , Disparidades nos Níveis de Saúde , Mortalidade Hospitalar/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , New York , Grupos Raciais , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/etnologia , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Estados Unidos , Brancos
17.
Biomed Res Int ; 2022: 9929038, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35928914

RESUMO

Background: Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients. Methods: We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI. Results: In total, 107 patients were included in the final analysis. The mean age was 70 (64-78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, and 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n = 11) for patients without AKI, 72.7% (n = 8) for patients with transient AKI, and 86.5% (n = 32) for patients with persistent AKI (P < 0.001). Kaplan-Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P < 0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR] = 2.582; 95% CI: 1.025-6.505; P = 0.044; and HR = 6.974; 95% CI: 3.334-14.588; P < 0.001). Conclusions: AKI duration can be an important predictive parameter in elder patients suffering from COVID-19 and are admitted to ICU. Among these patients, those exhibiting persistent AKI have a lower in-hospital survival rate than those with transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.


Assuntos
Injúria Renal Aguda , COVID-19 , Idoso , COVID-19/complicações , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Fatores de Risco
18.
Thorac Cardiovasc Surg ; 70(5): 362-376, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35948014

RESUMO

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2021 are analyzed. Under more than extraordinary conditions of the further ongoing worldwide coronavirus disease 2019 (COVID-19) pandemic, a total of 161,261 procedures were submitted to the registry. In total, 92,838 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 27,947 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.2:1) was 97.3%. For the 36,714 isolated heart valve procedures (19,242 transcatheter interventions included) it was 96.7 and 99.0% for the registered pacemaker and International Classification of Diseases (ICD) procedures (19,490), respectively. Concerning short- and long-term circulatory support, a total of 3,404 ECLS/ECMO implantations and 750 assist device implantations (L-/ R-/ BVAD, TAH), respectively were registered. In 2021 329 isolated heart transplantations, 254 isolated lung transplantations, and one combined heart-lung transplantations were performed.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.


Assuntos
COVID-19 , Procedimentos Cirúrgicos Cardíacos , Cirurgia Torácica , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Alemanha/epidemiologia , Mortalidade Hospitalar , Humanos , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Sociedades Médicas , Fatores de Tempo , Resultado do Tratamento
19.
Rev Bras Ter Intensiva ; 34(2): 220-226, 2022.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35946652

RESUMO

OBJECTIVE: To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance. METHODS: We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient's probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians' categories. We also stratified the results according to randomized question framing. RESULTS: We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians' experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians. CONCLUSION: Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals' prediction. Question framing affected the predictive performance of surrogates but not of physicians.


OBJETIVO: Comparar o desempenho preditivo de residentes, médicos seniores de unidades de terapia intensiva e decisores substitutos dos pacientes logo no início da internação na unidade de terapia intensiva e avaliar se diferentes apresentações de prognóstico (probabilidade de sobrevida versus probabilidade de óbito) influenciaram seus desempenhos. MÉTODOS: Os decisores substitutos e os médicos responsáveis pelos pacientes críticos foram questionados durante as primeiras 48 horas de internação na unidade de terapia intensiva sobre a probabilidade do desfecho hospitalar do paciente. O enquadramento da pergunta (isto é, a probabilidade de sobrevida versus a probabilidade de óbito durante a internação) foi randomizado. Para avaliar o desempenho preditivo, comparou-se a área sob a curva ROC para desfecho hospitalar entre as categorias decisores substitutos e médicos. Também estratificaram-se os resultados de acordo com o enquadramento da pergunta randomizado. RESULTADOS: Entrevistaram-se decisores substitutos e médicos sobre os desfechos hospitalares de 118 pacientes. O desempenho preditivo dos decisores substitutos foi significativamente inferior ao dos médicos (área sob a curva de 0,63 para decisores substitutos, 0,82 para residentes, 0,80 para residentes de medicina intensiva e 0,81 para médicos seniores de unidade de terapia intensiva). Não houve aumento no desempenho preditivo quanto à experiência dos médicos (ou seja, médicos seniores não previram desfechos melhor que médicos juniores). Os decisores substitutos pioraram seu desempenho de previsão quando perguntados sobre a probabilidade de óbito ao invés da probabilidade de sobrevida, mas não houve diferença entre os médicos. CONCLUSÃO: Observou-se desempenho preditivo diferente ao comparar decisores substitutos e médicos, sem qualquer efeito da experiência no prognóstico dos profissionais de saúde. O enquadramento da pergunta afetou o desempenho preditivo dos substitutos, mas não o dos médicos.


Assuntos
Estado Terminal , Médicos , Tomada de Decisões , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva
20.
Sci Rep ; 12(1): 13606, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948607

RESUMO

Previous studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with disease severity and poor prognosis in COVID-19 patients. We aimed to investigate the clinical implications of NLR in patients with COVID-19 complicated with cardiovascular diseases and/or its risk factors (CVDRF). In total, 601 patients with known NLR values were selected from the CLAVIS-COVID registry for analysis. Patients were categorized into quartiles (Q1, Q2, Q3, and Q4) according to baseline NLR values, and demographic and clinical parameters were compared between the groups. Survival analysis was conducted using the Kaplan-Meier method. The diagnostic performance of the baseline and follow-up NLR values was tested using receiver operating characteristic (ROC) curve analysis. Finally, two-dimensional mapping of patient characteristics was conducted using t-stochastic neighborhood embedding (t-SNE). In-hospital mortality significantly increased with an increase in the baseline NLR quartile (Q1 6.3%, Q2 11.0%, Q3 20.5%; and Q4, 26.6%; p < 0.001). The cumulative mortality increased as the quartile of the baseline NLR increased. The paired log-rank test revealed significant differences in survival for Q1 vs. Q3 (p = 0.017), Q1 vs. Q4 (p < 0.001), Q2 vs. Q3 (p = 0.034), and Q2 vs. Q4 (p < 0.001). However, baseline NLR was not identified as an independent prognostic factor using a multivariate Cox proportional hazards regression model. The area under the curve for predicting in-hospital death based on baseline NLR was only 0.682, whereas that of follow-up NLR was 0.893. The two-dimensional patient map with t-SNE showed a cluster characterized by high mortality with high NLR at follow-up, but these did not necessarily overlap with the population with high NLR at baseline. NLR may have prognostic implications in hospitalized COVID-19 patients with CVDRF, but its significance depends on the timing of data collection.


Assuntos
COVID-19 , Doenças Cardiovasculares , COVID-19/complicações , Mortalidade Hospitalar , Humanos , Linfócitos , Neutrófilos , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco
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