Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System.
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ABSTRACT:
SUBMITTER: Yeramaneni S
PROVIDER: S-EPMC7550093 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System.
Yeramaneni Samrat S Doshi Pratik P Sands Kenneth K Cooper Mandelin M Kurbegov Dax D Fromell Gregg G
Gastroenterology 20201012 3
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Project description:ObjectivesTo identify characteristics that predict 30-day mortality among patients critically ill with coronavirus disease 2019 in England, Wales, and Northern Ireland.DesignObservational cohort study.SettingA total of 258 adult critical care units.PatientsA total of 10,362 patients with confirmed coronavirus disease 2019 with a start of critical care between March 1, 2020, and June 22, 2020, of whom 9,990 were eligible (excluding patients with a duration of critical care less than 24 hr or missing core variables).Measurements and main resultsThe main outcome measure was time to death within 30 days of the start of critical care. Of 9,990 eligible patients (median age 60 yr, 70% male), 3,933 died within 30 days of the start of critical care. As of July 22, 2020, 189 patients were still receiving critical care and a further 446 were still in acute hospital. Data were missing for between 0.1% and 7.2% of patients across prognostic factors. We imputed missing data ten-fold, using fully conditional specification and continuous variables were modeled using restricted cubic splines. Associations between the candidate prognostic factors and time to death within 30 days of the start of critical care were determined after adjustment for multiple variables with Cox proportional hazards modeling. Significant associations were identified for age, ethnicity, deprivation, body mass index, prior dependency, immunocompromise, lowest systolic blood pressure, highest heart rate, highest respiratory rate, Pao2/Fio2 ratio (and interaction with mechanical ventilation), highest blood lactate concentration, highest serum urea, and lowest platelet count over the first 24 hours of critical care. Nonsignificant associations were found for sex, sedation, highest temperature, and lowest hemoglobin concentration.ConclusionsWe identified patient characteristics that predict an increased likelihood of death within 30 days of the start of critical care for patients with coronavirus disease 2019. These findings may support development of a prediction model for benchmarking critical care providers.
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Project description:When analyzing a 2 x 2 table, the two-sided Fisher's exact test and the usual exact confidence interval (CI) for the odds ratio may give conflicting inferences; for example, the test rejects but the associated CI contains an odds ratio of 1. The problem is that the usual exact CI is the inversion of the test that rejects if either of the one-sided Fisher's exact tests rejects at half the nominal significance level. Further, the confidence set that is the inversion of the usual two-sided Fisher's exact test may not be an interval, so following Blaker (2000, Confidence curves and improved exact confidence intervals for discrete distributions. Canadian Journal of Statistics 28, 783-798), we define the "matching" interval as the smallest interval that contains the confidence set. We explore these 2 versions of Fisher's exact test as well as an exact test suggested by Blaker (2000) and provide the R package exact2x2 which automatically assigns the appropriate matching interval to each of the 3 exact tests.
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Project description:IntroductionNosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on measures such as re-admission at 30 days remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions.MethodsWe conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO) with respect to the type of NP (ventilator-associated bacterial pneumonia [VABP], ventilated hospital-acquired bacterial pneumonia [vHABP], and non-ventilated HABP [nvHABP]), and characteristics and outcomes of the index hospitalization.ResultsAmong 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age [SD] 67.4 (13.9] vs. 63.0 [15.2] years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%).ConclusionsOne in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP.
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Project description:BACKGROUND:An increasing number of elderly patients with dementia are undergoing surgical operations. Little is known about the differential impact of dementia on surgical outcomes. We investigated whether demented patients undergoing surgical operations have worse outcomes than their non-demented counterparts. METHODS:We performed a cohort study of all patients undergoing a series of surgical operations who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2013. We examined the association of dementia with inpatient case-fatality, discharge to a facility, and length of stay (LOS). Coarsened exact matching was used to balance comorbidities among the comparison groups, and mixed effect methods were used to control for clustering at the hospital level. RESULTS:During the study period, 342,075 patients underwent surgical operations that met the inclusion criteria. Multivariable logistic regression models, after coarsened exact matching, demonstrated that demented patients were not associated with higher case-fatality (OR, 0.43; 95% CI, 0.13-1.36), but were associated with higher rates of discharge to a facility (OR, 1.71; 95% CI, 1.26-2.31) and longer LOS (Adjusted difference, 31%; 95% CI, 26%-36%). These persisted in pre-specified subgroups stratified on particular operations. CONCLUSIONS:Using a comprehensive all-payer cohort of surgical patients in New York State we identified an association of dementia with increased rate of discharge to rehabilitation and longer LOS. No difference was identified in the case fatality of the two groups. Policy makers, payers, and physicians should take these findings into account when designing new policies, and when counseling patients.
