ABSTRACT
Background and aimDuring the COVID-19 pandemic, the neurology department at St Mary’s Hospital had to direct the bulk of its acute work to a newly expanded ‘hot clinic’ running Monday to Friday through Same Day Emergency Care (SDEC). Face to face clinic appointments were also halted and instead triaged to SDEC when examination of the patient was necessary. Patients were referred through a number of routes directly to the neurology consultants or on-call registrar, and subsequently seen on an urgent basis. We were interested in evaluating the types of referrals made to this service as well as their final outcomes.ResultsA total of 255 patients were seen between 3 March 2021 and 3 August 2021. Approximately a third were from the A&E department and just less than a third were from the Western Eye Hospital, our local ophthalmology A&E. Most referrals were for headache or visual change, and 61% of patients did not need to re-attend SDEC. Importantly, a quarter were discharged home after specialist review, and none required admission from clinic. Thus our emergency service was successful in avoiding admissions while ensuring patients received the care they required in a timely fashion.
ABSTRACT
BACKGROUND: COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. OBJECTIVES: To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection. DESIGN/METHOD: PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model. RESULTS: 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42). CONCLUSION: Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.