Background: Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods: We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results: 1,608,980 (95% CI 1,570,803–1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions: Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.
Background: COronaVIrus Disease 2019 (COVID-19) has been observed to be associated with a hypercoagulable state. Intracardiac thrombosis is a serious complication but has seldom been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. Methods: COVID-19 inpatients during 2020 were retrospectively identified from the national inpatient sample (NIS) database, and data retrieved regarding clinical characteristics, intracardiac thrombosis, and adverse outcomes. Multivariable logistic regression was performed to identify the clinical factors associated with intracardiac thrombosis and in-hospital mortality and morbidities. Results: A total of 1,683,785 COVID-19 inpatients were identified in 2020 from NIS, with a mean age of 63.8 ± 1.6 years, and 32.2% females. Intracardiac thrombosis was present in 0.001% (1,830) patients. Overall, in-hospital outcomes include all-cause mortality 13.2% (222,695/1,683,785), cardiovascular mortality 3.5%, cardiac arrest 2.6%, acute coronary syndrome (ACS) 4.4%, heart failure 16.1%, stroke 1.3% and acute kidney injury (AKI) 28.3%. The main factors associated with intracardiac thrombosis were a history of congestive heart failure and coagulopathy. Intracardiac thrombosis was independently associated with a higher risk of in-hospital all-cause mortality (OR: 3.32, 95% CI: 2.42-4.54, p<0.001), cardiovascular mortality (OR: 2.95, 95% CI: 1.96-4.44, p<0.001), cardiac arrest (OR: 2.04, 95% CI: 1.22-3.43, p=0.006), ACS (OR: 1.62, 95% CI: 1.17-2.22, p=0.003), stroke (OR: 3.10, 95% CI: 2.11-4.56, p<0.001), and AKI (OR: 2.13 95% CI: 1.68-2.69, p<0.001), but not incident heart failure (p=0.27). Conclusion: Although intracardiac thrombosis is rare in COVID-19 inpatients, its presence was independently associated with higher risks of in-hospital mortality and most morbidities. Prompt investigations and treatments for intracardiac thrombosis are warranted when there is a high index of suspicion and a confirmed diagnosis respectively.
Background: Pregnancy in patients with pulmonary hypertension (PH) is associated with heightened risk of various medical complications. Our study aims to understand the patient characteristics and investigate the association between PH and these complications in pregnant patients during delivery. Methods: The National Inpatient Sample (NIS) was used to identify delivery hospitalizations from 2011 to 2020. The primary outcomes were in-hospital medical and obstetric complications. Multivariate logistic regression was performed to study the association of PH with these complications. Results: A total of 37,482,207 delivery hospitalizations in women ?18 years were identified from the NIS database out of which 9,593 patients had PH. Pregnant patients with PH had a higher incidence of complications during delivery including preeclampsia/eclampsia, cardiac arrhythmias, pulmonary edema amongst others, compared to pregnant patients without PH. Pregnant patients with PH had a higher incidence of in-hospital mortality compared to those without PH (0.51% vs 0.007%). In adjusted analyses, PH was independently associated with a higher risk of pulmonary edema (OR: 18.65 [95% CI: 13.71-25.38]), peripartum cardiomyopathy (14.06 [9.15-21.60]), venous thromboembolism (12.25 [7.80-19.24]), cardiac arrhythmias (11.75 [10.11-13.67]), acute kidney injury (7.53 [5.36-10.58]), preeclampsia/eclampsia (4.61 [4.04-5.25]), and acute coronary syndrome (2.83 [1.17-6.85]), compared with pregnant patients without PH. In-hospital mortality in patients with PH was associated with stroke (127.33 [78.49-206.57]), acute kidney injury (51.25 [34.40-76.36]), cardiac arrhythmias (24.80 [19.43-31.65]), peripartum cardiomyopathy (6.47 [3.23-12.97]), pulmonary edema (4.27 [2.18-8.37]), venous thromboembolism (2.75 [1.07-7.10]), and preeclampsia/eclampsia (1.87 [1.35-2.60]) compared to pregnant patients without PH. Conclusion: Delivery hospitalizations in patients with PH are associated with high risk of various complications. Prenatal counseling and multidisciplinary care are essential to help mitigate unfavorable outcomes in these patients.
Background:The endoscopic Mayo score (MS) is the most frequent score used for the evaluation of inflammatory activity in Ulcerative Colitis (UC), varying from 0 to 3 points. Recently the DUBLIN score (DS) emerged, which varies from 0 to 9 points and results from the product of the MS and the disease extent, according to Montreal classification, E1-E3. In this study we aimed to evaluate and compare the predictive ability of MS and DS for long term treatment failure. Methods: A retrospective and unicentric study was conducted, including patients with left-sided or extensive UC, asymptomatic and without the need for steroid therapy or therapy changes in the 6 months prior to undergoing total colonoscopy with calculation of MS and DS. Treatment failure was evaluated, defined by the need for therapy changes and/or hospitalization because of disease exacerbation, over a follow-up period of a minimum of 24 months and a maximum of 84 months. Results: A total of 204 patients were included, 104 (51%) females and with a mean age at diagnosis of 36.4 6 12.7 years. In the initial evaluation, 48 (23.5%) were being treated with anti-TNFa medication. The mean values of MS were 1.0 6 1.1 points and of DS were 2.2 6 2.6 points. During follow-up, 32 (15.7%) patients experienced treatment failure and patients initially treated with anti-TNFa medication had 2.3 times higher risk of treatment failure (P 5 0.042). MS values (AUC 0.809; P , 0.001; with sensitivity of 0.938 and specificity of 0.529 for values equal or superior to 1) and DS values (AUC 0.789; P , 0.001; with sensitivity of 0.844 and specificity of 0.581 for values equal or superior to 2) had good discriminative abilities in predicting treatment failure. There were no statistically significant differences in the discriminative ability between both scores (P 5 0.340). Conclusion(s): MS and DS had good discriminative abilities in predicting treatment failure. However, the integration of the disease extent in the DS as a complement of MS in the evaluation of UC was not associated with a higher predictive ability of long term treatment failure.
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