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Project description:Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients. Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis. Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p < 0.001). Log2-aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log2-EASIX (p < 0.001). For log2 aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4-6.5%], high (6-7) of 17.2% (95% CI = 14.7-19.6%), and very high (>7) of 47.6% (95% CI = 44.2-50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%. Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.
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Project description:We checked the effects of mutations on expression levels by using systematically mutated probes. We used Agilent custom microarray whose probe length is 60bp. To check artificial mutation effect, we designed 56 patterns of mutations, 24 patterns of insertions and deletions. On the microarray, we used 7,987 probes from Agilent human gene probes. In these experiments, we checked the difference of expression levels about at least 73 probes for each mutation type. We performed microarray experiments with an Agilent custom microarray. We measured gene expressions using a qPCR Human reference total RNA sample provided by CloneTech. Gene expression profiles were normalized with quintile normalization according to the Agilent protocol except that only non-mutated 219 probes were used. 6 replicate samples
2011-11-01 | E-GEOD-30978 | biostudies-arrayexpress
Project description:Rationale: The clinical data and corresponding dynamic CT findings were investigated in detail to describe the clinical and imaging profiles of COVID-19 pneumonia disease progression. Methods: Forty HCWs with COVID-19 were included in this study and 30 enrolled for imaging assessment. Disease was divided into four stages based on time from onset: stage 1 (1-6 days), stage 2 (7-13 days), stage 3 (14-22 days), and stage 4 (> 22 days). Clinical wand imaging data were analyzed retrospectively. Results: The cohort included 33 female and 7 male cases, with a median age of 40 years. Six had underlying comorbidities. More than half of the cases were nurses (22, 55%). Each stage included 39, 37, 34 and 32 CTs, respectively. Bilateral lesions, multifocal lesions and lesions with GGO pattern occurred in both lower lobes at all stages. The crazy-paving pattern (20, 54%), air bronchogram (13, 35%), and pleural effusion (2, 5%) were the most common CT features in stage 2. Consolidation score peaked in stage 2 whereas total lesions score peaked in stage 3. Conclusions: COVID-19 pneumonia in HCWs has a potential predilection for younger female workers. Stage 2 of COVID-19 pneumonia may be the key period for controlling progression of the disease, and consolidation scores may be an objective reflection of the severity of lung involvement.
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Project description:Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30-day readmission after pulmonary hypertension-related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30-day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension-related index events between 2012 and 2014 with 30-day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384-$85,647) and $41,604.50 (IQR: $22,481.50-$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670-$66,143) and $36,279 (IQR: $19,059-$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30-day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub-types, and identify methods and procedures to minimize readmission risk.
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Project description:SummaryFinding Maximum Exact Matches, i.e., matches between two strings that cannot be further extended to the left or right, is a classic string problem with applications in genome-to-genome comparisons. The existing tools rarely explicitly address the problem of MEM finding for a pair of very similar genomes, which may be computationally challenging. We present copMEM2, a multi-threaded implementation of its predecessor. Together with a few optimizations, including a carefully built predecessor query data structure and sort procedure selection, and taking care for highly similar data, copMEM2 allows to compute all MEMs of minimum length 50 between the human and mouse genomes in 59 s, using 10.40 GB of RAM and 12 threads, being at least a few times faster than its main contenders. On a pair of human genomes, hg18 and hg19, the results are 324 s and 16.57 GB, respectively.Availability and implementationcopMEM2 is available at https://github.com/wbieniec/copmem2.Supplementary informationSupplementary data are available at Bioinformatics online.
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