Surmortalite chirurgicale au cours de la pandemie de COVID-19 en France.

Introduction: Au cours de l'annee 2020, la plupart des ressources disponibles dans les hopitaux ont ete mobilisees pour gerer la pandemie de COVID-19, perturbant fortement l'activite chirurgicale avec un acces restreint aux soins critiques. Nous avons estime la surmortalite chirurgicale potentiellement attribuable a la pandemie et investigue un effet d'apprentissage hospitalier entre deux vagues successives. Methodes: Cette etude observationnelle nationale a inclus tous les patients non-COVID-19 ayant eu une intervention chirurgicale en France de 2019 a 2020. A l'aide d'un schema en triple difference et d'une modelisation statistique multi-niveaux, nous avons compare les changements de mortalite postoperatoire a 30 jours entre les annees, les groupes d'exposition a la pandemie (part de patients COVID-19 en soins critiques dans l'hopital) et les semestres, en tenant compte des facteurs de confusion lies au case-mix des patients et au clustering au sein des hopitaux. Nous avons egalement calcule des differences de mortalite standardisees ainsi que des nombres de deces excedentaires attribuables a la pandemie. Resultats: Parmi 1 870 515 patients non COVID-19 admis pour une intervention chirurgicale dans 655 hopitaux, 2,0 % sont decedes. La mortalite a augmente de 1,0 % (intervalle de confiance (IC) a 95% 0,6 %-1,4 %) et de 0,4 % (0,0%-1,0%) au cours des premiers et deuxiemes semestres chez les patients operes dans des hopitaux fortement exposes a la pandemie. Par rapport au groupe a faible exposition, cela correspondait a un risque de deces plus eleve au cours du premier semestre (ROR ajuste 1,56, IC a 95% 1,34-1,81) en particulier a l'exterieur des unites de soins critiques (1,98, 1,57-2,50), avec un effet d'apprentissage significatif au second semestre (0,76, 0,58-0,99). Discussion/Conclusion: Une surmortalite s'est produite en dehors des soins critiques, suggerant un acces limite des patients chirurgicaux a ces soins. Ces resultats questionnent l'importance de reserver des capacites de soins critiques postoperatoires suffisantes en prevision des futures urgences de sante publique. Mots-cles: COVID-19;Mortalite chirurgicale;Soins critiques Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2023

Surmortalité chirurgicale au cours de la pandémie de COVID-19 en France

Introduction Au cours de l'année 2020, la plupart des ressources disponibles dans les hôpitaux ont été mobilisées pour gérer la pandémie de COVID-19, perturbant fortement l'activité chirurgicale avec un accès restreint aux soins critiques. Nous avons estimé la surmortalité chirurgicale potentiellement attribuable à la pandémie et investigué un effet d'apprentissage hospitalier entre deux vagues successives. Méthodes Cette étude observationnelle nationale a inclus tous les patients non-COVID-19 ayant eu une intervention chirurgicale en France de 2019 à 2020. A l'aide d'un schéma en triple différence et d'une modélisation statistique multi-niveaux, nous avons comparé les changements de mortalité postopératoire à 30 jours entre les années, les groupes d'exposition à la pandémie (part de patients COVID-19 en soins critiques dans l'hôpital) et les semestres, en tenant compte des facteurs de confusion liés au case-mix des patients et au clustering au sein des hôpitaux. Nous avons également calculé des différences de mortalité standardisées ainsi que des nombres de décès excédentaires attribuables à la pandémie. Résultats Parmi 1 870 515 patients non COVID-19 admis pour une intervention chirurgicale dans 655 hôpitaux, 2,0 % sont décédés. La mortalité a augmenté de 1,0 % (intervalle de confiance (IC) à 95% 0,6 %-1,4 %) et de 0,4 % (0,0%-1,0%) au cours des premiers et deuxièmes semestres chez les patients opérés dans des hôpitaux fortement exposés à la pandémie. Par rapport au groupe à faible exposition, cela correspondait à un risque de décès plus élevé au cours du premier semestre (ROR ajusté 1,56, IC à 95% 1,34-1,81) en particulier à l'extérieur des unités de soins critiques (1,98, 1,57-2,50), avec un effet d'apprentissage significatif au second semestre (0,76, 0,58-0,99). Discussion/Conclusion Une surmortalité s'est produite en dehors des soins critiques, suggérant un accès limité des patients chirurgicaux à ces soins. Ces résultats questionnent l'importance de réserver des capacités de soins critiques postopératoires suffisantes en prévision des futures urgences de santé publique. Mots-clés COVID-19 ;Mortalité chirurgicale ;Soins critiques Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

