Red cell distribution width is a potent prognostic parameter for in-hospital and post-discharge mortality in hospitalized coronavirus disease 2019 patients: a registry-based cohort study on 3941 patients

Aim To investigate clinical and prognostic associations of red cell distribution width (RDW) in hospitalized coronavi - rus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 3941 consecutive COVID-19 patients admitted to a tertiary-level institution from March 2020 to March 2021 who had avail - able RDW on admission. Results The median age was 74 years. The median Charl - son comorbidity index (CCI) was 4. The majority of pa - tients (84.1%) on admission presented with severe or criti - cal COVID-19. Patients with higher RDW were significantly more likely to be older and female, to present earlier dur - ing infection, and to have higher comorbidity burden, worse functional status, and critical presentation of COVID-19 on admission. RDW was not significantly associated with C-re - active protein, occurrence of pneumonia, or need for oxy - gen supplementation on admission. During hospital stay, patients with higher RDW were significantly more likely to require high-flow oxygen therapy, mechanical ventilation, intensive care unit, and to experience prolonged immobi - lization, venous thromboembolism, bleeding, and bacte - rial sepsis. Thirty-day and post-hospital discharge mortality gradually increased with each rising RDW percent-point. In a series of multivariate Cox-regression models, RDW demon - strated robust prognostic properties at >14% cut-off level. This cut-off was associated with inferior 30-day and postdischarge survival independently of COVID-19 severity, age, and CCI; and with 30-day survival independently of COVID severity and established prognostic scores (CURB-65, 4Cmortality, COVID-gram and VACO-index). Conclusion RDW has a complex relationship with COVID19-associated inflammatory state and is affected by prior comorbidities. RDW can improve the prognostication in hospitalized COVID-19 patients

The attitude and knowledge of medical students regarding dementia

Zbog starenja stanovništva i sve većeg broja starijih osoba s demencijom, u skoroj budućnosti većina liječnika će se vjerojatno sve više susretati s osobama oboljelima od demencije u svome radu. Stoga, u svijetu postoji hitna potreba za poboljšanjem preddiplomskog medicinskog obrazovanja o demenciji kako bi se poboljšale vještine zdravstvenih djelatnika za kompetentnu njegu ljudi s demencijom u bolnicama i zajednici. Glavni cilj ovog istraživanja bio je utvrditi stavove o radu s osobama oboljelima od demencije i znanje o demencijama među studentima završne godine Medicinskog fakulteta Sveučilišta u Zagrebu. Pisani upitnik uključivao je šest kategorija pitanja o: sociodemografskim podacima (I.), uspjehu tijekom studija medicine (II.), osobnim interesima (III.), osobnim stavovima prema demenciji i iskustvima s oboljelima od demencije (IV.), poznavanju demencije (V.) i osobnom mišljenju o zastupljenosti demencije u dodiplomskom kurikulumu (VI.). Istraživanje je uključilo 231 studenta što čini 81,9 % od ukupnog broja studenata šeste godine Medicinskog fakulteta Sveučilišta u Zagrebu. Studenti imaju relativno neutralne stavove o radu s oboljelima od demencije te podosta slabo teoretsko znanje na našem ispitu znanja o demencijama. Studenti su pokazali najbolje teoretsko znanje o simptomima Alzheimerove bolesti, dok najslabije u području diferencijalne dijagnoze, epidemiologije i patogeneze Alzheimerove bolesti. Svaki 11. student šeste godine studija medicine nikada nije imao kontakt s osobom oboljelom od demencije. Većina studenata smatra kako bi studenti medicine tijekom medicinskog obrazovanja trebali provoditi više vremena s oboljelima od demencije te da na Medicinskom fakultetu ima premalo nastave iz područja demencija. Viši prosjek ocjena na studiju i viša ocjena iz kolegija Neurologija značajno su povezani s ostvarenim boljim rezultatom na našem ispitu znanja o demencijama. Rezultati ovoga rada upućuju na potrebu upotpunjavanja obrazovnog programa kojim će obogatiti studentska praksa boljom edukacijom o demencijama i većim kontaktom s oboljelima od demencije.Due to the ageing population and the growing number of elderly people with dementia, soon, most physicians are likely to encounter more and more people with dementia in their work. Therefore, there is an urgent need in the world to improve undergraduate medical education on dementia and the skills of health professionals to competently care for people with dementia in hospitals and the community. The main goal of this research was to determine attitudes towards working with people with dementia and the knowledge about dementia among final year students of the School of Medicine, University of Zagreb. The paper-and-pencil questionnaire included six categories of questions on sociodemographic data (I.), success during medical studies (II.), personal interests (III.), personal attitudes towards dementia and experiences with people with dementia (IV.), dementia knowledge exam (V.) and personal opinion on the prevalence of dementia in the undergraduate curriculum (VI.). The research included 231 students, which is 81.9 % of the total number of sixth-year students at the School of Medicine, University of Zagreb. Students have relatively neutral attitudes towards working with people with dementia and a rather poor theoretical knowledge in the dementia knowledge exam. Students showed the best theoretical knowledge about the symptoms of Alzheimer's disease, while their knowledge was the weakest in the field of differential diagnoses, epidemiology and pathogenesis of Alzheimer's disease. Every 11th sixth-year medical student has never had contact with a person with dementia. Most students believe that medical students should spend more time with people with dementia during their medical education and that there are too few classes in the field of dementia at the School of Medicine. The higher grade point average in the study and the higher grade in Neurology are significantly related to the better result achieved in our dementia knowledge exam. The results of this study point to the need to broaden the current educational program that will enrich student practice with better education about dementia and greater contact with people with dementia

