Glucose dysregulation and its association with COVID-19 mortality and hospital length of stay

Background and aimsWe investigate the impact of blood glucose on mortality and hospital length of stay (HLOS) among COVID-19 patients.MethodsRetrospective study of 456 patients with confirmed COVID-19 and glycemic dysregulation in the New York City area.ResultsWe found that impaired glucose adjusted for other organs systems involved (OR:1.87; 95% CI:1.36–2.57, p < 0.001), increased glucose nadir (OR:34.28; 95% CI:3.97–296.05, p < 0.01) and abnormal blood glucose levels at discharge (OR:5.07; 95% CI:2.31–11.14, p < 0.001) were each significantly associated with increased odds for mortality. New or higher from baseline insulin requirement during hospitalization (OR:0.34; 95% CI:0.15–0.78; p < 0.05) was significantly associated with decreased odds for mortality. Increased glucose peak (B = 0.001, SE=<0.001, p < 0.001), new or higher from baseline insulin requirement during hospitalization (B = 0.11, SE = 0.03, p < 0.001), and increased days to dysglycemia (B = 0.15, SE = 0.04, p < 0.001) were each significantly associated with increased HLOS. Increased glucose nadir (B = ?0.67, SE = 0.07, p < 0.001), insulin intravenous drip (B = ?0.10, SE = 0.05, p < 0.05), and increased proportion days endocrine system involved (B = ?0.25, SE = 0.06, p < 0.001) were each significantly associated with decreased HLOS.ConclusionGlucose dysregulation adversely affects mortality and HLOS in COVID-19. These data can help clinicians to guide patient treatment and management in COVID-19 patients.     

The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients

The purpose of this study was to determine the impact of identifying and treating infections on functional outcomes and length of stay (LOS). Our retrospective naturalistic study reviewed all new admissions to a tertiary geriatric psychiatry teaching hospital from 2003 to 2007. Over this four-year period, 390 patients were admitted and discharged with 21% (85) of patients identified as having infections on admission. Those with infections were compared to the group without to determine and compare clinical characteristics. Factors included in analysis were: age, gender, diagnoses, medical comorbidity, neuropsychiatric symptoms, functional outcomes, medications and LOS. Both groups were similar in gender, psychiatric diagnoses and severity of dementia. Those requiring antibiotics for treatment of infections on admission, were older (p = 0.003), had poorer baseline function (p = 0.005) and higher medical comorbidity (p < 0.001). At discharge, the group with infections showed greater functional improvement (p < 0.001), particularly in mobility (p = 0.005) and cognition (p = 0.046), and had a shorter LOS (p = 0.02). We conclude that a significant number of patients in tertiary geriatric services continue to have infections on admission. Early identification and treatment of infections can result in improved function and decreased LOS.     

Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay,in-hospital mortality,and functional rehabilitation indexes

ObjectiveTo determine the relationships between malnutrition and nutrition-related conditions according to the European Society of Clinical Nutrition and Metabolism (ESPEN) consensus and guidelines and clinical outcomes in postacute rehabilitation.MethodsOf 102 eligible inpatients, 95 (84.5 years old, 63.2% women) fulfilled inclusion criteria: aged ≥70 years, body mass index <30 kg/m², admission for rehabilitation. Mini-Nutritional Assessment-Short Form (MNA-SF≤11) identified patients “at risk” and ESPEN basic and etiology based definitions were applied. Nutrition-related conditions (sarcopenia, frailty, overweight/obesity, micronutrient abnormalities) were determined. We assessed the relationship between these conditions and the clinical and rehabilitation outcomes (relative functional gain, rehabilitation efficiency) during hospitalization.ResultsAll patients were “at risk” by MNA-SF criteria and 31 reported unintentional weight loss >5% in the last year or 2–3 kg in the last 6 months. Nineteen fulfilled the ESPEN basic definition, of which 10 had disease-related malnutrition with inflammation and 9 without inflammation, and 20 had cachexia. Sarcopenia (n = 44), frailty (n = 94), overweight/obesity (n = 59), and micronutrient abnormalities (n = 70) were frequent. Unintentional weight loss impaired all functional outcomes and increased length of stay [OR = 6.04 (2.87–9.22); p < 0.001]. In multivariate analysis, relationships between rehabilitation impact indices and the ESPEN basic and etiology-based definitions observed in univariate analysis persisted only (and marginally) for relative functional gain [OR = 13.24 (0.96–181.95); p = 0.005]. Infrequent in-hospital mortality prevented meaningful analysis of this outcome.ConclusionsESPEN basic and etiology-based definitions and nutrition related disorders were determined in postacute care. Malnutrition was associated with poor rehabilitation outcomes, mainly due to unintentional weight loss.     

