Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome

Background: In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS). Materials and methods: A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol withdrawal syndrome between November 2014 and March 2015. Results: Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (2 (P  50 years (OR 3.37, 95% CI 1.52-7.48, P 2 (OR 3.10, 95% CI 1.38-6.94, P < 0.01) and magnesium < 0.75 mmol/L (OR 4.11, 95% CI 1.3-12.8, P < 0.05) remained independently associated with death at 1 year. Conclusion: Overall, 1-year mortality was significantly higher among those patients who were magnesium deficient (<0.75 mmol/L) when compared to those who were replete (≥0.75 mmol/L; P < 0.001)

Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

Background: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. Methods: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020—1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. Results: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p &lt; 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p &lt; 0.001), clinical frailty score &gt; 3 (p &lt; 0.001), hypertension (p &lt; 0.05), heart failure (p &lt; 0.01), national early warning score (NEWS) &gt; 4 (p &lt; 0.01), positive CXR (p &lt; 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP &gt; 80 mg/L (p &lt; 0.05), albumin &lt; 35 g/L (p &lt; 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p &lt; 0.05), lymphocytes &lt; 1.5 109/l (p &lt; 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (&lt; 0.40 L/L (male)/ &lt; 0.37 L/L (female)) (p ≤ 0.01), urea &gt; 7.5 mmol/L (p &lt; 0.001), creatinine &gt; 130 mmol/L (p &lt; 0.05) and elevated urea: albumin ratio (&lt; 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4–8.2, p &lt; 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2–19.3, p &lt; 0.05), NEWS &gt; 4 (O.R. 2.4, 95% C.I. 1.1–4.4, p &lt; 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2–0.9, p &lt; 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1–4.4, p &lt; 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0—11.3, p &lt; 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2–20.5, p &lt; 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1–5.1, p &lt; 0.05) remained independently associated with 30-days mortality. Conclusion: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection

The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 infection: Comparison of 2 consecutive cohorts.

BackgroundIn order to manage the COVID-19 systemic inflammatory response, it is important to identify clinicopathological characteristics across multiple cohorts.MethodsThe aim of the present study was to compare the 4C mortality score, other measures of the systemic inflammatory response and clinicopathological characteristics in two consecutive cohorts of patients on admission with COVID-19. Electronic patient records for 2 consecutive cohorts of patients admitted to two urban teaching hospitals with COVID-19 during two 7-week periods of the COVID-19 pandemic in Glasgow, U.K. (cohort 1: 17/3/2020-1/5/2020) and (cohort 2: 18/5/2020-6/7/2020) were examined for routine clinical, laboratory and clinical outcome data.ResultsCompared with cohort 1, cohort 2 were older (p70 (p150mg/L (p3) (OR 11.3, 95% C.I. 2.3-96.7, pConclusionIn addition to the 4C mortality score, frailty score and a low albumin were strongly independently associated with 30-day mortality in two consecutive cohorts of patients admitted to hospital with COVID-19.Trial registrationclinicaltrials.gov: NCT04484545