Corpus overview


MeSH Disease

Human Phenotype


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    The Effect of Early Hydroxychloroquine-based Therapy in COVID-19 Patients in Ambulatory Care Settings: A Nationwide Prospective Cohort Study

    Authors: Tarek Sulaiman; Abdulrhman Mohana; Laila Alawdah; Nagla Mahmoud; Mustafa Hassanein; Tariq Wani; Amel Alfaifi; Eissa Alenazi; Nashwa Radwan; Nasser AlKhalifah; Ehab Elkady; Manwer AlAnazi; Mohammed Alqahtani; Khalid Abdalla; Yousif Yousif; Fouad AboGazalah; Fuad Awwad; Khaled AlabdulKareem; Fahad AlGhofaili; Ahmed AlJedai; Hani Jokhdar; Fahad Alrabiah

    doi:10.1101/2020.09.09.20184143 Date: 2020-09-13 Source: medRxiv

    ABSTRACT BACKGROUND: Currently, there is no proven effective therapy nor vaccine for the treatment of SARS-CoV-2. Evidence regarding the potential benefit of early administration of hydroxychloroquine (HCQ) therapy in symptomatic patients with Coronavirus Disease MESHD (COVID-19) is not clear. METHODS: This observational prospective cohort study took place in 238 ambulatory fever HP clinics in Saudi Arabia, which followed the Ministry of Health (MOH) COVID-19 treatment guideline. This guideline included multiple treatment options for COVID-19 based on the best available evidence at the time, among which was Hydroxychloroquine (HCQ). Patients with confirmed COVD-19 (by reverse transcriptase polymerase chain reaction (PCR) test) who presented to these clinics with mild to moderate symptoms during the period from 5-26 June 2020 were included in this study. Our study looked at those who received HCQ-based therapy along with supportive care (SC) and compared them to patients who received SC alone. The primary outcome was hospital admission within 28-days of presentation. The secondary outcome was a composite of intensive care admission (ICU) and/or mortality during the follow-up period. Outcome data were assessed through a follow-up telephonic questionnaire at day 28 and were further verified with national hospitalisation and mortality registries. Multiple logistic regression model was used to control for prespecified confounders. RESULTS: Of the 7,892 symptomatic PCR-confirmed COVID-19 patients who visited the ambulatory fever HP clinics during the study period, 5,541 had verified clinical outcomes at day 28 (1,817 patients in the HCQ group vs 3,724 in the SC group). At baseline, patients who received HCQ therapy were more likely to be males TRANS who did not have hypertension HP hypertension MESHD or chronic lung disease HP lung disease MESHD compared to the SC group. No major differences were noted regarding other comorbid conditions. All patients were presenting with active complaints; however, the HCQ groups had higher rates of symptoms compared to the SC group ( fever HP fever MESHD: 84% vs 66.3, headache HP headache MESHD: 49.8 vs 37.4, cough HP: 44.5 vs 35.6, respectively). Early HCQ-based therapy was associated with a lower hospital admission within 28-days compared to SC alone (9.4% compared to 16.6%, RRR 43%, p-value <0.001). The composite outcome of ICU admission and/or mortality at 28-days was also lower in the HCQ group compared to the SC (1.2% compared to 2.6%, RRR 54%, p-value 0.001). Adjusting for age TRANS, gender TRANS, and major comorbid conditions, a multivariate logistic regression model showed a decrease in the odds of hospitalisation in patients who received HCQ compared to SC alone (adjusted OR 0.57 [95% CI 0.47-0.69], p-value <0.001). The composite outcome of ICU admission and/or mortality was also lower for the HCQ group compared to the SC group controlling for potential confounders (adjusted OR 0.55 [95% CI 0.34-0.91], p-value 0.019). CONCLUSION: Early intervention with HCQ-based therapy in patients with mild to moderate symptoms at presentation is associated with lower adverse clinical outcomes among COVID-19 patients, including hospital admissions, ICU admission, and/or death.

