The Impact of Early Outpatient Treatments for Covid-19: A Retrospective Study

Background: Oral antivirals (nirmatrelvir/ritonavir and molnupiravir), intravenous short treatment of remdesivir and anti-SARS-CoV-2 monoclonal antibodies (mAbs) have been used for early COVID-19 treatments in high risk of disease progression patients. Little is known about the impact of therapies on post-acute COVID-19 (PACS). We aimed to compare the efficacy of these therapies in terms of death, hospitalization rate and PACS at 3 months. Method(s): We conducted a retrospective observational study including all eligible outpatients aged >=18 evaluated from April 2021 to March 2022 at our COVID-19 Clinic. Patients were stratified into 3 groups: mAbs, antivirals (oral and short-course remdesivir) and controls (eligible patients who refused treatment). Persistence of symptoms (fever, dysgeusia/anosmia, cough, pharyngodynia, dyspnea, chills, nasal congestion, myalgia, headache, gastrointestinal disease, and neuro-behavioural symptoms, such as asthenia, anxiety/mood disorder, memory and concentration deficit) were evaluated after 3 months. We estimated the associations between each considered outcome and treatment through univariate and multivariable logistic models adjusted by sex, age, vaccination, early COVID treatment, treatment group and number of comorbidities (when appropriate). Result(s): We included 649 patients (51.6% males, median age 67 years, 14% unvaccinated): 242 patients were treated with mAbs, 197 with antivirals and 210 received no treatment. Overall, 36.7% of subjects had cerebro-cardiovascular disease, 22% were obese and 50% had more than one comorbidity. Overall, 29 patients (4.5%) died or were hospitalized. Death or hospitalization was positively associated only with older ages with a significant linear trend (p for trend: 0.033). Data on PACS at 3 months were available for 323 (49.8%) patients. Females showed a positive association with long COVID, with an OR of 2.14 (95% CI: 1.30-3.53) as compared to men. Patients treated with antiviral drugs showed an inverse association with long COVID (OR: 0.43, 95% CI: 0.21-0.87 as compared to not treated patients). Patients who were treated with monoclonal antibodies showed an OR of 0.48 (95% CI: 0.25-0.92) as compared to those in the control group (Table 1). Conclusion(s): The impact of early COVID-19 therapies on PACS is unknown. Our results showed that these treatments, in particular mAbs, can reduce persistence of neuro-behavioural symptoms at 3 months. (Table Presented).

Characteristics of the population with mild COVID-19 symptoms eligible for early treatment attended in a single center in Northern Italy.

After more than two years from the first COVID-19 detected case in Brescia, Northern Italy, monoclonal antibodies and antiviral therapy aimed at early treatment of mild COVID-19 in patients at risk of progression and of hospitalization has been approved in Italy. Here we report the characteristics of the population eligible for the COVID-19 early treatments at our COVID-19 Early Therapy Unit of the Infectious Diseases Department of the ASST Spedali Civili of Brescia, with the aim to evaluate the characteristics of the foreign and native groups. Up to March the 31st, 2022, a total of 559 patients were referred to our Unit for COVID-19 early treatment, where 7.6% were foreigners, a group significantly younger than natives (p < 0.05). Particular differences are noticed between the native and the foreign population, where people aged > 65 years old were significantly more frequent among italians (39.7% vs 16.3%, p < 0.01), while primary or acquired immunodeficiencies were more frequent in foreigners (55.8% vs 38.9%, p = 0.03). Substantial differences are noted between native and foreign populations, where 14% and 26% (p < 0.05) respectively have never been vaccinated for COVID-19. Overall, 71% of the referred patients received an early treatment for mild COVID-19, with no differences between the two groups. Overall, on day 28 after treatment, 23 (4%) patients had been hospitalized due to COVID-19 related complications and four died (0,7%), no one was foreigner. In conclusion, while the treatment offered for mild COVID-19 appears to be rather uniform between the native and the foreign populations, some differences, especially in preventive vaccination COVID-19, must be taken into account.

Ultrasound in CoViD-19 not only for the lung: work-up of a case of acute kidney injury

Background: Acute kidney failure (AKI) is not an infrequent complication of CoViD 19 infection, especially in severe forms. Several pathogenic mechanisms could provoke AKI in CoViD 19: some aspecific (dehydratation, post-renal, rhabdomyolisis), other directly related to virus toxicity (tubulopathy, endothelial damage, coagulopathy), other to immune response. Ultrasound findings in AKI in CoViD 19 are poorly reported in literature at this moment and could help in diagnostic workup. Description of clinical case: A 72-year old hypertensive man born in Senegal was admitted for respiratory failure from CoViD-19, requiring NIV support. Starting creatinine levels slightly elevated (1,25 mg/dl) rapidly grew in the next days (2,74 mg/dl), although adequate crystalloid support;micro-hematuria and glycosuria were present with absence of relevant proteinuria;glycemic levels were high and HBA1c (7%) revealed previous diabetes. Ultrasound reveals normal dimension kidneys with preserved parenchymal thickness, but diffused hyper-echogenicity;Doppler study showed parenchymal IR in the upper range of normality (0,67-0,70). Renal function gradually improved with respiratory condition and patient was discharged 28 days after admission. Conclusions: AKI in CoViD-19 has relevant prognostic implications and ultrasound evaluation could inform about previous nephropathy, current renal damage and prognostic prevision through measurement of parenchymal IR, known to be related in several AKI conditions with prognosis and reversal of AKI condition.