Impact de la pandemie COVID-19 sur la mortalite hospitaliere des patients schizophrenes pris en charge pour une affection autre que le COVID-19.

Introduction: L'impact de la priorisation des ressources lors de la pandemie COVID 19 sur la prise en charge des populations les plus vulnerables (non atteintes de COVID-19) comme les patients atteints de schizophrenie a ete peu documentee alors que des disparites de prise en charge de cette population avaient deja ete demontrees avant meme la pandemie. L'objectif de l'etude etait d'etablir si l'impact de la pandemie de COVID-19 sur la mortalite hospitaliere non-COVID-19 et l'acces aux soins hospitaliers differait entre les patients atteints de schizophrenie et ceux sans trouble mental severe. Methodes: A partir des donnees nationales du PMSI, nous avons selectionne toutes les hospitalisations aigues (MCO) non liees a la COVID-19 dans la periode pre-COVID-19 (du 15r mars 2019 au 31 decembre 2019) et COVID-19 (du 15r mars 2020 au 31 decembre 2020) et inclus les patients atteints de schizophrenie pour les apparier a des patients sans trouble mental severe (ratio 1:10) sur l'age et le sexe. En utilisant une approche de difference de la difference, nous avons realise des modeles de regression logistique multivaries avec ajustement sur differents facteurs. Resultats: Au total, 198 186 patients atteints de schizophrenie ont ete apparies avec 1 981 860 temoins. La mortalite hospitaliere a 90 jours chez les patients atteints de schizophrenie a augmente significativement plus par rapport aux temoins (+0,47 % versus +0,21 %;OR ajuste=1,18;p<0,001);le taux d'admission en reanimation a stagne pour les patients schizophrenes alors qu'il a augmente pour les temoins (0,00 % versus +,.85 %;ORajuste=0,93, p<0,001). Discussion/Conclusion: Ces resultats suggerent une plus grande deterioration de l'acces, de l'efficacite et de la securite des soins aigus non COVID-19 chez les patients atteints de schizophrenie par rapport aux patients sans troubles mentaux severes et soulignent l'importance de developper des strategies specifiques pour les patients vulnerables en prevision des futures urgences de sante publique. Mot-cles: Schizophrenia, Mental disorders, Psychiatry, Health services research, Public health, COVID-19 disparities. Declaration de liens d'interets: LB has received honoraria/has been a consultant for Lundbeck. P-ML has been a consultant and/or advisor to or has received honoraria from from Eli-Lilly, Janssen, Lundbeck, Otsuka and Teva, GF has received honoraria/has been a consultant for Lundbeck and Eisai. The other authors declare no competing interests.Copyright © 2023

Impact de la pandémie COVID-19 sur la mortalité hospitalière des patients schizophrènes pris en charge pour une affection autre que le COVID-19

