INTRODUCTION

The social determinants of health refer to an individual's social, political, and economic situation and environment, which can have an impact on their health. On the other hand, disability-adjusted life years (DALYs) reflect the mortalities and morbidities incurred due to disease and injury.

This study aims to analyze the social determinants of health indicators and their association with communicable, non-communicable, and injury-related DALYs and deaths.

Data from World Health Organization, World Bank, and International Labor Organization were used and considered for the 17 Social Determinants of Health categories. Logistic regression was used to determine the relationship of social determinants of health indicators with communicable, non-communicable, and injury-related DALYs and deaths.

Results show that an increase in the population, monetary poverty, adult illiteracy, and fine particulate matter increase IPNN DALYs. This study also found correlations of socioeconomic factors to NCD deaths and DALYs attributable to the environment. NCD DALYs and deaths are found to increase with the number of poor living with 3.10 dollars a day, while median daily per capita income, and increase in persons above retiring age receiving pension decrease NCD DALYs attributable to the environment. Focusing on injury DALYs and deaths, an increase in the number of poor living at 3.10 dollars a day, non-agricultural informal employment, and total average concentration of f ine particulate matter increases injury DALYs while the latter is observed to decrease when there is an increase in the medial daily per capita income, agricultural employment outside the formal sector, and vulnerable persons covered by social assistance.

Socio-economic factors such as income, employment, education, and social welfare program affect morbidity, disability, and mortality.

INTRODUCTION

It is anticipated that Chronic Obstructive Pulmonary Disease (COPD) has greater risk in acquiring COVID-19 infection and poorer outcome. However, current worldwide data are conflicting.

This study primarily aims to compare the outcomes of COVID-19 patients with COPD and those without COPD in terms of length of hospital stay (LOS), recovery or mortality, treatment received, and predictors of mortality.

This is a retrospective cohort chart review of 1,017 admitted adult COVID-19 patients from July to December 2020. Age, gender, smoking status, current control and medications for COPD, COVID-19 severity, symptoms, treatment, and outcomes of the two study groups were compared.

Prevalence rate of COPD was 3.8%. COVID-19 patients with COPD were older (median age of 69 vs 54, pCONCLUSION

COPD increases the risk for severe COVID-19 and lengthens LOS.

BACKGROUND AND OBJECTIVES

A mounting evidence links dysregulated immune response to cases of fatal pneumonia seen in COVID-19 infection. We aimed to validate the COVID-19-associated Hyperinflammatory Syndrome (cHIS) score, a novel clinical tool devised to identify those at risk for adverse outcomes, in a local population and investigate the relationship of cHIS score taken at admission and the risk of mortality and the need of mechanical ventilation.

This retrospective cohort study analyzed the sociodemographic, clinical, and laboratory data of 1,881 COVID-19 patients admitted at a tertiary hospital in Davao City, Philippines from January to December 2021. We calculated the cHIS score, composed of six clinical and laboratory criteria from admission, and used multivariate logistic regression to determine the risk of mortality and need of mechanical ventilation.

The cHIS score taken at admission, regardless of cut-off value, was a significant predictor of mortality (OR 0.979 [99% CI 0.894-1.064]) and need of mechanical ventilation (OR 0.586 [99% CI 0.4975-0.6745]). Using the Youden Index, a cut-off cHIS score of 3 or more was a better predictor of mortality (sensitivity, 88.59%; specificity, 71.72%), and a cut-off score of 2 or more was a better predictor of need of mechanical ventilation (sensitivity, 84.02%; specificity, 70.82%) than other cutoff cHIS scores.

Among COVID-19 patients, the cHIS score at admission correlated with the risk of mortality and the need of mechanical ventilation. Cutoff scores of 3 and 2 had the optimal sensitivities and specificities to predict the risk of mortality and the need of mechanical ventilation, respectively.

BACKGROUND/OBJECTIVE

Although nutritional assessment tools have been available internationally, local data for their use in foreseeing adverse outcomes among admitted patients are currently unavailable. The primary objective of this study was to determine the association of nutritional status using Short Nutritional Assessment Questionnaire (SNAQ) and malnutrition risk using the MST (Malnutrition Screening Tool) with ICU admission and in-hospital mortality.

