Comorbidities increase in-hospital mortality in dengue patients in Brazil.
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ABSTRACT:
SUBMITTER: Werneck GL
PROVIDER: S-EPMC6056917 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Dengue patients with comorbidities may be at higher risk of death. In this cross-sectional study, healthcare databases from Mexico (2008-2014), Brazil (2008-2015), and Colombia (2009-2017) were used to identify hospitalized dengue cases and their comorbidities. Case fatality rates (CFRs), relative risk, and odds ratios (OR) for in-hospital mortality were determined. Overall, 678,836 hospitalized dengue cases were identified: 68,194 from Mexico, 532,821 from Brazil, and 77,821 from Colombia. Of these, 35%, 5%, and 18% were severe dengue, respectively. Severe dengue and age ≥ 46 years were associated with increased risk of in-hospital mortality. Comorbidities were identified in 8%, 1%, and 4% of cases in Mexico, Brazil, and Colombia, respectively. Comorbidities increased hospitalized dengue CFRs 3- to 17-fold; CFRs were higher with comorbidities regardless of dengue severity or age. The odds of in-hospital mortality were significantly higher in those with pulmonary disorders (11.6 [95% CI 7.4-18.2], 12.7 [95% CI 9.3-17.5], and 8.0 [95% CI 4.9-13.1] in Mexico, Brazil, and Colombia, respectively), ischemic heart disease (23.0 [95% CI 6.6-79.6], 5.9 [95% CI 1.4-24.6], and 7.0 [95% CI 1.9-25.5]), and renal disease/failure (8.3 [95% CI 4.8-14.2], 8.0 [95% CI 4.5-14.4], and 9.3 [95% CI 3.1-28.0]) across the three countries; the odds of in-hospital mortality from dengue with comorbidities was at least equivalent or higher than severe dengue alone (4.5 [95% CI 3.4-6.1], 9.6 [95% CI 8.6-10.6], and 9.0 [95% CI 6.8-12.0). In conclusion, the risk of death because of dengue increases with comorbidities independently of age and/or disease severity.
| S-EPMC8274750 | biostudies-literature
Project description:IntroductionThe aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures.MethodRetrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software.ResultThe mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period.ConclusionHip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality.
| S-EPMC9374234 | biostudies-literature
Project description:BackgroundThe impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality.MethodsWe analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated.ResultsA total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality.ConclusionsAdvanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
| S-EPMC10035222 | biostudies-literature
Project description:ObjectivesDengue imposes substantial economic, societal and personal burden in terms of hospital stay, morbidity and mortality. Early identification of dengue cases with high propensity of increased hospital stay and death could be of value in isolating patients in need of early interventions. The current study was aimed to determine the significant factors associated with dengue-related prolonged hospitalisation and death.DesignCross-sectional retrospective study.SettingTertiary care teaching hospital.ParticipantsPatients with confirmed dengue diagnosis were stratified into two categories on the basis of prolonged hospitalisation (≤3 days and >3 days) and mortality (fatal cases and non-fatal cases). Clinico-laboratory characteristics between these categories were compared by using appropriate statistical methods.ResultsOf 667 patients enrolled, 328 (49.2%) had prolonged hospitalisation. The mean hospital stay was 4.88±2.74 days. Multivariate analysis showed that dengue haemorrhagic fever (OR 2.3), elevated alkaline phosphatase (ALP) (OR 2.3), prolonged prothrombin time (PT) (OR 1.7), activated partial thromboplastin time (aPTT) (OR 1.9) and multiple-organ dysfunctions (OR 2.1) were independently associated with prolonged hospitalisation. Overall case fatality rate was 1.1%. Factors associated with dengue mortality were age >40 years (p=0.004), secondary infection (p=0.040), comorbidities (p<0.05), acute kidney injury (p<0.001), prolonged PT (p=0.022), multiple-organ dysfunctions (p<0.001), haematocrit >20% (p=0.001), rhabdomyolosis (p<0.001) and respiratory failure (p=0.007). Approximately half of the fatal cases in our study had prolonged hospital stay of greater than three days.ConclusionsThe results underscore the high proportion of dengue patients with prolonged hospital stay. Early identification of factors relating to prolonged hospitalisation and death will have obvious advantages in terms of appropriate decisions about treatment and management in high dependency units.