The attitude and knowledge of medical students regarding dementia

Zbog starenja stanovništva i sve većeg broja starijih osoba s demencijom, u skoroj budućnosti većina liječnika će se vjerojatno sve više susretati s osobama oboljelima od demencije u svome radu. Stoga, u svijetu postoji hitna potreba za poboljšanjem preddiplomskog medicinskog obrazovanja o demenciji kako bi se poboljšale vještine zdravstvenih djelatnika za kompetentnu njegu ljudi s demencijom u bolnicama i zajednici. Glavni cilj ovog istraživanja bio je utvrditi stavove o radu s osobama oboljelima od demencije i znanje o demencijama među studentima završne godine Medicinskog fakulteta Sveučilišta u Zagrebu. Pisani upitnik uključivao je šest kategorija pitanja o: sociodemografskim podacima (I.), uspjehu tijekom studija medicine (II.), osobnim interesima (III.), osobnim stavovima prema demenciji i iskustvima s oboljelima od demencije (IV.), poznavanju demencije (V.) i osobnom mišljenju o zastupljenosti demencije u dodiplomskom kurikulumu (VI.). Istraživanje je uključilo 231 studenta što čini 81,9 % od ukupnog broja studenata šeste godine Medicinskog fakulteta Sveučilišta u Zagrebu. Studenti imaju relativno neutralne stavove o radu s oboljelima od demencije te podosta slabo teoretsko znanje na našem ispitu znanja o demencijama. Studenti su pokazali najbolje teoretsko znanje o simptomima Alzheimerove bolesti, dok najslabije u području diferencijalne dijagnoze, epidemiologije i patogeneze Alzheimerove bolesti. Svaki 11. student šeste godine studija medicine nikada nije imao kontakt s osobom oboljelom od demencije. Većina studenata smatra kako bi studenti medicine tijekom medicinskog obrazovanja trebali provoditi više vremena s oboljelima od demencije te da na Medicinskom fakultetu ima premalo nastave iz područja demencija. Viši prosjek ocjena na studiju i viša ocjena iz kolegija Neurologija značajno su povezani s ostvarenim boljim rezultatom na našem ispitu znanja o demencijama. Rezultati ovoga rada upućuju na potrebu upotpunjavanja obrazovnog programa kojim će obogatiti studentska praksa boljom edukacijom o demencijama i većim kontaktom s oboljelima od demencije.Due to the ageing population and the growing number of elderly people with dementia, soon, most physicians are likely to encounter more and more people with dementia in their work. Therefore, there is an urgent need in the world to improve undergraduate medical education on dementia and the skills of health professionals to competently care for people with dementia in hospitals and the community. The main goal of this research was to determine attitudes towards working with people with dementia and the knowledge about dementia among final year students of the School of Medicine, University of Zagreb. The paper-and-pencil questionnaire included six categories of questions on sociodemographic data (I.), success during medical studies (II.), personal interests (III.), personal attitudes towards dementia and experiences with people with dementia (IV.), dementia knowledge exam (V.) and personal opinion on the prevalence of dementia in the undergraduate curriculum (VI.). The research included 231 students, which is 81.9 % of the total number of sixth-year students at the School of Medicine, University of Zagreb. Students have relatively neutral attitudes towards working with people with dementia and a rather poor theoretical knowledge in the dementia knowledge exam. Students showed the best theoretical knowledge about the symptoms of Alzheimer's disease, while their knowledge was the weakest in the field of differential diagnoses, epidemiology and pathogenesis of Alzheimer's disease. Every 11th sixth-year medical student has never had contact with a person with dementia. Most students believe that medical students should spend more time with people with dementia during their medical education and that there are too few classes in the field of dementia at the School of Medicine. The higher grade point average in the study and the higher grade in Neurology are significantly related to the better result achieved in our dementia knowledge exam. The results of this study point to the need to broaden the current educational program that will enrich student practice with better education about dementia and greater contact with people with dementia