This was a prospective-cohort study which included 122 purposively-selected adult participants who were non-intubated, admitted for medical and surgical managements, stayed for at least 24 hours, had no COVID-19 infection, and were not admitted in any critical care unit. The SNAQ and MST questionnaires, which are validated tools and consists of  two to three easy-to-answer questions, were used among the participants and their scores were tallied in order to get their nutritional status and malnutrition risk. Primary endpoints measured were length of hospital stay, incidence of mortality, and ICU admission rate. Comorbidities were taken into account using the Charlson Comorbidity Index.

Categorizing the SNAQ scores showed 33.61% were severely malnourished which was similar when using the MST classification, wherein 34.43% were at risk of malnutrition. None of the participants were admitted to the intensive care unit (ICU). Malnutrition risk and nutritional status was not significantly associated with 30-day in-hospital mortality (p >0.05). On the other hand, results of the Cox proportional hazards showed that SNAQ and MST significantly predicted the hazard of 30-day in-hospital mortality, increasing the hazard of mortality by 2.58 times and 3.67 times, respectively, for every 1-unit increase in SNAQ and MST scores. Similarly, nutritional status using the SNAQ classification indicated the severely malnourished category significantly predicted the hazard of mortality, increasing it by 9.22 times for those who are severely malnourished. Also, malnutrition risk using the MST classification indicated that those who were at risk of malnutrition were 9.80 times at greater hazard of mortality than those who were not at risk of malnutrition.

The MST and SNAQ classification are screening tools for nutritional status (SNAQ) and malnutrition risk (MST) that can be administered at the onset of the patient’s hospital course and have been demonstrated in this study to predict 30-day in-hospital mortality. It is important to note that none of the patients included in this study required intensive care unit admission.

BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

Retrospective cohort study.

Pediatric patients aged 1 month to 18 years seen at the ED.

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

OBJECTIVES

To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality.

Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity.

In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity.

The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.

BACKGROUND AND OBJECTIVE

Patients with liver cirrhosis have an increased risk for poor postoperative outcomes after non-hepatic surgery, with liver dysfunction being the most important predictor of poor outcomes. This study aims to determine the association of the albumin-bilirubin (ALBI) grade, aspartate aminotransferase-platelet ratio index (APRI) score, and ALBI-APRI score with postoperative outcomes among cirrhotic patients who have undergone non-hepatic surgery.

This was a retrospective cohort study involving 34 patients. Age, ASA class, urgency of surgery, etiology of liver cirrhosis, preoperative Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, ALBI grade, APRI score, and ALBI-APRI score were documented. The outcomes analyzed were postoperative hepatic decompensation (POHD) and in-hospital mortality. Bivariate analysis using the Mann-Whitney U test and Fisher’s exact test was performed. Receiver operating characteristic (ROC) curve analysis was performed to compare the ability of the liver scoring systems to predict the occurrence of study outcomes. Binary logistic regression was performed to measure the odds ratio.

The ALBI grade and ALBI-APRI score were significantly associated with both POHD and in-hospital mortality. Both scores were non-inferior to the CTP and MELD scores in predicting study outcomes. Compared to CTP and MELD scores, the ALBI grade was more sensitive but less specific in predicting POHD and as sensitive but more specific in predicting in-hospital mortality. The ALBI-APRI score was less sensitive but more specific than the ALBI grade in predicting both POHD and in-hospital mortality.

The ALBI grade and ALBI-APRI score were both associated with postoperative hepatic decompensation and in-hospital mortality and were noninferior to the CTP score and MELD score in predicting short-term in-hospital outcomes among cirrhotic patients after non-hepatic surgery.

