Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL.

BACKGROUND: Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19. METHODS: This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting. RESULTS: A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017-1.109 and OR = 2.438, 95%CI 1.023-5.813, respectively). CONCLUSIONS: Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.

COVID-19 severity and mortality in patients with CLL: an update of the international ERIC and Campus CLL study.

Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to Coronavirus disease 2019 (COVID-19) due to age, disease, and treatment-related immunosuppression. We aimed to assess risk factors of outcome and elucidate the impact of CLL-directed treatments on the course of COVID-19. We conducted a retrospective, international study, collectively including 941 patients with CLL and confirmed COVID-19. Data from the beginning of the pandemic until March 16, 2021, were collected from 91 centers. The risk factors of case fatality rate (CFR), disease severity, and overall survival (OS) were investigated. OS analysis was restricted to patients with severe COVID-19 (definition: hospitalization with need of oxygen or admission into an intensive care unit). CFR in patients with severe COVID-19 was 38.4%. OS was inferior for patients in all treatment categories compared to untreated (p < 0.001). Untreated patients had a lower risk of death (HR = 0.54, 95% CI:0.41-0.72). The risk of death was higher for older patients and those suffering from cardiac failure (HR = 1.03, 95% CI:1.02-1.04; HR = 1.79, 95% CI:1.04-3.07, respectively). Age, CLL-directed treatment, and cardiac failure were significant risk factors of OS. Untreated patients had a better chance of survival than those on treatment or recently treated.

Id: 3526666 Tubular Pouchplasty Transoral Outlet Reduction (Ttore) Is Superior to and More Durable Than Traditional Tore in a Large Cohort Study

The proceedings contains 638 papers. The topics discussed include: 3526666 TUBULAR POUCHPLASTY TRANSORAL OUTLET REDUCTION (TTORE) IS SUPERIOR TO AND MORE DURABLE THAN TRADITIONAL TORE IN A LARGE COHORT STUDY;3522113 ENDOSCOPIC VERSUS SURGICAL GASTROJEJUNAL REVISION FOR WEIGHT REGAIN IN ROUX-EN-Y GASTRIC BYPASS PATIENTS: 5-YEAR SAFETY AND EFFICACY COMPARISON;3526904 PRIMARY OBESITY SURGERY ENDOLUMINAL 2 (POSE 2.0): AN INTERNATIONAL MULTICENTER PROSPECTIVE TRIAL WITH PLICATION DURABILITY ASSESSMENT;3523069 CHANGES IN INCRETINS, BILE ACIDS AND THE MICROBIOME AFTER DUODENAL MUCOSAL RESURFACING IN PATIENTS WITH TYPE 2 DIABETES;3523981 THE “ERAS” PROTOCOL REDUCES POST ENDOSCOPIC BARIATRIC PROCEDURE HEALTHCARE UTILIZATION;3520884 QUANTIFYING HEALTHCARE UTILIZATION AND DELAY IN TREATMENT OF GASTRIC STENOSIS FOLLOWING SLEEVE GASTRECTOMY;3523424 ENODOSCOPIC SLEEVE GASTROPLASTY (ESG) SUCCESSES AND FAILURES: PREDICTORS FOR ESG REVISION;3525620 ENDOSCOPIC SLEEVE GASTROPLASTY AS NEW HOPE FOR MILD OBESITY;3526737 HOW WELL MY PATIENT WILL DO? PERSONALITY TRAITS PREDICT WEIGHT LOSS AFTER ENDOSCOPIC SLEEVE GASTROPLASTY;3492486 SEMAGLUTIDE IN ASSOCIATION TO ENDOSCOPIC SLEEVE GASTROPLASTY: TAKING ENDOSCOPIC BATRIATRIC PROCEDURES OUTCOMES TO THE NEXT LEVEL;3520710 GLYCEMIC AND HEPATIC OUTCOMES AFTER ENDOSCOPIC DUODENAL MUCOSAL RESURFACING: A SYSTEMATIC REVIEW AND META-ANALYSIS;3525747 SHORT TERM OUTCOMES OF ENDOSCOPIC SLEEVE GASTROPLASTY (ESG) IN TYPE III OBESE PATIENTS: A CLINICAL, RETROSPECTIVE, SINGLE CENTER STUDY;3526510 ENDOSCOPIC SEPTOTOMY/STAPLE LINE RELEASE TO TREAT AN UNUSUAL CAUSE OF DYSPHAGIA AFTER SLEEVE GASTRECTOMY;3526579 MODIFIED ENDOSCOPIC SUBMUCOSAL DISSECTION – TRANSORAL OUTLET REDUCTION (ESD-TORE) FOR WEIGHT REGAIN;3522594 SAFETY AND FEASIBILITY OF SAME DAY DISCHARGE AFTER PER ORAL ENDOSCOPIC PYLOROMYOTOMY IN REFRACTORY GASTROPARESIS: A PILOT STUDY;3524289 IMPACT OF COVID-19 ON THE MANAGEMENT AND OUTCOMES OF SEVERE ACUTE CHOLANGITIS: FINDINGS FROM A NATIONWIDE CLINICAL DATA RESEARCH NETWORK

Pivoting in the pandemic: a qualitative study of child and adolescent psychiatrists in the times of COVID-19 (preprint)

Objectives We examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic.Methods We conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the US. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software.Results We identified three main thematic domains within participants’ response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: 1) Unsettling, or “who have we been?” (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); 2) Adaptation, or “who are we now?” (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and 3) Reimagination, or “who will we become?” (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested.Conclusion These three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.