The effect of outpatient antibiotic treatment of coronavirus disease 2019 on the outcomes in the emergency department: a propensity score matching study

Aim To determine the effect of outpatient oral antibiotics on coronavirus disease 2019 (COVID-19) in patients presenting to the emergency department. Methods This retrospective cohort study with propensity score matching conducted at University Hospital Dubrava collected data on all emergency department visits due to COVID-19 in November 2020. The primary outcome was hospital admission. The secondary outcomes were pneumonia development, respiratory failure, and required level of respiratory support. Results Overall, 1217 visits were evaluated and 525 patients were included in the analysis. After propensity score matching, 126 pairs of treated patients and controls were identified. Patients and controls did not differ in physical examination findings, laboratory test results, radiographic findings, or defined outcomes before and after matching. Conclusion This study suggests no benefit of empirical oral antibiotics for outpatient treatment of COVID-19. In patients presenting to the emergency department, prior oral antibiotic treatment did not affect hospital admission rates or the level of respiratory support required

Hypoosmolar and hyperosmolar COVID-19 patients are predisposed to dismal clinical outcomes

We aimed to investigate the associations of hypo- and hyperosmolarity at hospital admission with clinical characteristics and outcomes in 5645 consecutive hospitalized COVID-19 patients treated at a tertiary-level institution. Serum osmolarity was calculated as 2x Na (mmol/L) + urea (mmol/L) + glucose (mmol/L), with normal range from 275 to 295 mOsm/L. Median serum osmolarity was 292.9 mOsm/L with 51.8% normoosmolar, 5.3% hypoosmolar and 42.9% hyperosmolar patients present at the time of hospital admission. Hypoosmolarity was driven by hyponatremia, and was associated with the presence of chronic liver disease, liver cirrhosis, active malignancy and epilepsy. Hyperosmolarity was driven by an increase in urea and glucose and was associated with the presence of chronic metabolic and cardiovascular comorbidities. Both hypo- and hyperosmolar patients presented with more severe COVID-19 symptoms, higher inflammatory status, and experienced higher mortality in comparison to normoosmolar patients. In multivariate analysis, hypoosmolarity (adjusted odds ratio (aOR)=1.39, p = 0.024) and hyperosmolarity (aOR = 1.9, p < 0.001) remained significantly associated with higher mortality independently of older age, male sex, higher Charlson Comorbidity Index and more severe COVID-19. Disruptions in serum osmolarity are frequent in COVID-19 patients, may be easy to detect and target therapeutically, and thus potentially moderate associateds poor prognosis

Predictors of prolonged hospitalization of COVID-19 patients

Purpose Despite the importance of hospital bed network during the pandemic, there are scarce data available regarding factors predictive of prolonged length of hospitalization of COVID-19 patients. Methods We retrospectively analyzed a total of 5959 consecutive hospitalized COVID-19 patients in period 3/2020–6/2021 from a single tertiary-level institution. Prolonged hospitalization was defned as hospital stay>21 days to account for mandatory isolation period in immunocompromised patients. Results Median length of hospital stay was 10 days. A total of 799 (13.4%) patients required prolonged hospitalization. Factors that remained independently associated with prolonged hospitalization in multivariate analysis were severe or critical COVID-19 and worse functional status at the time of hospital admission, referral from other institutions, acute neurological, acute surgical and social indications for admission vs admission indication of COVID-19 pneumonia, obesity, chronic liver disease, hematological malignancy, transplanted organ, occurrence of venous thromboembolism, occurrence of bacterial sepsis and occurrence of Clostridioides difcile infection during hospitalization. Patients requiring prolonged hospitalization experienced higher post-hospital discharge mortality (HR=2.87, P<0.001). Conclusions Not only severity of COVID-19 clinical presentation but also worse functional status, referral from other hospitals, certain indications for admission, certain chronic comorbidities, and complications that arise during hospital stay independently refect on the need of prolonged hospitalization. Development of specifc measures aimed at improvement of functional status and prevention of complications might reduce the length of hospitalizatio

The performance of the WHO COVID-19 severity classification, COVID-GRAM, VACO Index, 4C Mortality, and CURB-65 prognostic scores in hospitalized COVID-19 patients: data on 4014 patients from a tertiary center registry

