Seroprevalence of ANTI-SARS-CoV-2 antibodies in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) treated with biologic and/or immunosuppressant drugs are at increased risk for opportunistic infections. Seroprevalence studies can confirm the diagnosis of SARS-CoV-2 infections as well as the associated risk factors. This is a descriptive study which primary endpoints were to highlight the prevalence of SARS-CoV-2 antibodies in a cohort of IBD patients in March 2021, and to analyze seroconversion in patients with known COVID-19 infection and its relationship with IBD treatments. Patients filled in a questionnaire about symptoms of COVID-19 infection and clinical information about their IBD. All included patients were tested for SARS-CoV-2 antibodies. 392 patients were included. Among patients with clinical infection, 69 patients (17,65%) were IgG-positive, 286 (73,15%) IgG-negative and 36 (9,21%) indeterminate. In relation to seroconversion among patients under biologic treatment, 13 patients of the 23 with a previous positive CRP developed antibodies (56.5%). However, when the influence of immunosuppressive treatment on the probability of developing antibodies was analyzed, no significant differences were seen between those patients with or without treatment (77.8% vs. 77.1%, p = 0.96). In our cohort of IBD patients, after one year of pandemic, there were 18.64% IgG positive patients, a higher prevalence than the general population (15.7%).

Serum prevalence of SARS-COv2 antibodies in patients with inflammatory bowel disease before vaccination

Introduction: Patients with inflammatory bowel disease (IBD) treated with biologic and/or immunosuppressant drugs are at increased risk for opportunistic infections, including viral infections (1) Previous studies have postulated that patients with IBD were not at increased risk of severe SARS-CoV-2 infections (2) although given the absence of microbiological confirmation at the onset of the pandemic, past infection could not be confirmed. Seroprevalence studies can confirm the diagnosis of SARS-CoV-2 infections as well as the associated risk factors. Aims & Methods: This is a descriptive study which primary endpoint was to highlight the prevalence of SARS-CoV-2 antibodies in a cohort of patients diagnosed with IBD followed in our unit, between 26 February and 26 March 2021, one year after the start of the pandemic. Patients with scheduled on-site visits to our unit were included;they filled in a detailed questionnaire about symptoms of COVID-19 infection, demographic data and clinical information about their IBD. All included patients were tested for SARS-CoV-2 antibodies by ELISA. Results: 338 patients were included: 181 with a diagnosis of Crohn's disease, 132 with ulcerative colitis and 25 with indeterminate colitis;baseline characteristics are shown in Table 1. There were 74 patients with clinically suspected infection compared to 264 without compatible clinical features. Among patients with clinical infection, 63 patients (18,64%) were IgG-positive, 243 (71,89%) IgG-negative and 32 (9,47%) indeterminate;These results were compared with the prevalence data of the Spanish Government in the community of Madrid (IgG positive 15,7%);differences were not statistically significant (p<0.05) (5). The positivity rate was analysed according to the treatment received. At the beginning of the pandemic, there were 46 patients without treatment (serological positivity rate 13,04%), 90 patients receiving mesalazine (IgG positive 27,78%), 51 patients receiving immunomodulators (IgG positive 27,45%), 85 patients with biological treatment (IgG positive 17,64%) and 56 patients combined biological and immunosuppressive treatment (serological positivity rate 5,36%).);these results were statistically significant (p <0,05). It is difficult to establish whether these differences between treatments are due to a lower number of infections (more patient care in the immunocompromised groups) or a lower seroconversion rate. (Table Presented) Conclusion: Although SARS-CoV-2 infection has been a diagnostic challenge in some cases, the presence of antibodies by ELISA allows confirmation of past infection. In our cohort of IBD patients, after one year of pandemic, there were 18.64% IgG positive patients, a higher prevalence than the general population (15.7%) (4). These differences may be justified by a higher number of hospital visits, the inflammatory disease itself or the treatments received.

Increased in hospital mortality in stroke during the COVID-19 era and related factors

Background and Aims: The COVID-19 pandemic has had enormous implications for stroke care. We aim to analyze its impact in stroke outcomes and mortality in two comprehensive stroke centers (CSC) from the Catalonian network. Methods:We studied all stroke patients admitted during 2020 and compared them with the admissions of 2019. Clinical and functional outcomes (mRS at discharge, in-hospital complications and mortality) were analyzed. Related factors, including SARS-CoV-2 infection, were determined. Results: A total of 2674 stroke patients were admitted in 2020, and 2652 during 2019. A higher number of unknown-onset strokes (45% vs 40%, p<0.01), ASPECTS<7 (8.3% vs 5.7%, p=0.03) and longer time from symptoms-onset to hospital-admission (median: 337 vs. 272min, p<0.01) were detected during 2020. Conversely, no significant differences appeared in stroke code activation (61.5% vs 62.5%), stroke subtype (ICH 9.1% vs 8.9%), severity (median NIHSS: 4 vs 5), pre-morbid mRS (mRS<3 81.8% vs 80.2%) or other relevant clinical characteristics nor reperfusion treatments (23.8% vs 23.9%). In-hospital complications and discharge-mRS were similar. However, we observed higher inhospital mortality in 2020 (9.6 vs 6.6%, p<0.001). An adjusted regression model pointed pre-morbid mRS, baseline NIHSS, ASPECTS and inhospital complications (OR 1.26, 1.14, 0.87 and 1.38 respectively, p<0.01) as independent predictors of mortality. SARS-CoV-2 infection (3.7% of strokes in 2020) was not predictor of mortality;in fact, these patients showed similar outcomes than the remaining 2020 strokes. Conclusions: The increased in-hospital mortality detected in 2020 in our series may be due to pandemic-related delays in stroke detection and hospital arrival rather than the direct effect of COVID-19.

Stroke etiologies in patients with COVID-19: the svin COVID-19 multinational registry

Background and purpose: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID- 19 from 31 hospitals in 4 countries (3/1/20-6/16/20). Results: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60-79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p=0.01). In that model, older age (aOR2.05 per decade, 95%CI 1.35-3.11, p<0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p=0.01) were also independently predictive of mortality. Conclusions: Our findings suggest that cryptogenic stroke among COVID-19 patients may berelated to more severe disease and carries a significant risk of early mortality.