| S-EPMC5724230 | biostudies-literature
Project description:The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. We conducted a retrospective cohort study in a German tertiary care university hospital. Predictive accuracy was compared using the area under the receiver-operating characteristic curves (AUROC). In a post hoc approach, a regression model was fitted and cross-validated to estimate the association of comorbidities and intraoperative factors with mortality. This model was used to improve prediction by recalibrating the CCI for surgical patients (sCCIs) and constructing a new surgical mortality score (SMS). The data of 182,886 patients with surgical interventions were analyzed. The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001). Predictive quality further improved after recalibration of the sCCI and construction of the new SMS (AUROCSMS 0.928 vs AUROCsCCI 0.896, P < 0.001). The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.
| S-EPMC4554144 | biostudies-literature
Project description:ObjectivesIn critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.DesignRetrospective cohort study.SettingTen Dutch ICUs between January 2011 and April 2017.PatientsAdult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available.InterventionsNone.Measurements and main resultsA logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]).ConclusionsAn increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.
| S-EPMC8594512 | biostudies-literature
Project description:BackgroundThe ongoing Coronavirus disease of 2019 (COVID-19) pandemic has hit Brazil hard in period of different dominant variants. Different COIVD-19 variants have swept through the region, resulting that the total number of cases in Brazil is the third highest in the world. This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality.MethodsWe fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27, 2020 to March 15, 2022. The in-hospital mortality risks of vaccinated and unvaccinated patients were compared, with adjustment for age, state, ethnicity, education and comorbidities. And the effects of variables to in-hospital mortality were also compared. Stratified analysis was conducted across different age groups and vaccine types.ResultsBy fitting the multivariate mixed-effects Cox model, we concluded that age was the most important risk factor for death. With regards to educational level, illiterate patients (hazard ratio: 1.63, 95% CI: 1.56-1.70) had a higher risk than those with a university or college degree. Some common comorbidities were more dangerous for hospitalized patients, such as liver disease (HR: 1.46, 95% CI: 1.34-1.59) and immunosuppression (HR:1.32, 95% CI: 1.26-1.40). In addition, the states involving Sergipe (HR: 1.75, 95% CI: 1.46-2.11), Roraima (HR: 1.65, 95% CI: 1.43-1.92), Maranhão (HR: 1.57, 95% CI: 1.38-1.79), Acre (HR: 1.44, 95% CI: 1.12-1.86), and Rondônia (HR: 1.26, 95% CI: 1.10-1.44) in the north and the northeast region tended to have higher hazard ratios than other area. In terms of vaccine protection, vaccination did not significantly reduce mortality among hospitalized patients. Sinovac and AstraZeneca offered different protection in different regions, and no vaccine provided high protection in all regions.ConclusionThe study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequality. We found that ethnic concentrations were consistent with higher proportion of death cases relative to population size. White Brazilians had more frequent international travel opportunities. As race revealed the intersection of social connections, we speculated that uneven interactions with residential communities partially contribute to the spread of the epidemic. Additionally, the vaccine showed different protection in different regions. In the northern and northeastern regions, AstraZeneca was much more protective than Sinovac, while Sinovac was more protective for hospitalized patients with varying numbers of comorbidities in the Central-west, Southeast and South regions.