    Characteristics and outcomes of patients admitted to Swedish intensive care units for COVID-19 during the first 60 days of the 2020 pandemic: a registry-based, multicenter, observational study.

    Authors: Michelle S Chew; Patrik Blixt; Rasmus Ahman; Lars Engerstrom; Henrik Andersson; Ritva Kiiski Berggren; Anders Tegnell; Sarah McIntyre

    doi:10.1101/2020.08.06.20169599 Date: 2020-08-07 Source: medRxiv

    Background The mortality of patients admitted to the intensive care unit (ICU) with COVID-19 is unclear due to variable censoring and substantial proportions of undischarged patients at follow-up. Nationwide data have not been previously reported. We studied the outcomes of Swedish patients at 30 days after ICU admission. Methods We conducted a registry-based cohort study of all adult TRANS patients admitted to Swedish ICUs from 6 March-6 May, 2020 with laboratory confirmed COVID-19 disease and complete 30-day follow-up. Data including baseline characteristics, comorbidities, intensive care treatments, organ failures and outcomes were collected. The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and the primary outcome. Results A total of 1563 patients were identified. Median ICU length of stay was 12 (5-21) days, and fifteen patients remained in ICU at the time of follow-up. Median age TRANS was 61 (52-69), median Simplified Acute Physiology Score III (SAPS III) was 53 (46-59), and 66.8% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 (75.0-140.6) mmHg, 74.7% suffered from moderate to severe acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD). The 30-day all-cause mortality was 26.7%. The majority of deaths occurred during ICU admission. Age TRANS, male TRANS sex (adjusted odds ratio [aOR] 1.5 [1.1-2.1]), SAPS III score (aOR 1.3 [1.2-1.4]), severe ARDS (aOR 3.1 [2.0-4.8], specific COVID-19 pharmacotherapy (aOR 1.4 [1.0-1.9]), and CRRT (aOR 2.2 [1.6-3.0]), were associated with increased mortality. With the exception of chronic lung disease HP, the presence of comorbidities was not independently associated with mortality. Conclusions Thirty-day mortality rate in COVID-19 patients admitted to Swedish intensive care units is generally lower than previously reported. Mortality appears to be driven by age TRANS, baseline disease severity, the degree of organ failure and ICU treatment, rather than preexisting comorbidities.

    Machine learning prediction for mortality of patients diagnosed with COVID-19: a nationwide Korean cohort study

    Authors: Chansik An; Hyunsun Lim; Dong-Wook Kim; Jung Hyun Chang; Yoon Jung Choi; Seong Woo Kim

    doi:10.21203/ Date: 2020-06-19 Source: ResearchSquare

    The rapid spread of COVID-19 is likely to result in the shortage of medical resources, which necessitates accurate prognosis prediction to triage patients effectively. This study used the nationwide cohort of South Korea to develop a machine learning model to predict prognosis based on sociodemographic and medical information. Of 10,237 COVID-19 patients, 228 (2.2%) died, 7,772 (75.9%) recovered, and 2,237 (21.9%) were still in isolation or being treated at the last follow-up (April 16, 2020). The Cox proportional hazards regression analysis revealed that age TRANS > 70, male TRANS sex, moderate or severe disability, the presence of symptoms, nursing home residence, and comorbidities of diabetes mellitus HP diabetes mellitus MESHD ( DM MESHD), chronic lung disease HP chronic lung disease MESHD, or asthma HP asthma MESHD were significantly associated with increased risk of mortality (p ≤ 0.047). For machine learning, the least absolute shrinkage and selection operator (LASSO), linear support vector machine (SVM), SVM with radial basis function kernel, random forest (RF), and k-nearest neighbors were tested. In prediction of mortality, LASSO and linear SVM demonstrated high sensitivities SERO (90.3% [95% confidence interval: 83.3, 97.3]and 92.0% [85.9, 98.1], respectively) and specificities (91.4% [90.3, 92.5] and 91.8%, [90.7, 92.9], respectively) while maintaining high specificities >90%. The most significant predictors for LASSO included old age TRANS and preexisting DM MESHD or cancer MESHD; for RF they were old age TRANS, infection MESHD route (at large clusters or from personal contact with an infected individual), and underlying hypertension HP hypertension MESHD. The proposed prediction model may be helpful for the quick triage of patients without having to wait for the results of additional tests such as laboratory or radiologic studies, during a pandemic when limited medical resources have to be wisely allocated without hesitation.

    CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

    Authors: Ruoran Wang; Min He; Jirong Yue; Lang Bai; Dan Liu; Zhixin Huang; Ting Zhu; Yan Kang

    doi:10.21203/ Date: 2020-06-01 Source: ResearchSquare

    Background The coronavirus disease MESHD 2019 (COVID-19) pneumonia HP pneumonia MESHD, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19.Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score.Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age TRANS (p < 0.001) and male TRANS ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension HP hypertension MESHD (p < 0.001), chronic lung disease HP chronic lung disease MESHD (p = 0.001) and cardiovascular disease MESHD (p = 0.005). Complications such as respiratory failure HP respiratory failure MESHD(p < 0.001), acute kidney injury HP acute kidney injury MESHD ( AKI MESHD) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001).Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

    Interim Analysis of Risk Factors for Severe Outcomes among a Cohort of Hospitalized Adults TRANS Identified through the U.S. Coronavirus Disease MESHD 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

    Authors: Lindsay Kim; Shikha Garg; Alissa O'Halloran; Michael Whitaker; Huong Pham; Evan J. Anderson; Isaac Armistead; Nancy M. Bennett; Laurie Billing; Kathryn Como-Sabetti; Mary Hill; Sue Kim; Maya L. Monroe; Alison Muse; Arthur Reingold; William Schaffner; Melissa Sutton; H. Keipp Talbot; Salina M. Torres; Kimberly Yousey-Hindes; Rachel A Holstein; Charisse Cummings; Lynette Brammer; Aron Hall; Alicia Fry; Gayle E. Langley

    doi:10.1101/2020.05.18.20103390 Date: 2020-05-22 Source: medRxiv

    Background: As of May 15, 2020, the United States has reported the greatest number of coronavirus disease MESHD 2019 (COVID-19) cases and deaths globally. Objective: To describe risk factors for severe outcomes among adults TRANS hospitalized with COVID-19. Design: Cohort study of patients identified through the Coronavirus Disease MESHD 2019-Associated Hospitalization Surveillance Network. Setting: 154 acute care hospitals in 74 counties in 13 states. Patients: 2491 patients hospitalized with laboratory-confirmed COVID-19 during March 1-May 2, 2020. Measurements: Age TRANS, sex, race/ethnicity, and underlying medical conditions. Results: Ninety-two percent of patients had at least 1 underlying condition; 32% required intensive care unit (ICU) admission; 19% invasive mechanical ventilation; 15% vasopressors; and 17% died during hospitalization. Independent factors associated with ICU admission included ages TRANS 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male TRANS sex (aRR 1.34); obesity HP obesity MESHD (aRR 1.31); immunosuppression (aRR 1.29); and diabetes MESHD (aRR 1.13). Independent factors associated with in-hospital mortality included ages TRANS 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male TRANS sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease MESHD (aRR 1.33); chronic lung disease HP chronic lung disease MESHD (aRR 1.31); cardiovascular disease MESHD (aRR 1.28); neurologic disorders MESHD (aRR 1.25); and diabetes MESHD (aRR 1.19). Race/ethnicity was not associated with either ICU admission or death MESHD. Limitation: Data were limited to patients who were discharged or died in-hospital and had complete chart abstractions; patients who were still hospitalized or did not have accessible medical records were excluded. Conclusion: In-hospital mortality for COVID-19 increased markedly with increasing age TRANS. These data help to characterize persons at highest risk for severe COVID-19-associated outcomes and define target groups for prevention and treatment strategies.