Introduction L'impact de la priorisation des ressources lors de la pandémie COVID 19 sur la prise en charge des populations les plus vulnérables (non atteintes de COVID-19) comme les patients atteints de schizophrénie a été peu documentée alors que des disparités de prise en charge de cette population avaient déjà été démontrées avant même la pandémie. L'objectif de l'étude était d'établir si l'impact de la pandémie de COVID-19 sur la mortalité hospitalière non-COVID-19 et l'accès aux soins hospitaliers différait entre les patients atteints de schizophrénie et ceux sans trouble mental sévère. Méthodes A partir des données nationales du PMSI, nous avons sélectionné toutes les hospitalisations aiguës (MCO) non liées à la COVID-19 dans la période pré-COVID-19 (du 15r mars 2019 au 31 décembre 2019) et COVID-19 (du 15r mars 2020 au 31 décembre 2020) et inclus les patients atteints de schizophrénie pour les apparier à des patients sans trouble mental sévère (ratio 1:10) sur l'âge et le sexe. En utilisant une approche de différence de la différence, nous avons réalisé des modèles de régression logistique multivariés avec ajustement sur différents facteurs. Résultats Au total, 198 186 patients atteints de schizophrénie ont été appariés avec 1 981 860 témoins. La mortalité hospitalière à 90 jours chez les patients atteints de schizophrénie a augmenté significativement plus par rapport aux témoins (+0,47 % versus +0,21 %;OR ajusté=1,18;p<0,001);le taux d'admission en réanimation a stagné pour les patients schizophrènes alors qu'il a augmenté pour les témoins (0,00 % versus +,.85 %;ORajusté=0,93, p<0,001). Discussion/Conclusion Ces résultats suggèrent une plus grande détérioration de l'accès, de l'efficacité et de la sécurité des soins aigus non COVID-19 chez les patients atteints de schizophrénie par rapport aux patients sans troubles mentaux sévères et soulignent l'importance de développer des stratégies spécifiques pour les patients vulnérables en prévision des futures urgences de santé publique. Mot-clés Schizophrenia, Mental disorders, Psychiatry, Health services research, Public health, COVID-19 disparities. Déclaration de liens d'intérêts LB has received honoraria/has been a consultant for Lundbeck. P-ML has been a consultant and/or advisor to or has received honoraria from from Eli-Lilly, Janssen, Lundbeck, Otsuka and Teva, GF has received honoraria/has been a consultant for Lundbeck and Eisai. The other authors declare no competing interests.

Pathophysiological insights from lung diffusing capacity for nitric monoxide (DLNO) after COVID-19

Background: Gas exchange abnormalities in COVID-19 survivors might involve impairment of the transfer through alveolar-capillary membrane and/or loss of capillary bed. Membrane diffusing capacity (Dm) and capillary volume (Vc) can be calculated from combined DLCO-DLNO. Aim(s): To investigate the values of Dm and Vc after COVID-19. Method(s): We retrospectively included all the patients (Pts) having performed DLCO-DLNO after COVID-19 in 4 French centres between 2020/04/20 and 2021/12/16. We excluded Pts with known history of COPD, severe asthma, interstitial lung disease, pulmonary hypertension, and congestive heart failure. We collected data from clinical records, pulmonary function test (PFT), and CT-scan when performed +/-1.5 months from PFT. Result(s): Data from 132 Pts have been analysed yet (over a total of about 500): 72 men (55%), mean age 57.7+/-13 years, mean BMI 30+/-5.7. 25 Pts (19%) were grade 1-4 on COVID-19 WHO scale (no oxygen), 45 (34%) were grade 5 (oxygen), 44 (33%) were grade 6 (NIV or high-flow oxygen), and 18 (14%) were grade 7-9 (mechanical ventilation). Median time between COVID-19 and PFT was 4.4 months [3.1-6.1]. 58 Pts (44%) had DLCO < lower limit of normal (LLN), with a significant correlation between initial COVID-19 severity and later DLCO. Mean Dm and Vc were 48.7% +/-15.1 and 80.2% +/-21. The most frequent pattern was Dm < LLN and normal Vc, in 78 Pts (59%). Only 1 (1%) had isolated Vc < LLN with normal Dm. Among the 37 (28%) with both Dm and Vc < LLN, 36 performed a CT-scan that showed fibrosing sequellae in 26 (72%). Conclusion(s): Dm was the most decreased variable, suggesting delayed healing after COVID-19. Decreased Vc was frequently associated with pulmonary fibrosis.

