Temporal trends in clinical characteristics and in-hospital mortality among patients with COVID-19 in Japan for waves 1, 2, and 3: A retrospective cohort study.
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ABSTRACT: Introduction
Little information is available on the temporal trends in the clinical epidemiology and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) in Japan for waves 1, 2, and 3.Methods
A national claims database was used to analyze the time trends in admission, medical procedure, and in-hospital mortality characteristics among patients with COVID-19. Patients who were ≥18 years and discharged from January 1, 2020 to February 28, 2021 were included.Results
A multilevel logistic regression analysis of 51,252 patients revealed a decline in mortality in waves 2 and 3 (risk-adjusted mortality range = 2.17-4.07%; relative risk reduction = 23-59%; reference month of April 2020 = 5.32%). In the subgroup analysis, a decline in mortality was also observed in patients requiring oxygen support but not mechanical ventilation (risk-adjusted mortality range = 5.98-11.68%; relative risk reduction = 22-60%; reference month of April 2020 = 15.06%). Further adjustments for medical procedure changes in the entire study population revealed a decrease in mortality in waves 2 and 3 (risk-adjusted mortality range = 2.66-4.05%; relative risk reduction = 24-50%).Conclusions
A decline in in-hospital mortality was observed in waves 2 and 3 after adjusting for patient/hospital-level characteristics and medical treatments. The reasons for this decline warrant further research to improve the outcomes of hospitalized patients.
SUBMITTER: Endo H
PROVIDER: S-EPMC9239980 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC4183166 | biostudies-literature
Project description:OBJECTIVES:Several physiological abnormalities that develop during COVID-19 are associated with increased mortality. In the present study, we aimed to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients, based on a set of variables available soon after the hospitalisation triage. SETTING:Retrospective cohort study of 516 patients consecutively admitted for COVID-19 to two Italian tertiary hospitals located in Northern and Central Italy were collected from 22 February 2020 (date of first admission) to 10 April 2020. PARTICIPANTS:Consecutive patients?18 years admitted for COVID-19. MAIN OUTCOME MEASURES:Simple clinical and laboratory findings readily available after triage were compared by patients' survival status ('dead' vs 'alive'), with the objective of identifying baseline variables associated with mortality. These were used to build a COVID-19 in-hospital mortality risk score (COVID-19MRS). RESULTS:Mean age was 67±13 years (mean±SD), and 66.9% were male. Using Cox regression analysis, tertiles of increasing age (?75, upper vs <62 years, lower: HR 7.92; p<0.001) and number of chronic diseases (?4 vs 0-1: HR 2.09; p=0.007), respiratory rate (HR 1.04 per unit increase; p=0.001), PaO2/FiO2 (HR 0.995 per unit increase; p<0.001), serum creatinine (HR 1.34 per unit increase; p<0.001) and platelet count (HR 0.995 per unit increase; p=0.001) were predictors of mortality. All six predictors were used to build the COVID-19MRS (Area Under the Curve 0.90, 95%?CI 0.87 to 0.93), which proved to be highly accurate in stratifying patients at low, intermediate and high risk of in-hospital death (p<0.001). CONCLUSIONS:The COVID-19MRS is a rapid, operator-independent and inexpensive clinical tool that objectively predicts mortality in patients with COVID-19. The score could be helpful from triage to guide earlier assignment of COVID-19 patients to the most appropriate level of care.
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Project description:BackgroundIn Ethiopia, the trend of neonatal mortality showed slow pace of reduction from 2000-2016 compared to the reduction in infant and under-five mortality over the same period. This study aimed at unpacking the trends of admission, specific causes and rate of neonatal mortality as well as predictors of neonatal mortality at a general hospital in Somali region of Ethiopia.MethodsA hospital based retrospective cohort study was conducted from 25th of May 2017to 10th of June, 2017. All the new-borns admitted in the neonatal Intensive Care Unit of the hospital were reviewed over three years period (Aug2014-May2017). Data were cleaned and exported to SPSS version 20 and both descriptive and analytical analysis were executed. The level of significance was set at P<0.05. Binary logistic regression was used to produce summary of statistics including crude and adjusted odds ratio and 95% confidence intervals.ResultsThis study reviewed a total of 792 new-borns below the age of 28 days admitted in the NICU of Karamara hospital over a period of three years (August, 2014 to May, 2017). The mean birth weight was 2733 ± 740 g and neonates with normal birth weight stood at 64%. Seven hundred forty seven new-borns (94.3%) were discharged alive while 45 (5.7%) new-borns died in the course of hospitalization making a Neonatal Mortality Rate (NMR) of 5.7% (57 per 1000 live births), and 96 percent of these deaths were early neonatal deaths that occurred in the first one week of life (i.e. <7 days).After all variables which had an association with neonatal mortality (P <0.05) were entered in to a multivariate logistic model to control the effect of confounders: prematurity (AOR = 0.492(0.253, 0.957), P = 0.037) and average length of stay below two days (AOR = 0.418(0.186, 0.936), P = 0.034) were independently associated with neonatal mortality showing protective effect.ConclusionThe causes of neonatal death reported in this study are preventable, the neonatal mortality rate is high compared to the national and regional figures. Prematurity and shorter length of stay in the NICU of less than two days showed independent association with neonatal mortality. This calls for more work along the continuum of care, improving the quality of care, early transfer of sick neonates to the NICU along with scaling up establishment of the NICUs in other hospitals of the region.
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Project description:BackgroundGlobally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria.ObjectiveWe assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital.MethodsA temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software.ResultsThe median age of the newborns at admission was 26.5 (10-53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03).ConclusionThe case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.
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