Relationship between dementia and length of stay of general medical patients admitted to acute care

Objective: To determine the contributing factors that lead to increased length of stay (LOS) of patients with dementia. Methods: A case‐controlled study in a tertiary metropolitan hospital general medical unit was conducted. Patients were aged 65 and over, 26 cases with dementia were identified and 26 controls without dementia were randomly selected. Results: The mean (± SD) LOS for patients with dementia was significantly longer than for those without dementia (20.59 ± 15.38 days vs. 9.6 ± 6.45 days, P = 0.02). In addition to dementia, severity of illness, referral to the aged care assessment team, and day of week admitted were also significant independent predictors of increased LOS. Conclusion: Reasons for increased LOS of patients with dementia remain unclear. Cognitive impairment due to dementia is likely to increase within the context of an increasing and ageing population. Specific strategies may be required within in‐hospital clinical pathways to assist the needs of this group.     

Simple clinical score is associated with mortality and length of stay of acute general medical admissions to an Australian hospital

Background: In a rural Irish hospital, a simple clinical score (SCS) determined at the time of admission enabled stratification of acute general medical admissions into five categories that were associated incrementally with patients' immediate and 30‐day mortality. The aim of this study was to examine the representative performance of this SCS in predicting the outcomes of general medical admissions to an Australian teaching hospital. Methods: A retrospective chart review was undertaken of a representative sample from 480 admissions in 2007 to an urban university teaching hospital in Australia. The SCS was calculated and related to that patient's outcome in terms of mortality, length of stay, nursing home placement on discharge, the occurrence of medical emergency team call and intensive care unit transfer. These data were compared, where possible, with the outcomes reported in the Irish hospital. Results: Four hundred and seventeen complete sets of data allowed calculation of the SCS. There were significant linear correlations of the SCS (divided into quintiles) and patients' in‐hospital and 30‐day mortality, their length of stay and their discharge to a nursing home. There was no association of the SCS and the patients' readmission rate, intensive care unit transfer rate or likelihood of a medical emergency team call. The significant trends replicated those from the Irish hospital. Conclusion: The SCS can predict significant outcomes for general medical admissions in an Australian hospital despite obvious differences to the hospital of its derivation. A wider study of Australasian hospitals and the performance of the SCS as a predictor of general medical admission outcomes is underway.     

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AimTo investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.MethodsA observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.ResultsData from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29–98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3–436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1–66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).ConclusionThis study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.     

Mortality and health care burden of Budd Chiari syndrome in the United States: A nationwide analysis (1998-2017)

BACKGROUNDThe Budd Chiari syndrome (BCS) is a rare and potentially fatal disease, but there is a paucity of data on the in- hospital mortality as well its economic burden on the health care system. AIMTo evaluate trends in mortality, length of hospital stays and resource utilization among inpatients with BCS.METHODSData on all adult patients with a diagnosis of BCS were extracted from the National Inpatient Sample (NIS) from 1998 to 2017. To make inferences regarding the national estimates for the total number of BCS discharges across the study period, sample weights were applied to each admission per recommendations from the NIS.RESULTSDuring the study period, there were 3591 (8.73%) in-patient deaths. The overall in-hospital mortality rates among BCS patients decreased from 18% in 1998 to 8% in 2017; the mortality decreased by 4.41% (P < 0.0001) every year. On multivariate analysis, older age, higher comorbidity score, acute liver failure, acute kidney injury, acute respiratory failure, hepatic encephalopathy, hepatorenal syndrome, inferior vena cava thrombosis, intestinal infarct, sepsis/septic shock and cancer were associated increased risk of mortality. The average of length of stay was 8.8 d and it consistently decreased by 2.04% (95%CI: -2.67%, -1.41%, P < 0.001) from 12.7 d in 1998 to 7.6 d in 2017.The average total charges after adjusted for Medical Care Consumers Price Index to 2017 dollars during the time period was $94440 and the annual percentage change increased by 1.15% (95%CI: 0.35%, 1.96%, P = 0.005) from $95515 in 1998 to $103850 in 2017.CONCLUSIONThe in-hospital mortality rate for patients admitted with BCS in the United States has reduced between 1998 and 2017 and this may a reflection of better management of these patients.     

Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study

We describe associations between sense of coherence (SOC) and sense of well-being, diseases, physical function and the predictive value of SOC on depression and mortality. The study included 190 participants, aged 85-103 years. Linear correlation analysis was used for relationships between SOC scores and continuous variables. The effects of SOC score on 1- and 4-year mortality, as well as on depression at the 5-year follow-up, were investigated using Cox regression models. The mean SOC score was 71.8 ± 10.2 (±S.D.). SOC score was positively related to well-being (p ≤ 0.001). Heart failure (p = 0.009), chronic obstructive pulmonary disease (p = 0.015), depression (p = 0.015), and osteoarthritis (p = 0.032) were significantly associated with low SOC scores, as were high scores on the Geriatric Depression Scale (GDS) (p = 0.002). One-year mortality was significantly associated with the SOC score (OR = 0.945, confidence interval (CI) = 0.898-0.995, p = 0.032), while the 4-year mortality was not (OR = 0.995, CI = 0.973-1.018, p = 0.674). The SOC score did not predict depression at 5-year follow-up (OR = 0.977, CI = 0.937-1.018, p = 0.267). Strong SOC was associated with well-being in this group of old people. Low SOC was found among those with diseases known to have a negative influence on daily life.