查看更多>>摘要：Background: The coronavirus disease 2019 (COVID-19) is responsible for one of the largest public health crises the United States has seen to date。 This study explores the outcomes of African American and non-African American COVID-19-positive patients hospitalized in rural Southwest Georgia to identify differences in morbidity and mortality between the groups。 Methods: We performed a retrospective cohort analysis among adults aged ≥18 years admitted with COVID-19 between March 2， 2020 and June 17， 2020 at Phoebe Putney Health System。 Data on demographics， comorbidities， presenting symptoms， and hospital course were obtained。 Patients were divided into two groups: African Americans and non-African Americans。 We examined differences in patient characteristics between groups using chi-square tests for categorical variables， t-test for parametric continuous variables， and Wilcoxon rank-sum tests for non-parametric continuous variables。 Statistical Analysis Software (SAS) version 9。4 was used for statistical analysis。 Results: Among 710 patients， median age was 63 years， 43。8% were males， and 83。3% were African Americans。 African Americans had higher prevalence of obesity and hypertension， were more likely to present with fever， and present with longer duration of symptoms prior to presentation。 In-hospital mortality was similar between the groups， as was need for mechanical ventilation， ICU care， and new dialysis。 African Americans were more likely to be discharged home compared to non-African Americans。 Conclusions: There was no difference in in-hospital mortality; however， African Americans had disproportionately higher hospitalizations， likely to significantly increase the morbidity burden in this population。 Urgent measures are needed to address this profound racial disparity。 ? 2021
查看更多>>摘要：Background: Coronavirus disease (COVID-19) continues to lead to worldwide morbidity and mortality。 This study examined the association between blood type and clinical outcomes in patients with COVID-19 measured by a calculated morbidity score and mortality rates。 The secondary aim was to investigate the relationship between patient characteristics and COVID-19 associated clinical outcomes and mortality。 Methods: Logistic regression was used to determine what factors were associated with death。 A total morbidity score was constructed based on overall patient's COVID-19 clinical course。 This score was modeled using Quasi-Poisson regression。 Bayesian variable selection was used for the logistic regression to obtain a posterior probability that blood type is important in predicting worsened clinical outcomes and death。 Results: Neither blood type nor Rh+ status was a significant moderator of death or morbidity score in regression analyses。 Increased age (adjusted Odds Ratio=3。37， 95% CI=2。44–4。67)， male gender (aOR=1。35， 95% CI=1。08-1。69)， and number of comorbid conditions (aOR=1。28， 95% CI=1。01-1。63) were significantly associated with death。 Significant factors in predicting total morbidity score were age (adjusted Multiplicative Effect=1。45; 95% CI=1。349-1。555) and gender (aME=1。17; 95% CI=1。109-1。243)。 The posterior probability that blood type influenced death was only 10%。 Conclusions: There is strong evidence that blood type was not a significant predictor of clinical course or death in patients hospitalized with COVID-19。 Older age and male gender led to worse clinical outcomes and higher rates of death; older age， male gender， and comorbidities predicted a worse clinical course and higher morbidity score。 Race was not a significant predictor of death in our population and was associated with an increased， albeit not significant， morbidity score。 ? 2022 Southern Society for Clinical Investigation
