Impact Short-Long Term Exposure of Air Pollution on Covid-19 Outcome

Introduction: Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. Aim(s): In this study, we wanted to investigate if recent and chronic exposures to ambient air pollution (AP) is associated with COVID-19 disease severity in a cohort of hospitalized COVID-19 patients. Method(s): 283 COVID-19 patients were recruited at the time of admission to hospital. Several clinical parameters and outcomes were collected from medical records, including the duration of stay, the early-warning score (EWS), oxygen saturation in blood at admission, admission to the intensive care unit (ICU), and clinical improvement at 30 and at 90 days after the day of admission. Daily exposure levels for PM , PM , NO and black carbon (BC) were modeled using a high-resolution spatiotemporal model. Based on daily exposure levels, average exposures 2 days and 1 week before admission and chronic exposure. Result(s): We observed a significant association between the duration of stay and exposure to PM , PM and NO (recent and chronic exposure). For BC, only chronic exposure (CP) was significantly associated with the duration of stay. On average, the duration of stay increased by 1 to 6 days for an inter-quartile range increase in average exposure to AP in the week before admission. CP was associated with 2 to 3 days increased duration of stay. An increase in PM2.5 and PM10 exposure 1 week before admission was associated with higher EWS. Conclusion(s): Exposure to AP was associated with duration of stay and EWS at the time of admission, which implies a potential link between AP exposure and COVID-19 disease severity, and a significant influence of AP exposure on the pressure of care systems.

The Impact of Biological Ageing on Clinical Severity in Hospitalized Covid-19 Patients

Background: Previous data has suggested that shorter telomere length (TL) is associated with higher risk of adverse COVID-19 outcomes, independent of several major risk factors for COVID-19 including age. Aim(s): We aimed at further exploring the relationship between TL and COVID-19 outcome in hospitalized patients. Method(s): 257 patients with proven COVID-19 infection with or without respiratory symptoms were included. Leucocyte TL was determined using qPCR (quantitative polymerase chain reaction) in leukocytes collected at the time of hospitalization. Clinical assessment related to disease severity and progress were collected from medical records, hospitalization duration, ventilation, early warning score (EWS) and clinical improvement using the WHO-scores. Result(s): Patients with longer TL at admission had less severe outcomes and a more rapid health improvement. the odds ratios for a 1-SD increment in TL associated with hospitalization duration were 0.58 (95%Cl: 0.46-0.73: P<0.0001) unadjusted and 0.77 (95%Cl:0.59-0.99: P=0.044) adjusted for age, sex, BMI, smoking, ethnicity and comorbidities. In men, a 1-SD increment in TL was associated with lower odds (adjusted OR=0.48 95%Cl 0.30-0.77 P=0.0015) to be on ventilation, and with a lower EWS at admission (adjusted s=0.13 95%Cl:0.23-0.02 P=0.024). Finally, a 1-SD increment in TL in men was associated with a stronger decline in disease severity (based on WHOscores) after 30 days post-hospitalization(adjusted s=0.29 95%Cl:0.56-0.03 P=0.029). Conclusion(s): Biological ageing forms an additional risk factor in COVID-19 infected patients to have more disease severity and progression. TL, especially in men, may form a biological basis in these observations.

Longitudinal changes in global structural brain connectivity and cognitive performance in former hospitalized COVID-19 survivors: an exploratory study.

BACKGROUND: Long-term sequelae of COVID-19 can result in reduced functionality of the central nervous system and substandard quality of life. Gaining insight into the recovery trajectory of admitted COVID-19 patients on their cognitive performance and global structural brain connectivity may allow a better understanding of the diseases' relevance. OBJECTIVES: To assess whole-brain structural connectivity in former non-intensive-care unit (ICU)- and ICU-admitted COVID-19 survivors over 2 months following hospital discharge and correlate structural connectivity measures to cognitive performance. METHODS: Participants underwent Magnetic Resonance Imaging brain scans and a cognitive test battery after hospital discharge to evaluate structural connectivity and cognitive performance. Multilevel models were constructed for each graph measure and cognitive test, assessing the groups' influence, time since discharge, and interactions. Linear regression models estimated whether the graph measurements affected cognitive measures and whether they differed between ICU and non-ICU patients. RESULTS: Six former ICU and six non-ICU patients completed the study. Across the various graph measures, the characteristic path length decreased over time (ß = 0.97, p = 0.006). We detected no group-level effects (ß = 1.07, p = 0.442) nor interaction effects (ß = 1.02, p = 0.220). Cognitive performance improved for both non-ICU and ICU COVID-19 survivors on four out of seven cognitive tests 2 months later (p < 0.05). CONCLUSION: Adverse effects of COVID-19 on brain functioning and structure abate over time. These results should be supported by future research including larger sample sizes, matched control groups of healthy non-infected individuals, and more extended follow-up periods.

Experiences of COVID-ICU-survivors: Mixed-methods study of psychological consequences by written survey

Background: In the coming years, mental health care may come into contact with patients who developed psychological complaints related to their critical illness and stay in the intensive care unit (ICU) as a result of COVID-19. However, the experiences of these patients are to date rarely documented. Aim: Gaining insight into the experiences of COVID-ICU-survivors. Methods: 19 COVID-ICU survivors answered a written survey four months after admission. Screening lists measured psychological complaints and sleeping disorders. Visual analogue scales (VAS) measured the influence of the pandemic context and the quality of life. A written survey mapped patient experiences. Quantitative data were analyzed descriptively and qualitative data by means of thematic analysis. Results: 50% of the participants experienced psychological complaints or sleeping disorders. A limited social network and media coverage of COVID-19 complicated the recovery process of patients. 19% of the participants experienced a reduced quality of life. A weak social network caused feelings of hopelessness. Still, patients showed great resilience. Conclusion: Most COVID-ICU survivors are resilient enough to integrate their experiences into their lives, despite the challenges the pandemic context poses on their rehabilitation. It is therefore important not to over medicalise psychological complaints that occur during rehabilitation. Our attention needs to be directed to those with a weak social network. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (Dutch) Achtergrond: De komende jaren kan de geestelijke gezondheidszorg te maken krijgen met patienten die psychische klachten krijgen gerelateerd aan hun kritieke ziekte en intensivecare(ic)-opname wegens COVID-19. Ervaringen van deze patienten werden tot op heden weinig gedocumenteerd. Doel Inzicht verwerven in de ervaringen van patienten met ic-opname wegens COVID-19. Methode: 19 patienten met ic-opname wegens COVID-19 beantwoordden vier maanden na opname een schriftelijke enquete. Met screeningslijsten maten we psychische klachten en slaapstoornissen. Met visueel-analoge schalen (VAS'sen) maten we de invloed van de pandemische context en de levenskwaliteit. Een geschreven interview bracht patientervaringen in kaart. Kwantitatieve data werden descriptief geanalyseerd en kwalitatieve data thematisch. Resultaten: 50% van de deelnemers ervoer psychische klachten of slaapstoornissen. Een beperkt sociaal netwerk en mediaaandacht voor COVID-19 bemoeilijkten het herstelproces van patienten. 19% van de deelnemers ervoer een verminderde levenskwaliteit. Een zwak sociaal netwerk veroorzaakte gevoelens van hopeloosheid. Toch lieten patienten een grote veerkracht zien. Conclusie: Hoewel de pandemische context uitdagingen stelt aan de revalidatie van COVID-ic-overlevenden, beschikken de meeste patienten over voldoende veerkracht om hun ervaringen te integreren in hun leven. Het is dan ook belangrijk psychische klachten die optreden tijdens revalidatie niet te medicaliseren. Onze aandacht dient te gaan naar degenen met een zwak sociaal netwerk. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers.

This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th-May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions (n = 429), 39% (n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor-penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42-6.22), lower SpO2/FiO2 ratio on admission (OR 0.96; 95% CI 0.92-0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12-8.27) and longer hospital stay (OR 1.09; 95% CI 1.03-1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards.

[Experiences of COVID-ICU-survivors: mixed-methods study of psychological consequences by written survey]

BACKGROUND: In the coming years, mental health care may come into contact with patients who developed psychological complaints related to their critical illness and stay in the intensive care unit (ICU) as a result of COVID-19. However, the experiences of these patients are to date rarely documented. AIM: Gaining insight into the experiences of COVID-ICU-survivors. METHODS 19 COVID-ICU survivors answered a written survey four months after admission. Screening lists measured psychological complaints and sleeping disorders. Visual analogue scales (VAS) measured the influence of the pandemic context and the quality of life. A written survey mapped patient experiences. Quantitative data were analyzed descriptively and qualitative data by means of thematic analysis. RESULTS: 50% of the participants experienced psychological complaints or sleeping disorders. A limited social network and media coverage of COVID-19 complicated the recovery process of patients. 19% of the participants experienced a reduced quality of life. A weak social network caused feelings of hopelessness. Still, patients showed great resilience. CONCLUSION: Most COVID-ICU survivors are resilient enough to integrate their experiences into their lives, despite the challenges the pandemic context poses on their rehabilitation. It is therefore important not to overmedicalise psychological complaints that occur during rehabilitation. Our attention needs to be directed to those with a weak social network.

Resting energy expenditure measured by indirect calorimetry: Ventilated Covid-19 patients are normometabolic

Rationale: Indirect calorimetry is gold standard to assess Resting Energy Expenditure (1). The aim was to determine REE and objectify evolution of metabolism over time in critically ill, ventilated COVID-19 patients. Methods: We performed indirect calorimetry during the course of disease. Extra safety measures to protect healthcare practitioners were taken. REE, Respiratory Quotient, VO2, VCO2 and their variability were monitored. Results: 19 IC's were performed in 6 patients between day1 and day 26 of ventilation. Mean age: 63y (range 52-74), 5 male patients, survival 67%. Average BMI was 30.3. On average, the Energy Expenditure was 2021kcal/day or 21 kcal/kg/day. [Formula presented] REE in kcal/kg/day. Horizontal axis: ventilation day. Vertical axis: patient number Conclusion: Although contra-indicated by some (2), we performed IC in COVID-19 patients and found a mean REE of 2021 kcal/day or 21 kcal/kg/day. The evolution over time showed variable findings but no ‘ebb and flood phases’. References: 1: ESPEN guideline on clinical nutrition in the intensive care unit.Singer P et al. Clin Nutr. 2019 Feb;38(1):48-79. 2: Nutrition Therapy in Critically Ill Patients with Coronavirus Disease (COVID-19). Martindale R et al.JPEN J Parenter Enteral Nutr. 2020 May 27:10.1002/jpen.1930. Disclosure of Interest: None declared