Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it ...is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation.
We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS). Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality.
We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis OR 0.59 (95% CI 0.34-1.0); p = 0.058.
In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.
Homogeneity, mass fractions of about forty trace elements and Sr isotope composition of Ca carbonate reference materials (RMs) between original and nano‐powdered pellets are compared. Our results ...using nanosecond and femtosecond LA‐(MC)‐ICP‐MS show that the nano‐pellets of the RMs MACS‐3NP, JCp‐1NP and JCt‐1NP are about a factor of 2–3 more homogeneous than the original samples MACS‐3, JCp‐1 and JCt‐1, and are therefore much more suitable for microanalytical purposes. With the exception of Si, the mass fractions of the synthetic RM MACS‐3 agree with its fine‐grained analogue MACS‐3NP. Very small, but significant, differences between original and nano‐pellets are observed in the RMs JCp‐1 and JCt‐1 for some trace elements with very low contents, indicating the need for re‐certification. Strontium mass fractions in the analysed RMs are high (1500–7000 mg kg−1), and their isotope compositions determined by LA‐MC‐ICP‐MS in the original and the nano‐pellets agree within uncertainty limits.
key points
Investigations of carbonate reference materials using fs‐ and ns‐ LA‐ICP‐MS.
Nanopowdered pellets are a factor 2 –3 more homogenous than original samples.
New reference values for MACS‐3 are provided.
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