查看更多>>摘要：Background: Coronavirus disease 2019 (COVID-19) can progress to cardiovascular complications which are linked to higher in-hospital mortality rates。 Infective endocarditis (IE) can develop in patients with recent COVID-19 infections， however， characterization of IE following COVID-19 infection has been lacking。 To better characterize this disease， we performed a systematic review with descriptive analysis of the clinical features and outcomes of these patients。 Methods: Our search was conducted in 8 databases for all published reports of probable or definite IE in patients with a prior COVID-19 confirmed diagnosis。 After ensuring an appropriate inclusion of the articles， we extracted data related to clinical characteristics， modified duke criteria， microbiology， outcomes， and procedures。 Results: Searches generated a total of 323 published reports， and 20 articles met our inclusion criteria。 The mean age of patients was 52。2 ± 16。9 years and 76。2% were males。 Staphylococcus aureus was isolated in 8 (38。1%) patients， Enterococcus faecalis in 3 patients (14。3%) and Streptococcus mitis/oralis in 2 (9。5%) patients。 The mean time interval between COVID-19 and IE diagnoses was 16。7 ± 15 days。 Six (28。6%) patients required critical care due to IE， 7 patients (33。3%) underwent IE-related cardiac surgery and 5 patients (23。8%) died during their IE hospitalization。 Conclusions: Our systematic review provides a profile of clinical features and outcomes of patients with a prior COVID-19 infection diagnosis who subsequently developed IE。 Due to the ongoing COVID-19 pandemic， it is essential that clinicians appreciate the possibility of IE as a unique complication of COVID-19 infection。 ? 2022 Southern Society for Clinical Investigation
查看更多>>摘要：Background Acute upper gastrointestinal (GIT) bleeding is a common medical emergency clinically manifested by hematemesis and/or melena。 This study aimed to elucidate the roles of Helicobacter pylori and the platelet-spleen ratio as risk factors for variceal bleeding in patients with portal hypertension secondary to liver cirrhosis。 Methods The study was conducted on 200 patients with liver cirrhosis of various etiologies who were divided into two groups: group 1 included 100 patients with liver cirrhosis and portal hypertension with or without a history of upper GIT bleeding， and group 2 included 100 patients with liver cirrhosis without portal hypertension。 Upper GIT endoscopy was performed， and biopsy samples were taken from the gastric antral mucosa for rapid urease testing。 The platelet-spleen diameter ratio was calculated for all patients。 Results In group 1， most patients who had a history of variceal bleeding were H。 pylori-negative whereas most patients without a history of variceal bleeding were H。 pylori-positive， implying that H。 pylori may play a significant role as a protective factor against variceal bleeding。 The calculated odds ratio for the rapid urease test was low (0。851)， whereas the calculated odds ratio for the platelet-spleen diameter ratio was higher (9。766) than that for the rapid urease test。 Thus， the rapid urease test plays a significantly higher role than the platelet-spleen ratio as a risk factor for bleeding (p-value = 0。001)。 Conclusions H。 pylori has a more significant relationship with upper GIT bleeding than the platelet-spleen diameter ratio。 ? 2022
查看更多>>摘要：Background: Psoriasis is a common chronic inflammatory skin disease associated with an increased risk for acute infections。 Because chronic kidney disease is a risk factor for pneumonia， end-stage renal disease (ESRD) patients with psoriasis may have an increased risk for acquiring pneumonia。 Material and Methods: A retrospective cohort analysis was performed using the United States Renal Data System， a medical claims database of all ESRD patients undergoing dialysis in the US。 Logistic regression analysis was used to investigate the association of psoriasis with pneumonia in ESRD patients。 Results: A total of 6841 (0。7%) ESRD patients were diagnosed with psoriasis; 385，976 (36%) ESRD patients had pneumonia。 Although simple models showed that psoriasis was associated with an increased risk of pneumonia in the ESRD population (odds ratio (OR) = 1。14)， the final multivariable model found that psoriasis was protective for pneumonia (OR = 0。56) when controlling for age， race， sex， ethnicity， dialysis modality， Charlson Comorbidity Index (CCI)， multiple sclerosis， tobacco use and alcohol use。 This is due to both the CCI and tobacco use being strong confounders of the association of psoriasis and pneumonia。 Black， other race and Hispanic ethnicity were also protective for pneumonia， while increasing age and CCI， female sex， hemodialysis， multiple sclerosis and tobacco and alcohol use were associated with increased risk。 Conclusions: When controlling for multiple factors， psoriasis does not increase the risk for pneumonia in ESRD patients。 In this cohort， other factors， such as the CCI and tobacco use， were more strongly associated with increased risk for pneumonia than psoriasis。 ? 2022