Background and Objective: Several studies have examined the predictors of mortality among COVID-19-infected patients; however, to date, few published studies focused on end-stage renal disease patients. The present study,therefore, aims to determine the predictors of in-hospital mortality among end-stage renal disease patients with COVID-19 admitted to a Philippine tertiary hospital. Methods: The researcher utilized a retrospective cohort design. A total of 449 adult end-stage renal disease patients on renal replacement therapy diagnosed with moderate-to-severe COVID-19 and were admitted at the National Kidney and Transplant Institute from June 2020 to 2021 were included. Logistic regression analysis was used to determine the factors associated with in-hospital mortality. Results: In-hospital mortality among end-stage renal disease patients with COVID-19 was 31.18% (95% CI: 26.92- 35.69%). Older age (OR=1.03), male sex (OR=0.56), diabetes mellitus (OR=1.80), coronary artery disease (OR=1.71), encephalopathy (OR=7.58), and intubation (OR=30.78) were associated with in-hospital mortality. Conclusion Patients with ESRD and COVID-19 showed a high in-hospital mortality rate. Older age, diabetes mellitus, coronary artery disease, encephalopathy, and intubation increased the odds of mortality. Meanwhile, males had lower odds of mortality than females.
COVID-19 ; Kidney Failure, Chronic ; Hospital Mortality ; Renal Replacement Therapy

BACKGROUND: There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. METHODS: Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. RESULTS: A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. CONCLUSIONS Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.
Female ; Humans ; China/epidemiology* ; Cities ; Cold Temperature ; Hot Temperature ; Mortality ; Temperature ; Time Factors ; Middle Aged ; Male

Introduction: Since the breakout of COVID-19 in December 2019, the virus has already affected and taken millions of lives over the past year. There is still much to learn about this disease. It has been postulated that the human kidney is a potential pathway for COVID-19 due to the presence of the ACE2 receptors found in the surfaces of kidney cells. Some studies that demonstrated acute tubular necrosis and lymphocyte infiltration among post mortem COVID-19 patients, concluding that the virus could directly damage the kidney, increasing the risk of the development of Acute Kidney Injury (AKI) among patients with COVID-19. This study investigated the incidence and severity of AKI among hospitalized COVID-19 patients and the association of the degree of AKI with regards to the severity and outcomes of COVID-19 patients. Methods: This was a single-center cross-sectional study retrospective chart review of COVID-19 patients who developed AKI. Descriptive statistics were used to summarize the general and clinical characteristics of the patients. Frequency and proportion were used for categorical variables. Shapiro-Wilk test was used to determine the normality distribution of continuous variables. Continuous quantitative data that met the normality assumption was described using mean and standard deviation, while those that did not were described using median and range. Continuous variables which are normally distributed were compared using the One-way ANOVA, while those variables that are not normally distributed were compared using the Kruskal-Wallis H test. For categorical variables, the Chi-square test was used to compare the outcomes. If the expected percentages in the cells are less than 5%, Fisher's Exact Test was used instead. Results: A total of 1441 COVID-19 in-patients from March 1, 2020 to March 1, 2021 were reviewed, 59 of whom were excluded. Among the adults with COVID-19 who developed AKI, 60% were in stage I, 10% in stage II, and 30% in stage III. The incidence of AKI among COVID-19 in-patients at Makati Medical Center was 13.10% (95% CI 11.36% - 14.99%). Among the 181 patients, 79 (43.65%, 95% CI 36.30 - 51.20) had died. The mortality rate is 22.02% for Stage I, 50% for Stage II, and 85.19% for Stage III. The median length of hospital stay was 12 days, ranging from 1 day up to 181 days. Full renal recovery on discharge was observed only in one-third of the patients. It was observed in 44.95% of those in Stage I, 27.78% of those in Stage II, and 5.56% of those in Stage III. Conclusion The study demonstrated that the incidence of AKI in hospitalized COVID-19 patients was 13.1% (95% CI 11.36% - 14.99%), which was lower than previously reported. This could be attributed to the longer study period wherein, to date, we have a better understanding of the disease and had already established a standard of care for treatment for the disease attributing to the decreased incidence of AKI among COVID-19 patients than what was initially reported. The development of AKI has a direct correlation with the degree of infection. Among patients who developed AKI, 20% required renal replacement therapy. Overall development of AKI increases the risk of mortality among hospitalized COVID-19 patients. The stage of AKI has a direct correlation with regards to mortality and has an indirect relationship with regards to renal recovery.
Acute Kidney Injury ; COVID-19 ; Renal Replacement Therapy ; Mortality