Trajectories of respiratory recovery after severe SARSCoV-2 infection (RE2COVERI): a pragmatic, longitudinal cohort study

Background: Severe COVID-19 survivors may exhibit functional impairment, radiological sequelae and persistent symptoms at short to mid-term follow-up. Aim(s): To determine the trajectories of respiratory recovery after severe COVID-19, and factors that could influence it. Method(s): Prospective, multicentre, longitudinal cohort study of adult patients hospitalized for severe COVID-19 (LOS >= 7d, oxygen flow >= 3L), evaluated at 3 months from hospital discharge with conditional follow-up at 6 and 12 months. Result(s): 486 participants from 13 French hospitals were included (median age 61y;female sex 27%): 173 needed oxygen only, 96 required non invasive ventilatory support and 217 were intubated. 454 (93%) patients were evaluated at 3 months, whereas 294 (60%) and 163 (34%) were followed up at 6 and 12 months, respectively. At 3- months assessment, a restrictive lung defect, an altered diffusion capacity and significant radiological abnormalities were observed in 33%, 71% and 57% of the cases, respectively. In case of extended follow-up, FVC (% pred.) increased by 4 points at M6 and by 7 points at M12, in mean;DLCO (% pred.) by 5 and 7 points, respectively. Age, sex, obesity, immunodepression, chronic cardiac or respiratory disease, initial extension of pneumonia and mechanical ventilation over 14 days were associated with lung function at 3 months but not with respiratory trajectories from this time point. Conclusion(s): A systematic follow-up seems justified after a severe COVID-19, especially in patients with extensive radiological lesions during acute illness. Pulmonary function and residual radiological abnormalities may improve up to 1-year after hospital discharge. Covid-19 A.

National trends in suicide-related behaviors among youths between 2005-2020, including COVID-19: a Korean representative survey of one million adolescents.

OBJECTIVE: It is difficult to conclude that COVID-19 is associated with a decrease in the suicide attempts rate by comparing only a short-term period. Therefore, it is necessary to examine attempted suicide rates through a trend analysis over a longer period. This study aimed to investigate an estimated long-term trend regarding the prevalence of suicide-related behaviors among adolescents in South Korea from 2005 to 2020, including COVID-19. SUBJECTS AND METHODS: We sourced data from a national representative survey (Korea Youth Risk Behavior Survey) and analyzed one million Korean adolescents aged 13 to 18 years (n=1,057,885) from 2005 to 2020. The 16-year trends regarding the prevalence of sadness or despair and suicidal ideation and attempt and the trend changes before and during COVID-19. RESULTS: Data of 1,057,885 Korean adolescents was analyzed (weighted mean age, 15.03 years; males, 52.5%; females, 47.5%). Although the 16-year trend in the prevalence of sadness or despair and suicide ideation and attempt consistently decreased (prevalence of sadness or despair between 2005-2008, 38.0% with 95% confidence interval [CI], 37.7 to 38.4 vs. prevalence in 2020, 25.0% [24.5 to 25.6]; suicide ideation between 2005-2008, 21.9% [21.6 to 22.1] vs. prevalence in 2020, 10.7% [10.3 to 11.1]; and suicide attempt between 2005-2008, 5.0% [4.9 to 5.2] vs. prevalence in 2020, 1.9% [1.8 to 2.0]), the downward slope decreased during COVID-19 (ßdiff in sadness, 0.215 with 95% CI 0.206 to 0.224; ßdiff in suicidal ideation, 0.245 [0.234 to 0.256]; and ßdiff in suicide attempt, 0.219 [0.201 to 0.237]) compared with pre-pandemic period. CONCLUSIONS: This study found that the observed risk of suicide-related behaviors during the pandemic was higher than expected through long-term trend analysis of the prevalence of sadness/despair and suicidal ideation and attempts among South Korean adolescents. We need a profound epidemiologic study of the change in mental health due to the pandemic's impact and the establishment of prevention strategies for suicide ideation and attempt.