Aim: To evaluate the predictive properties of several common prognostic scores regarding survival outcomes in hospitalized COVID-19 patients. Methods: We retrospectively reviewed the medical records of 4014 consecutive COVID-19 patients hospitalized in our tertiary level institution from March 2020 to March 2021. Prognostic properties of the WHO COVID-19 severity classification, COVID-GRAM, Veterans Health Administration COVID-19 (VACO) Index, 4C Mortality Score, and CURB-65 score regarding 30-day mortality, in-hospital mortality, presence of severe or critical disease on admission, need for an intensive care unit treatment, and mechanical ventilation during hospitalization were evaluated. Results: All of the investigated prognostic scores significantly distinguished between groups of patients with different 30-day mortality. The CURB-65 and 4C Mortality Score had the best prognostic properties for prediction of 30-day mortality (area under the curve [AUC] 0.761 for both) and in-hospital mortality (AUC 0.757 and 0.762, respectively). The 4C Mortality Score and COVID-GRAM best predicted the presence of severe or critical disease (AUC 0.785 and 0.717, respectively). In the multivariate analysis evaluating 30-day mortality, all scores mutually independently provided additional prognostic information, except the VACO Index, whose prognostic properties were redundant. Conclusion: Complex prognostic scores based on many parameters and comorbid conditions did not have better prognostic properties regarding survival outcomes than a simple CURB-65 prognostic score. CURB-65 also provides the largest number of prognostic categories (five), allowing more precise risk stratification than other prognostic scores

Red cell distribution width is a potent prognostic parameter for in-hospital and post-discharge mortality in hospitalized coronavirus disease 2019 patients: a registry-based cohort study on 3941 patients

Aim: To investigate clinical and prognostic associations of red cell distribution width (RDW) in hospitalized coronavirus disease 2019 (COVID-19) patients. ----- Methods: We retrospectively analyzed the records of 3941 consecutive COVID-19 patients admitted to a tertiary-level institution from March 2020 to March 2021 who had available RDW on admission. ----- Results: The median age was 74 years. The median Charlson comorbidity index (CCI) was 4. The majority of patients (84.1%) on admission presented with severe or critical COVID-19. Patients with higher RDW were significantly more likely to be older and female, to present earlier during infection, and to have higher comorbidity burden, worse functional status, and critical presentation of COVID-19 on admission. RDW was not significantly associated with C-reactive protein, occurrence of pneumonia, or need for oxygen supplementation on admission. During hospital stay, patients with higher RDW were significantly more likely to require high-flow oxygen therapy, mechanical ventilation, intensive care unit, and to experience prolonged immobilization, venous thromboembolism, bleeding, and bacterial sepsis. Thirty-day and post-hospital discharge mortality gradually increased with each rising RDW percent-point. In a series of multivariate Cox-regression models, RDW demonstrated robust prognostic properties at >14% cut-off level. This cut-off was associated with inferior 30-day and post-discharge survival independently of COVID-19 severity, age, and CCI; and with 30-day survival independently of COVID severity and established prognostic scores (CURB-65, 4C-mortality, COVID-gram and VACO-index). ----- Conclusion: RDW has a complex relationship with COVID-19-associated inflammatory state and is affected by prior comorbidities. RDW can improve the prognostication in hospitalized COVID-19 patients

The performance of the WHO COVID-19 severity classification, COVID-GRAM, VACO Index, 4C Mortality, and CURB-65 prognostic scores in hospitalized COVID-19 patients: data on 4014 patients from a tertiary center registry

Aim: To evaluate the predictive properties of several common prognostic scores regarding survival outcomes in hospitalized COVID-19 patients. Methods: We retrospectively reviewed the medical records of 4014 consecutive COVID-19 patients hospitalized in our tertiary level institution from March 2020 to March 2021. Prognostic properties of the WHO COVID-19 severity classification, COVID-GRAM, Veterans Health Administration COVID-19 (VACO) Index, 4C Mortality Score, and CURB-65 score regarding 30-day mortality, in-hospital mortality, presence of severe or critical disease on admission, need for an intensive care unit treatment, and mechanical ventilation during hospitalization were evaluated. Results: All of the investigated prognostic scores significantly distinguished between groups of patients with different 30-day mortality. The CURB-65 and 4C Mortality Score had the best prognostic properties for prediction of 30-day mortality (area under the curve [AUC] 0.761 for both) and in-hospital mortality (AUC 0.757 and 0.762, respectively). The 4C Mortality Score and COVID-GRAM best predicted the presence of severe or critical disease (AUC 0.785 and 0.717, respectively). In the multivariate analysis evaluating 30-day mortality, all scores mutually independently provided additional prognostic information, except the VACO Index, whose prognostic properties were redundant. Conclusion: Complex prognostic scores based on many parameters and comorbid conditions did not have better prognostic properties regarding survival outcomes than a simple CURB-65 prognostic score. CURB-65 also provides the largest number of prognostic categories (five), allowing more precise risk stratification than other prognostic scores

Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. ----- Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. ----- Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. ----- Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes