ABSTRACT
Background: In response to the COVID-19 pandemic, many health systems postponed routine screening and care to conserve resources and reduce patient exposure. As a result, several studies have shown a decline in the diagnosis of new cancer cases, a process that relies heavily on the use of screening tools and modalities. The Washington D.C. area is home to a heterogeneous patient population and one of the highest income gaps in the United States. Patterns in healthcare inequality in the area mirror these disparities. This study aims to identify the impact of the COVID-19 pandemic on cancer diagnosis rates compared to prior years and analyze whether vulnerable populations in the D.C. area were disproportionately affected. Methods: Data was collected from the George Washington University (GWU) Cancer Registry. The study population included patients age 18 and up residing in D.C., Maryland or Virginia who were diagnosed with any cancer at the GWU Health System within the following date ranges: April 1 to September 30 of 2018, 2019, 2020 and September 1, 2019 to February 29, 2020. Data collected included age at diagnosis, race, ethnicity, cancer site, stage at diagnosis, and patient zip code as a proxy for socioeconomic status (SES). Median income by zip code was labeled as low, middle or high. Chi square analysis was used to compare changes in each of these demographic and SES categories between each time frame. Results: There were 372 new cancer diagnoses during the COVID-19 period, April 1 2020 to September 30 2020. During this time period in 2018 and 2019, there were 525 and 539 new cancer diagnoses, respectively. Immediately prior to the COVID-19 period, September 1 2019 to February 29 2020, there were 588 new cancer diagnoses. Patterns of cancer type, age at diagnosis, sex, clinical stage, pathological stage and SES did not significantly differ between the COVID-19 period and any other time period (p > 0.05 for all categories). However, ethnicity did change significantly with a slight increase in the number of Hispanic patients diagnosed during the COVID-19 period as compared to the 2018 and 2019 time periods (p = 0.041) and the September 2019 to February 2020 time period (p = 0.0005). Conclusions: Through this retrospective analysis, we observed a decrease in new cancer diagnoses during the COVID-19 period with no significant differences in patient age, sex, cancer type, cancer stage or SES. There was a slight increase in cancer diagnoses among Hispanic patients during the COVID-19 period. These results suggest that most groups were equally impacted by the COVID-19 pandemic with respect to cancer diagnosis. However, this may be specific to the region we studied and limited by the population size and our means of collecting data about patient SES. Further studies comparing early and late impacts of COVID-19 on cancer care will be important to identify specific communities for targeted outreach and intervention.
ABSTRACT
Background: Cardiac injury has been identified as an independent risk factor of mortality in COVID-19, but early recognition of severe COVID-19 illness remains challenging. Several lab parameters have been proposed to help guide clinical decisions. This study aimed to evaluate the association between troponin (TN), N-terminal pro-brain naturietic peptide (BNP), and sodium and adverse clinical outcomes in COVID-19.Methods: This retrospective single-center cohort included consecutive COVID-19 patients admitted to the George Washington University Hospital between March 2020 and May 2020. Patient demographics, cardiovascular comorbidities, and laboratory values were examined. Elevated TN and BNP were defined as >0.02 ng/mL and >150 ng/L, respectively. Primary outcomes included ICU admission and mortality. The presence of underlying cardiovascular disease (CVD) was analyzed to evaluate for relative effect on clinical outcomes. Chi-square and multinomial regression models were utilized to evaluate the association between biomarkers and clinical outcomes.Results: 290 patients were identified with a median age of 62 and the majority were male (52.4%), Black (71.3%), and had CVD risk factors (72.1%). ICU admission occurred in 88 (30.3%) while death occurred in 74 (25.5%) individuals. Patients with both an elevated TN and CVD were more likely to experience ICU admission or death (OR=2.55, p=0.017) while patients with both elevated TN and elevated BNP had markedly increased odds of ICU admission or death (OR=7.53, p<0.001). Among patients with CVD, hypernatremia (Na>145) was associated with over an eight-fold increased odds of ICU admission or death (OR=8.57, p<0.001). An isolated elevated BNP with CVD did not increase the risk of primary events.Conclusion: Among COVID-19 patients with underlying CVD, the presence of an elevated TN or hypernatremia was associated with significantly increased odds of ICU admission or death. Elevated BNP with CVD did not increase risk of events. Identifying these factors on presentation may prove helpful for early triage of high-risk patients.
ABSTRACT
Background: Severe acute respiratory syndrome coronavirus 2 (COVID-19) is linked to adverse cardiovascular outcomes in hospitalized patients but predicting the clinical course remains challenging. The purpose of this study was to examine the association between two biomarkers, troponin-I (TN) and interleukin-6 (IL-6), and cardiovascular morbidity and mortality in patients hospitalized with COVID-19. Methods: This is a retrospective single-center study of patients hospitalized with COVID-19 from March 2020 to May 2020. Elevated TN and IL-6 were defined as >0.02 ng/ml and >65.9 ng/mL respectively. The primary outcome was mortality with secondary outcomes including intensive care unit (ICU) admission and adverse cardiovascular outcomes (heart failure (HF), arrhythmia, myocardial infarction (MI), and pericarditis). Chi-squared tests and student t-tests were used for statistical analyses to examine the relationship between the presence of positive biomarkers and outcomes;p<0.05 significant. Results: In total, 150 patients were identified with the majority being African American (70%), males (55%) and an average age of 63.7 years. Patients with elevated TN had significantly increased mortality rates (36.1% vs. 19.2%, OR 2.4, p=0.021), incidence of arrhythmias (15.3% vs. 1.3%, OR 13.9, p=0.002), incidence of HF (13.9% vs. 1.3%, OR 12.4, p=0.003), and incidence of MI (13.9% vs. 1.3%, OR 12.4, p=0.003). Patients with elevated IL-6 had significantly higher mortality rates (42.7% vs. 12.0%, OR 5.5, p=<0.001), ICU admissions (50.7% vs. 18.7%, OR 4.5, p=<0.0001), incidence of arrhythmias (13.3% vs. 2.7%, OR 5.6, p=0.016), incidence of HF (12.0% vs. 2.7%, OR 5.0, p=0.028), and incidence of MI (13.3% vs. 1.3%, OR 11.4, p= 0.0048). Conclusion: Myocardial injury evidenced by elevated TN and elevated IL-6 are predictive of severe COVID-19 infections and cardiovascular complications, irrespective of race as seen in this cohort. Early detection at hospital admission and perhaps subsequent monitoring of TN and IL-6 could be beneficial in triage and to identify potential early escalation of care.