17-year trends of body mass index, overweight, and obesity among adolescents from 2005 to 2021, including the COVID-19 pandemic: a Korean national representative study.

OBJECTIVE: There is a lack of pediatric studies that have analyzed trends in mean body mass index (BMI) and the prevalence of obesity and overweight over a period that includes the mid-stage of the COVID-19 pandemic. Thus, we aimed to investigate trends in BMI, overweight, and obesity among Korean adolescents from 2005 to 2021, including the COVID-19 pandemic. SUBJECTS AND METHODS: We used data from the Korea Youth Risk Behavior Web-based Survey (KYRBS), which is nationally representative of South Korea. The study included middle- and high-school students between the ages of 12 and 18. We examined trends in mean BMI and prevalence of obesity and/or overweight during the COVID-19 pandemic and compared these to those of pre-pandemic trends in each subgroup by gender, grade, and residential region. RESULTS: Data from 1,111,300 adolescents (mean age: 15.04 years) were analyzed. The estimated weighted mean BMI was 20.48 kg/m2 (95% CI, 20.46-20.51) between 2005 and 2007, and this was 21.61 kg/m2 (95% CI, 21.54-21.68) in 2021. The prevalence of overweight and obesity was 13.1% (95% CI, 12.9-13.3%) between 2005 and 2007 and 23.4% (95% CI, 22.8-24.0%) in 2021. The mean BMI and prevalence of obesity and overweight have gradually increased over the past 17 years; however, the extent of change in mean BMI and in the prevalence of obesity and overweight during the pandemic was distinctly less than before. The 17-year trends in the mean BMI, obesity, and overweight exhibited a considerable rise from 2005 to 2021; however, the slope during the COVID-19 pandemic (2020-2021) was significantly less prominent than in the pre-pandemic (2005-2019). CONCLUSIONS: These findings enable us to comprehend long-term trends in the mean BMI of Korean adolescents and further emphasize the need for practical prevention measures against youth obesity and overweight.

Trajectoires de recuperation respiratoire apres une infection COVID-19 severe (RE2COVERI) : resultats d'une etude pragmatique de suivi jusqu'a 1 an

Introduction: Les survivants de formes severes a critiques de COVID-19 peuvent presenter des sequelles fonctionnelles et radiologiques et des symptomes persistants a distance de l'episode aigu justifiant un suivi prolonge. L'objectif de l'etude est de determiner les trajectoires de recuperation respiratoire apres un COVID-19 severe, et les facteurs qui pourraient l'influencer. Methodes: Etude de cohorte prospective, multicentrique, longitudinale de patients adultes hospitalises pour COVID-19 severe (duree d'hospitalisation >= 7 j, debit d'oxygene >= 3 L) ou critique (intubation), evalues (clinique, TDM, EFR, test de marche, questionnaires de symptomes et de qualite de vie) 3 mois apres leur sortie de l'hopital, avec un suivi ulterieur conditionnel a 6 et 12 mois. Resultats: Au total, 486 participants ont ete inclus dans 13 hopitaux francais (age median : 61 ans;sexe feminin : 27 %) : 173 avaient necessite de l'oxygene seul, 96 un support ventilatoire non invasif (CPAP, OHD ou VNI) et 217 avaient ete intubes. Au total, 454 patients (93 %) ont ete evalues a 3 mois, 294 (60 %) et 163 (34 %) ont ete suivis respectivement jusqu'a 6 et 12 mois. Une dyspnee d'effort, un syndrome restrictif, un trouble de la diffusion et des anomalies radiologiques significatives ont ete observees respectivement dans 62 %, 33 %, 71 % et 57 % des cas a M3. En cas de suivi prolonge, la DLCO (% theo.) et la CVF (% theo.) augmentaient en moyenne de +4 points a M6 et respectivement de +6 points et +7 points a M12. Le sexe, l'indice de masse corporelle, les maladies cardiovasculaires ou respiratoires chroniques, l'immunodepression, l'etendue de la pneumonie pendant la phase aigue de la maladie et la duree prolongee (> 14 j) de ventilation mecanique invasive etaient associes a la DLCO a M3, mais pas a sa trajectoire ulterieure. Parmi 476 patients (97,9 %) ayant eu au moins une TDM thoracique au cours du suivi, 196 (41 %) avaient des sequelles significatives sur leur derniere imagerie. Le sexe, l'etendue de la pneumonie a la phase aigue, la duree de la ventilation mecanique invasive et la DLCO a M3 etaient independamment associes au resume des composantes physiques du SF-36, tandis que seul l'age etait associe au resume des composantes mentales du SF-36. Conclusion(s): Bien que la fonction respiratoire s'ameliore et que les anomalies radiologiques residuelles regressent jusqu'a 1 an apres l'episode aigu, une proportion importante des survivants de formes severes ou critiques de COVID-19 ont des sequelles radiologiques et fonctionnelles importantes et des symptomes residuels pouvant affecter leur qualite de vie et justifiant un tel suivi. Copyright © 2022

FACTORS ASSOCIATED with the SEVERITY of COVID-19 INFECTION in PATIENTS with SPONDYLOARTHRITIS: RESULTS of the FRENCH RMD COVID-19 COHORT

Background: To our knowledge, no published work has described precisely the severity and evolution of SARS-CoV-2 infection in patients with spondyloarthritis (SpA). Data on COVID-19 from cohorts of patients with immune-mediated infam-matory diseases concern small samples of SpA. Objectives: Our objective was to describe the severity and course of COVID-19 in a large cohort of patients with SpA, including axial SpA (axSpA) and psoriatic arthritis (PsA), and to identify factors associated with severe forms. Methods: Patients: individuals with Spondyloarthritis (SpA) from the French RMD COVID-19 cohort (observational, national, multicenter cohort) with a diagnosis of COVID-19 (clinical, PCR, CT or serology) were included. Data collected: demographics, type of SpA, comorbidities, treatments, severity of COVID-19. Severity of COVID-19 was graded according to care needed: mild = outpatient care;moderate = non-intensive hospital treatment;severe = intensive care unit admission or death;severe = moderate or severe. Statistical analyses: Logistic regression models were used to identify factors associated with these severe forms. All variables with p <0.20 in the univariate analysis were proposed in the multivariate model. Treatment variables (non-ste-roidal anti-infammatory drugs (NSAIDs), methotrexate (MTX), sulfasalazine (SLZ), TNF inhibitors (TNFi), IL-17 inhibitors (IL-17i) and IL-23p19/p40 inhibitors (IL-23p19/p40i)) were included in the models, even if p≥0.20. Results: Between March 2020 and April 2021, 626 SpAs reported COVID-19 with a mild course in 508 cases (81.1%), moderate in 93 cases (14.8%), and severe in 25 cases (3.9%), including 6 deaths. The cohort analyzed included 349 women (55.8%), mean age 49.3 ± 14.1 years, mean BMI 27.1 ± 5.4 with 403 axSpA (64.4%), 187 PsA (29.9%) and 36 other SpA, duration of disease 11.3 ± 9.8 years;352 (56.2%) had at least one comorbidity, of which obesity (23.6%), hypertension (15.5%), and smoking (10.4%) were the most frequent. Among them, 104 were treated with NSAIDs (16.6%), 186 with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) including 156 MTX, and 460 (73.5%) with biological DMARDs (379 TNFi, 57 IL-17i, 15 IL-23p19/p40i, 9 others). The following variables were associated with severe COVID-19 outcomes: age, body mass index, chronic obstructive lung disease, cardiovascular disease, diabetes, hypertension, interstitial lung disease, renal failure, and corticosteroids intake. The factors independently associated with severe COVID-19 outcomes were cor-ticosteroid intake (3.15 [CI95%: 1.46-6.76], p 0.004), and age (OR=1.06 [CI95%: 1.04-1.08], p <0.001] while anti-TNF (OR=0.26 [CI95%: 0.09-0.78], p=0.01]) was protective. NSAIDs intake (OR=0.97 [CI95%: 0.48-1.98]), SLZ (OR=7.9 [CI95%: 0.60-103]), or anti-IL17 (OR=0.37 [CI95%: 0.10-1.31]) was not associated with infection severity. Conclusion: The course of COVID-19 was mild for the majority of SpA patients (81.1%). Corticosteroid intake was associated with more severe COVID-19 outcomes, whereas TNFi were found to be protective.