    Analysis of the Clinical Characteristics of 77 COVID-19 Deaths

    Authors: Kaige Wang; Zhixin Qiu; Dan Liu; Jianfei Luo; Jiasheng Liu; Tao Fan; Chunrong Liu; Panwen Tian; Ye Wang; Zhong Ni; Shumin Zhang; Weimin Li

    doi:10.21203/ Date: 2020-04-20 Source: ResearchSquare

    Purpose: For the emerging pandemic Coronavirus Disease MESHD 2019 (COVID-19), no clear description on its deaths’ clinical characteristics and causes of death MESHD is available. Hence, this study analyzed clinical characteristics of 77 COVID-19 deaths, providing data support to further understand this disease.Method: A retrospective analysis of 77 COVID-19 deaths in East Branch, Renmin Hospital of Wuhan University from February 1 to March 7, 2020 was performed in clinical characteristics, laboratory results, causes of death MESHD, and subgroup comparison. Results: Totally 72.7% of the deaths ( male TRANS- female TRANS ratio: 51:26, average age TRANS at death: 71, mean survival time: 17.4 days) had hypertension HP hypertension MESHD, heart disease MESHD, diabetes MESHD, chronic lung disease HP chronic lung disease MESHD, and other comorbidities. Acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD) and sepsis HP sepsis MESHD were the main causes of death MESHD. Increases in C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer and lactic acid (LAC), and decreases in lymphocyte, cluster of differentiation (CD) 4+ and CD8+ cells were common in laboratory results. Subgroup analysis showed: 1) Most female TRANS deaths had cough HP cough MESHD and diabetes MESHD. 2) The male TRANS proportion in young and middle- aged TRANS deaths was higher; while elderly TRANS deaths were more prone to myocardial injury MESHD and elevated CRP. 3) There was no statistical difference between short-term and non-short-term survival subgroups. 4) CRP and LDH increased and CD4+ and CD8+ cells decreased significantly in patients with hypertension HP hypertension MESHD.Conclusions: The majority of COVID-19 deaths are males TRANS, especially the elderly TRANS with underlying diseases. The main causes of death include ARDS MESHD and sepsis HP sepsis MESHD. Most female TRANS deaths have cough HP cough MESHD and diabetes MESHD. Myocardial injury MESHD is common in elderly TRANS deaths. Patients with hypertension HP hypertension MESHD are prone to increased inflammatory index, tissue hypoxia MESHD and cellular immune injury.Authors Kaige Wang and Zhixin Qiu contributed equally to this work.

    Epidemiology, clinical course, and outcomes of critically ill adults TRANS with COVID-19 in New York City: a prospective cohort study

    Authors: Matthew J Cummings; Matthew R Baldwin; Darryl Abrams; Samuel D Jacobson; Benjamin J Meyer; Elizabeth M Balough; Justin G Aaron; Jan Claassen; LeRoy E Rabbani; Jonathan Hastie; Beth R Hochman; John Salazar-Schicchi; Natalie H Yip; Daniel Brodie; Max R O'Donnell

    doi:10.1101/2020.04.15.20067157 Date: 2020-04-20 Source: medRxiv

    Background: Nearly 30,000 patients with coronavirus disease MESHD-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill MESHD patients with COVID-19 in this setting are needed. Methods: We prospectively collected clinical, biomarker, and treatment data on critically ill adults TRANS with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation. Results: Of 1,150 adults TRANS hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age TRANS was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male TRANS. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension HP hypertension MESHD (63%; 162/257) and diabetes mellitus HP diabetes mellitus MESHD (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese MESHD, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age TRANS, hypertension HP hypertension MESHD, chronic lung disease HP lung disease MESHD, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality. Conclusions: Critical illness MESHD among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.

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MeSH Disease
Human Phenotype

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