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Background: Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Method(s): We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Result(s):We analyzed data of 176,137 hospitalizations because of COVID- 19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P<0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P<0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of casefatality in patients with PE (OR 2.81, 95% CI 1.66-2.12, P<0.001). Conclusion(s): In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions.
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Background and aim: In Veneto region, rates of hospitalization (2.4 per 10,000) and 30-day mortality (4.3%) for non-variceal upper gastrointestinal bleeding (NVUGIB) were stable during 2012-2019. The COVID-19 pandemic has caused a global health emergency and the aim of this study was to evaluate COVID-19 impact on hospitalizations and mortality for NVUGIB in Veneto region. Material(s) and Method(s): This is a retrospective study based on administrative databasescarried out to compare NVUGIB hospitalizations and 30-day mortality after hospital admission before (2018- 2019) and duringthe COVID-19 pandemic (2020-2021).The indicator proposed by the National Outcomes Evaluation Programme was adopted,includingall NVUGIB hospitalizations of patients over 18 years old, residing in Veneto, excluding conditions with indication of anticoagulant or antiplatelet therapy, trauma, cardiovascular surgeries, cancer, cirrhosis. The crude and standardized hospitalization rates (sHR,direct standardization method),and 30-day mortality were calculated. Chi-square, Mann Whitney test, ORand adjusted OR (aOR), estimated throughlogistic regression analysis were used to compare the two periods. Result(s): 3,436 eligible admissions for NVUGIB were identified, 1,872 before COVID-19and 1,564 during the pandemic: 815 in 2020 and 749 in 2021. The distribution by age and sex in the two periods was comparable: 42% females, above 60% patients aged >70 years;females were older (p<.0001) (median age: males 72 (IQR:57-81), females 81 (IQR:70-87)). sHR were significantly higher in the pre- COVID-19 period (2.34 per 10,000 population 95% CI 2.23-2.45 Vs. 1.90 95% CI 1.80-1.99) and comparable between 2020 and 2021 (1.99;95% CI:1.85-2.12Vs. 1.81;95% CI:1.68-1.94 p-value=0.0644). Rates increased with age and were higher for patients over 80. Rates were also higher among males for both periods and for all age groups. Crude 30-day mortality was significantly higher for females in both periods(F:M risk ratio: pre-COVID-19: 1.57 - p-value: 0.0355;during covid: 1.49 - p-value: 0.0316) and was higher during the pandemic both for males (3.75% vs 6.11%) and females (5.9%vs 9.12%) also after adjusting for age (aOR males: 1.71;95% CI:1.13-2.61;females: 1.56;95% CI:1.04-2.33). Conclusion(s): COVID-19 pandemic has caused a global reduction of access to care with an important decrease also of NVUGIB hospitalization rate (- 19%) and a concomitant rise of 30-day mortality (+58%).Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.
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Background and aim: Because of COVID-19 pandemic several healthcare activities were temporarily ceased during the two epidemic waves. However all urgencies, as well as oncological services, including screening colonoscopy following positive fecal occult blood test (FOBT), were always guaranteed, except in the first phase. The aim of this study is to quantify the impact of COVID-19 pandemic on colonoscopy and colorectal cancer surgical activities, analysing the reduction of screening activity. Materials and methods: We analysed retrospectively colorectal= cancer screening, colonoscopy and colorectal cancer surgical interventions from January to November 2020, compared to the average of the same period in 2018 and 2019. Data was extracted from the regional screening database, hospital discharge records and regional digital archives of outpatient services. ᵪ2 test was used to compare the reduction of screening and non-screening colonoscopies. Results: 453,877 people were invited to participate in the FOBT, within the regional colorectal cancer screening programme, 115,976 fewer than the previous two years (-20.4%), with an adherence rate that dropped from 65.2% to 54.2%. The monthly reduction of screening participants was greater than the reduction of people invited to the screening programme and most marked in April (-86.8%) and May (-81.0%). Colonoscopies fell by 22.2% (67,138 in 2020 Vs. 86,298 for the 2018-2019) and it reached its lowest in April (-70.4%). The reduction was of 13.1% for screening colonoscopies following a positive FOBT, and 24.9% for non-screening colonoscopies (p<0.001). Surgical interventions were strongly reduced as well, from a yearly average of 2,466 to 2,250 colorectal cancer surgical procedures in 2020 (-8.7%), with the lowest rate in April and May, respectively -17.4% and -34.9%. Conclusions: COVID-19 pandemic markedly reduced colorectal cancer screening activity, to the point that regional screening programmes were not able to completely recover the work lost during the first epidemic wave. Following the reduction of FOBT, also colonoscopy and colorectal cancer surgical interventions decreased during the epidemic wave and, up to November 2020, these healthcare services did not completely recover the lost work either. Nevertheless, considering the greater reduction of non-screening compared to screening colonoscopies, colorectal cancer screening seems to play a pivotal role in limiting the decrease of endoscopic and surgical interventions
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Background and aim: Gastrointestinal bleeding (GIB) is still a common medical emergency and an important cause of morbidity and mortality. The COVID-19 pandemic has caused a global health emergency and affected resources in all health sectors significantly and its impact has a fundamental importance for the reduced access to care. As a result of the coronavirus pandemic, people also may not seek needed medical care due to cancelled appointments, and fear of going to the emergency room has more than halved accesses. The aim of this study was to investigate how the first phase of the COVID-19 pandemic (March-May 2020) affected the hospital management of Non-variceal upper gastrointestinal bleeding (NVUGIB) in Veneto Region. Materials and methods: This is a retrospective study based on the anonymous administrative computerized database of hospital discharges in the Veneto Region (about 4.9 million inhabitants, North-East of Italy) carried out to compare NVUGIB hospitalizations of the first phase of COVID-19 pandemic with the last fouryear monthly average of the same period. All the hospital discharges form public and accredited hospital with NVUGIB as principal diagnosis were collected. Statistical analyses were performed with Odds Ratio (OR). Results: Comparing the 3 months of the first COVID-19 pandemic phase with the same period of previous years, NVUGIB hospitalization decrease of 29%, from an average of 742 to 525 discharges and length of stay shows a small increase passing from 8.8 to 9.4 days. Stratification by gender doesn’t show variation with a prevalence of males (55%) while mean age rises from 70.4 to 72.9 yrs., with a more marked age increase among males (67 to 70.1 yrs) than females (74.9 to 76.3 yrs). Case fatality rate (CFR) rises from 4.4% to 5.9% (OR=1,35;95% CI: 0.81-2.23;p=0.2448) and confirms the better outcomes for a hospitalization in gastroenterological unit (OR=0.51;95% CI: 0.15-1.71;p=0.2743). (Figure Presented) (Figure Presented)Conclusions: The COVID-19 pandemic has had a major impact on NVUGIB hospitalization in Veneto Region, and the extent of thatimpact is well defined form March to May with a return to pre-COVID rates starting from June. The generalized reduction of access to healthcare and the consequent fall of NVUGIB hospitalizations seems to cause a selection of cases with the hospitalization limited to the most serious patients
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OBJECTIVE: The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS: The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS: Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS: This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.
Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Death Certificates , COVID-19/complications , Cause of Death/trends , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Epidemics , Humans , Italy/epidemiology , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/mortalityABSTRACT
Background: Veneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic. Aim: This paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020. Methods: Information on the public health response was collected from regional health authorities' official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case fatality ratios (CFRs) were calculated. Results: Key elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Hospitalised cases (n=3,623;34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age. Conclusion: In the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.