Internal and emergency medicine
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Extrinsic causes of restrictive lung syndrome in idiopathic pulmonary fibrosis (IPF) patients have been poorly investigated. We aimed to investigate the influence of the anterior chest wall deformity, noninvasively assessed by modified Haller index (MHI), on spirometry parameters and outcome in a consecutive population of patients with mild-to-moderate IPF. Sixty consecutive IPF patients (73.8 ± 6.6 years, 45 males) were included in this retrospective study. ⋯ During follow-up, 13 deaths and 16 pulmonary or cardiovascular hospitalizations were detected. At multivariate Cox regression analysis, concave-shaped chest wall (MHI > 2.5) (HR 4.55, 95% CI 1.02-20.4), increased C-reactive protein (HR 1.68, 95% CI 1.08-2.61) and absence of beta-blocker therapy (HR 0.13, 95% CI 0.01-0.26) were independently associated to the investigated outcome. MHI assessment and implementation may help the clinician to identify, among IPF patients, those with poorer prognosis over a medium-term follow-up.
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Although the assessment of nutrition is essential for stroke patients, detailed associations between nutritional status at admission, subsequent complications, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH) are unclear. We aimed to elucidate these associations using the Controlling Nutritional Status (CONUT) score. Consecutive patients with acute ICH were investigated. ⋯ Multivariable logistic analysis showed that higher CONUT scores were independently associated with poor outcome (odds ratio, 1.28; 95% confidence interval, 1.09-1.49; P = 0.002) after adjusting for baseline characteristics, HE, and aspiration pneumonia. Each component of CONUT was a useful predictor of subsequent complications. Malnutrition, determined using the CONUT score, was independently associated with poor outcomes in patients with ICH after adjusting for these complications.
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Robust evidence of whether vitamin D deficiency is associated with COVID-19 infection and its severity is still lacking. The aim of the study was to evaluate the association between vitamin D levels and the risks of SARS-CoV-2 infection and severe disease in those infected. A retrospective study was carried out among members of Clalit Health Services (CHS), the largest healthcare organization in Israel, between March 1 and October 31, 2020. ⋯ An inverse correlation was demonstrated between the level of vitamin D and the risks of SARS-CoV-2 infection and of severe disease in those infected. Patients with very low vitamin D levels (< 30 nmol/L) had the highest risks for SARS-CoV-2 infection and also for severe COVID-19 when infected-OR 1.246 [95% CI 1.210-1.304] and 1.513 [95% CI 1.230-1.861], respectively. In this large observational population study, we show a significant association between vitamin D deficiency and the risks of SARS-CoV-2 infection and of severe disease in those infected.
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Observational Study
Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry.
Uncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. ⋯ In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters: C2 (OR = 1.30, p = 0.001), C3 (OR = 1.14, p = 0.178), C4 (OR = 2.28, p < 0.001), C5 (OR = 1.07, p = 0.479), C6 (OR = 2.29, p < 0.001), and C7 (OR = 1.28, p = 0.001). We identified 7 groups based on the presence of lymphopenia, elevated CRP, LDH, ferritin, and D-dimer at the time of hospital admission for COVID-19. Clusters C4 (lymphopenia + LDH + CRP), C6 (ferritin + D-dimer), and C7 (D-dimer) had the worst prognosis in terms of in-hospital mortality.
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Retinal vein occlusion (RVO) is the second most common retinal vascular disorder, after diabetic retinopathy. Most patients suffering RVO develop some degree of visual loss consequent to retinal complications such as edema and microhemorrhages. Even if some risk factors for RVO have been identified, the clinical outcome of RVO remains highly unpredictable because studies investigating potential prognostic markers for visual improvement are lacking. ⋯ We retrospectively evaluated the levels of vitamin B12 at diagnosis in 203 patients with RVO, and in a parallel cohort of 120 age- and sex-matched patients without RVO from an internal medicine ward, and correlated them with visual outcome at follow-up (median time 150 days, IQR 30-210). In patients with RVO, vitamin B12 levels at diagnosis were significantly lower than in controls and independently predicted worse clinical outcome at multivariate analysis (OR 3.2; CIs 1.2-8.2; p = 0.015). Our data suggest the opportunity to prospectively evaluate the effect on visual outcome of cyanocobalamin supplementation in RVO patients.