查看更多>>摘要：Background: Recent studies suggest that balanced fluids improve inpatient outcomes compared to normal saline。 The objective of this study was to obtain insights into clinicians’ knowledge， attitudes and perceived prescribing practices concerning IV isotonic fluids and to analyze perceived prescribing in the context of actual prescribing。 Methods: This study， conducted at a single center (Medical University of South Carolina)， included 1) a cross-sectional survey of physicians and advanced practice providers (APPs) (7/2019-8/2019) and 2) review electronic health record (EHR) claims data (2/2018-1/2019) to quantify the prescribing patterns of isotonic fluids。 Results: Clinicians perceived ordering equivalent amounts of normal saline and balanced fluids although normal saline ordering predominated (59。7%)。 There was significant variation in perceived and actual ordering across specialties， with internal medicine/subspecialty and emergency medicine clinicians reporting preferential use of normal saline and surgical/subspecialty and anesthesia clinicians reporting preferential use of balanced fluids (p < 0。0001)。 Clinicians who self-reported providing care in an intensive care unit (ICU) reported more frequent use of balanced fluids than non-ICU clinicians (p = 0。03)。 Actual prescribing data mirrored these differences。 Clinicians’ self-reported use of continuous infusions (p = 0。0006) and beliefs regarding the volume of fluid required to cause harm (p = 0。003) were also associated with self-reported differences in fluid prescribing。 Clinician experience， most clinical considerations (e。g。， indications， contraindications， barriers to using a specific fluid)， and fluid cost were not associated with differential prescribing。 Conclusions: Persistent normal saline utilization is associated with certain specialties， care locations， and the rate and volume of fluid administered， but not with other clinical considerations or cost。 These findings can guide interventions to improve evidence-based fluid prescribing。 ? 2022 Southern Society for Clinical Investigation
查看更多>>摘要：Background: The aim of the study was to quantify the relationship between acute kidney injury (AKI) and alcohol use disorder (AUD)。 Methods: We used a large academic medical center and the MIMIC-III databases to quantify AKI disease and mortality burden as well as AKI disease progression in the AUD and non-AUD subpopulations。 We used the MIMIC-III dataset to compare two different methods of encoding AKI: ICD-9 codes， and the Kidney Disease: Improving Global Outcomes scheme (KDIGO) definition。 In addition to the AUD subpopulation， we also present analyses for the hepatorenal syndrome (HRS) and alcohol-related cirrhosis subpopulations identified via ICD-9/ICD-10 coding。 Results: In both the ICD-9 and KDIGO encodings of AKI， the AUD subpopulation had a higher incidence of AKI (ICD-9: 43。3% vs。 37。92% AKI in the non-AUD subpopulations; KDIGO: 48。65% vs。 40。53%) in the MIMIC-III dataset。 In the academic dataset， the AUD subpopulation also had a higher incidence of AKI than the non-AUD subpopulation (ICD-9/ICD-10: 12。76% vs。 10。71%)。 The mortality rate of the subpopulation with both AKI and AUD， HRS， or alcohol-related cirrhosis was consistently higher than that of the subpopulation with only AKI in both datasets， including after adjusting for disease severity using two methods of severity estimation in the MIMIC-III dataset。 Disease progression rates were similar for AUD and non-AUD subpopulations。 Conclusions: Our work shows that the AUD patient subpopulation had a higher number of AKI patients than the non-AUD subpopulation， and that patients with both AKI and AUD， HRS， or alcohol-related cirrhosis had higher rates of mortality than the non-AUD subpopulation with AKI。 ? 2022 The Authors