Thoracic sarcopenia as a predictive factor of SARS-COV2 evolution.

PURPOSE: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection. MATERIALS AND METHODS: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measurement of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected. RESULTS: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p = 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR = 0.98 [0.97; 0.99]), (p = 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001). CONCLUSION: This study demonstrates that thoracic and abdominal sarcopenia are independently associated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection.

Facteurs associés à la sévérité de l’infection COVID-19 chez les patients atteints de spondyloarthrite : résultats de la French RMD COVID-19 cohorte

Introduction Il n’y a pas, à notre connaissance, de publication décrivant précisément la sévérité et l’évolution de l’infection à SARS-CoV-2 dans la spondyloarthrite (SpA). Les données sur la COVID-19 issues des cohortes de patients avec maladies inflammatoires à médiation immunitaire concernent de faibles effectifs de SpA. Notre objectif était de décrire la sévérité et l’évolution de la COVID-19 dans une large cohorte de patients atteints de SpA (SpA axiale et rhumatisme psoriasique) et d’identifier les facteurs associés aux formes sévères. Patients et méthodes Patients : spondyloarthrites (SpA) de la French RMD COVID-19 cohort (cohorte observationnelle, nationale, multicentrique) avec un diagnostic de COVID-19 (clinique, PCR, scanner ou sérologie). Données collectées : démographiques, type de SpA, comorbidités, traitements, gravité de la COVID-19. La gravité de la COVID-19 a été classée en fonction des soins nécessaires : bénin=soins ambulatoires ;modéré=traitement hospitalier non intensif ;sévère=admission en unité de soins intensifs ou décès ;grave=modéré ou sévère. Analyses statistiques : des modèles de régression logistique ont été utilisés pour identifier les facteurs associés à ces formes graves. Toutes les variables avec p<0,20 en analyse univariée ont été proposées dans le modèle multivarié. Les variables de traitement (AINS, méthotrexate [MTX], sulfasalazine [SLZ], anti-TNF et anti-IL17) étaient incluses dans les modèles, même si p≥0,20. Résultats Entre mars 2020 et avril 2021, 626 SpA ont déclaré une COVID-19 dont l’évolution avait été bénigne dans 508 cas (81,1 %), modérée dans 93 cas (14,8 %) et sévère dans 25 cas (3,9 %), dont 6 décès. La cohorte analysée comprenait 349 femmes (55,8 %), âge moyen 49,3±14,1 ans, IMC moyen 27,1±5,4 avec 403 SpA axiale (64,4 %), 187 RPso (29,9 %) et 36 autres SpA, durée de la maladie 11,3±9,8 ans ;352 (56,2 %) avaient au moins une comorbidité dont l’obésité (23,6 %), l’hypertension artérielle (15,5 %) et le tabagisme (10,4 %) étaient les plus fréquentes. Parmi eux, 104 étaient traités par AINS (16,6 %), 186 par csDMARD dont 156 méthotrexate, et 460 (73,5) % par biomédicaments (379 anti-TNF, 57 anti-IL17 : 57, 15 anti-IL12/23, 9 autres). Les facteurs indépendamment associés à une COVID-19 grave étaient la corticothérapie (OR=2,83 [IC95 % : 1,41–5,66]) et l’âge (OR=1,07 [1,05–1,09]) alors le genre féminin (OR=0,64 [0,41–0,99]) et les anti-IL17 (OR=0,51 [0,32–0,81]) avaient un caractère protecteur. Un traitement par AINS (OR=0,91 [IC95 % : 0,47–1,77]), par sulfasalazine (OR=6,81 [0,59–77,41]) ou par anti-TNF (OR=0,67 [0,33–1,35]) n’était pas associé à la gravité de l’infection. Conclusion L’évolution de la COVID-19 a été bénigne pour la majorité des patients atteints de SpA (81,1 %). La corticothérapie était associée à des infections plus graves alors que les anti-IL17 avaient un caractère protecteur.

Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol.

CONTEXT: Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. OBJECTIVES: The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. MATERIALS AND METHODS: The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. STUDY POPULATION: Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses' aides, auxiliary nurses and midwives will be included. COLLECTED DATA: Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). ETHICS: This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). EXPECTED RESULTS: Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

Nurse and nurse practitioner-lead monoclonal antibody initiative for solid organ transplant (SOT) recipients with COVID-19

Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.

Sleep Apnea Diagnosed by Full Polysomnography Is a Factor of Acute Hypoxic Respiratory Failure in Covid-19: A Prospective Clinical-Based Cohort Study

Introduction: COVID-19 is a respiratory disease with clinical manifestation, severity, and outcomes heterogeneity, from asymptomatic presentation to an acute hypoxemic respiratory failure. Clinical characteristics and comorbidities may affect susceptibility to a more severe COVID-19. We hypothesize that obstructive sleep apnea (OSA) may be a significant factor that mitigates COVID-19 severity. Methods: A prospective multicentric cohort "Co-survivors" with a sample size of 400 patients was set and started recruiting in June 2020. Patients with a respiratory presentation of COVID-19 were selected. All severities of COVID-19 were allowed from outpatients to patients requiring prolonged invasive mechanical ventilation. At 3-months follow-up, patients underwent a cardio-respiratory clinical investigation. Initial and actual clinical manifestations and comorbidities were collected. All patients underwent a full polysomnography (PSG) or respiratory polygraphy (PG). Results: At the time of the analysis, 121 patients were included in the cohort. OSA was diagnosed before COVID-19 and already treated in 10 patients, and 23 were waiting for investigation. Full PSG was performed in 88 patients (80 PSG and 8 PG). OSA was absent in 15 (17%) patients, while mild, moderate, and severe OSA was present in 30 (34.1%), 21 (23.9%) and 22 (25%), respectively. Outpatient COVID-19 was reported in 30 (34.1%), hospitalization was needed without and with acute respiratory failure in 13 (14%) and 45 (51%) patients, respectivelly. These later were predominantly male and older, did not exhibit more comorbidity but metabolic characteristics with significant higher body mass index and waist circumference. Sleep recordings revealed an AHI of 7.4 [1.7;15.4], 15.7 [8.3;48.9] and 21.9 [14;35.1] p<0.01 in these three classes of COVID-19 severity, respectively. Finally, undiagnosed OSA was a factor of COVID-19 severity. Conclusions: Patients with OSA are highly represented in a population of COVID-19 survivors. About 10% of the patients were diagnosed prior to infection, undiagnosed moderate or severe OSA was diagnosed in 48.9% of the remaining patents. Moreover, OSA is likely to be a factor of acute respiratory failure in patients infected with SARS-CoV-2.

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry.

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.