| S-EPMC9250816 | biostudies-literature
Project description:BackgroundThe ongoing Coronavirus disease of 2019 (COVID-19) pandemic has hit Brazil hard in period of different dominant variants. Different COIVD-19 variants have swept through the region, resulting that the total number of cases in Brazil is the third highest in the world. This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality.MethodsWe fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27, 2020 to March 15, 2022. The in-hospital mortality risks of vaccinated and unvaccinated patients were compared, with adjustment for age, state, ethnicity, education and comorbidities. And the effects of variables to in-hospital mortality were also compared. Stratified analysis was conducted across different age groups and vaccine types.ResultsBy fitting the multivariate mixed-effects Cox model, we concluded that age was the most important risk factor for death. With regards to educational level, illiterate patients (hazard ratio: 1.63, 95% CI: 1.56-1.70) had a higher risk than those with a university or college degree. Some common comorbidities were more dangerous for hospitalized patients, such as liver disease (HR: 1.46, 95% CI: 1.34-1.59) and immunosuppression (HR:1.32, 95% CI: 1.26-1.40). In addition, the states involving Sergipe (HR: 1.75, 95% CI: 1.46-2.11), Roraima (HR: 1.65, 95% CI: 1.43-1.92), Maranhão (HR: 1.57, 95% CI: 1.38-1.79), Acre (HR: 1.44, 95% CI: 1.12-1.86), and Rondônia (HR: 1.26, 95% CI: 1.10-1.44) in the north and the northeast region tended to have higher hazard ratios than other area. In terms of vaccine protection, vaccination did not significantly reduce mortality among hospitalized patients. Sinovac and AstraZeneca offered different protection in different regions, and no vaccine provided high protection in all regions.ConclusionThe study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequality. We found that ethnic concentrations were consistent with higher proportion of death cases relative to population size. White Brazilians had more frequent international travel opportunities. As race revealed the intersection of social connections, we speculated that uneven interactions with residential communities partially contribute to the spread of the epidemic. Additionally, the vaccine showed different protection in different regions. In the northern and northeastern regions, AstraZeneca was much more protective than Sinovac, while Sinovac was more protective for hospitalized patients with varying numbers of comorbidities in the Central-west, Southeast and South regions.
| S-EPMC9250816 | biostudies-literature
Project description:BackgroundThe ongoing Coronavirus disease of 2019 (COVID-19) pandemic has hit Brazil hard in period of different dominant variants. Different COIVD-19 variants have swept through the region, resulting that the total number of cases in Brazil is the third highest in the world. This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality.MethodsWe fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27, 2020 to March 15, 2022. The in-hospital mortality risks of vaccinated and unvaccinated patients were compared, with adjustment for age, state, ethnicity, education and comorbidities. And the effects of variables to in-hospital mortality were also compared. Stratified analysis was conducted across different age groups and vaccine types.ResultsBy fitting the multivariate mixed-effects Cox model, we concluded that age was the most important risk factor for death. With regards to educational level, illiterate patients (hazard ratio: 1.63, 95% CI: 1.56-1.70) had a higher risk than those with a university or college degree. Some common comorbidities were more dangerous for hospitalized patients, such as liver disease (HR: 1.46, 95% CI: 1.34-1.59) and immunosuppression (HR:1.32, 95% CI: 1.26-1.40). In addition, the states involving Sergipe (HR: 1.75, 95% CI: 1.46-2.11), Roraima (HR: 1.65, 95% CI: 1.43-1.92), Maranhão (HR: 1.57, 95% CI: 1.38-1.79), Acre (HR: 1.44, 95% CI: 1.12-1.86), and Rondônia (HR: 1.26, 95% CI: 1.10-1.44) in the north and the northeast region tended to have higher hazard ratios than other area. In terms of vaccine protection, vaccination did not significantly reduce mortality among hospitalized patients. Sinovac and AstraZeneca offered different protection in different regions, and no vaccine provided high protection in all regions.ConclusionThe study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequality. We found that ethnic concentrations were consistent with higher proportion of death cases relative to population size. White Brazilians had more frequent international travel opportunities. As race revealed the intersection of social connections, we speculated that uneven interactions with residential communities partially contribute to the spread of the epidemic. Additionally, the vaccine showed different protection in different regions. In the northern and northeastern regions, AstraZeneca was much more protective than Sinovac, while Sinovac was more protective for hospitalized patients with varying numbers of comorbidities in the Central-west, Southeast and South regions.
| S-EPMC9250816 | biostudies-literature
Project description:ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil.Study designA retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020.MethodsClinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model.ResultsDuring the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22).ConclusionsAmong hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.
| S-EPMC7836512 | biostudies-literature