查看更多>>摘要：Background: Sepsis is one of the leading causes of hospital mortality， and diabetes is a risk factor for the development of infections。 Although strong evidence has shown an association between metformin and reduced risk of infections， the risk of developing infections with newer classes of oral anti-diabetic drugs (OADs) has been less certain。 Our study aims to examine the association between outpatient OAD use and hospital admissions for infections。 Methods: The study cohort included 1。39 million adults with diabetes utilizing the Veterans Health Affairs Corporate Data Warehouse。 Multivariate logistic regression was used to estimate the effect of each drug class on hospital admission for infection while adjusting for covariates。 Results: After adjusting for covariates， those who took metformin during the study period had 3。3% lower odds of hospital admission for infection compared to those who were never on metformin (OR 0。97， 95% CI 0。95-0。98)。 OADs that were associated with a statistically significant increased odds of being admitted included meglitinides (OR 1。22， 95% CI 1。07-1。38)， SGLT2 inhibitors (OR 1。16， 95% CI 1。08-1。24)， alpha-glucosidase inhibitors (OR 1。09， 95% CI 1。04-1。15)， and DPP4 inhibitors (OR 1。04， 95% CI 1。01-1。06)。 Conclusions: Metformin was associated with lower odds of hospital admission for infection while meglitinides， SGLT2 inhibitors， alpha-glucosidase inhibitors， and DPP4 inhibitors were associated with higher odds of admission for infection。 ? 2022 Southern Society for Clinical Investigation
查看更多>>摘要：Background: In China， health screening has become common， although colonoscopy is not always available or acceptable。 We sought to develop a prediction model of colorectal cancer (CRC) for health screening population based on readily available clinical data to reduce labor and economic costs。 Methods: We conducted a cross-sectional study based on a health screening population in Karamay Central Hospital。 By collecting clinical data and basic information from participants， we identified independent risk factors and established a prediction model of CRC。 Internal and external validation， calibration plot， and decision curve analysis were employed to test discriminating ability， calibration ability， and clinical practicability。 Results: Independent risk factors of CRC， which were readily available in primary public health institutions， included high-density lipoprotein cholesterol， male sex， total cholesterol， advanced age， and hemoglobin。 These factors were successfully incorporated into the prediction model (AUC 0。740， 95% CI 0。713-0。767)。 The model demonstrated a high degree of discrimination and calibration， in addition to a high degree of clinical practicability in high-risk people。 Conclusions: The prediction model exhibits good discrimination and calibration and is pragmatic for CRC screening in rural areas and primary public health institutions。 ? 2022
查看更多>>摘要：Background: Extensive studies have revealed that long non-coding RNAs (lncRNAs) are associated with sepsis-induced acute lung injury (ALI)。 This study focused on the function and potential mechanisms of lncRNA zinc finger antisense 1 (ZFAS1) in a cell model of sepsis-induced ALI。 Methods: To induce sepsis-induced ALI in vitro and in vivo， mice were subjected to cecal ligation and puncture (CLP) operation， and human small airway epithelial cells (HSAECs) were stimulated with lipopolysaccharide (LPS) (10 μg/mL)。 Relative expression of oxidative stress-responsive 1 (OXSR1)， lncRNA ZFAS1， and microRNA (miR)-96-5p was detected by quantitative real-time polymerase chain reaction (qRT-PCR)。 Relative protein expression of Bax， Bcl-2， and OXSR1 was determined by western blotting。 Moreover， enzyme-linked immunosorbent assay was used to measure the levels of IL-6， IL-1β， and TNF-α。 A dual-luciferase reporter assay was conducted to test the targeting interplay between ZFAS1/OXSR1 and miR-96-5p。 Results: Up-regulation of lncRNA ZFAS1 and OXSR1 and down-regulation of miR-96-5p was observed in lung tissues of CLP-induced mice and LPS-treated HSAECs。 Decreased ZFAS1 expression or increased miR-96-5p expression repressed inflammation and apoptosis and promoted cell viability in LPS-treated HSAECs。 The lncRNA ZFAS1 competitively binds to miR-96-5p and inversely modulates miR-96-5p expression。 MiR-96-5p directly targets OXSR1 and inversely regulates OXSR1 expression。 In addition， the protective effects of ZFAS1 knockdown on LPS-induced HSAECs were reversed by miR-96-5p inhibition or OXSR1 overexpression。 Conclusions: Down-regulation of lncRNA ZFAS1 attenuated LPS-induced ALI in HSAECs by regulating the miR-96-5p/OXSR1 axis。 ? 2022 Southern Society for Clinical Investigation
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