ABSTRACT
INTRODUCTION: Although high-dose corticosteroids can hypothetically curb the cytokine storm effectively, the clinical benefit of pulse methylprednisolone in coronavirus disease 2019 (COVID-19) remains inconclusive. We compared pulse methylprednisolone therapy with dexamethasone as a COVID-19 treatment. METHOD(S): Using a Japanese multicenter database involving 350 acute care centers, we identified adults aged>=18 years admitted for COVID-19 and discharged between January 2020 and December 2021 who received pulse methylprednisolone (>=250 mg/day) or intravenous dexamethasone (>=6 mg/day) on the day of admission or the next day. One-to-one propensity score matching was performed with age, sex, comorbidities, disease severity, hospital size, and time of admission as covariates. The primary outcome was in-hospital mortality. Secondary outcomes were the length of hospital stay (LOS), insulin-requiring hyperglycemia, and fungal infection. RESULT(S): We included 1,202 (mean age, 62.4+/-16.3;male, 70.9%) and 7,669 (mean age, 61.6+/-16.3;male, 66.0%) patients in the pulse methylprednisolone and dexamethasone group, respectively. After propensity score matching (1,197 pairs), pulse methylprednisolone was associated with higher in-hospital mortality (12.0% vs 8.8%;p=0.011), longer LOS (13.0 [interquartile range: 9.0-22.0] vs 12.0 [8.0-18.0] days;p=0.002), and higher hyperglycemia incidence (16.3% vs 9.7%;p< 0.001), while fungal infection incidence (6.3% vs 4.6%;p=0.339) was not significantly different. In subgroup analysis, among patients who received mechanical ventilation (IMV) on the day of admission or the next day, in-hospital mortality was similar between the two groups (22.2% vs 20.5%;p=0.792). However, among patients without IMV, pulse methylprednisolone was associated with higher mortality (10.3% vs 7.0%;p=0.010). The sensitivity analysis involving patients who received >=1 g/day of methylprednisolone vs 6 mg/ day of dexamethasone showed consistent results. CONCLUSION(S): Compared to dexamethasone, pulse methylprednisolone may be associated with worse COVID-19 outcomes, especially in patients not on IMV. Providers should be aware of the potential consequences according to the type and dose of corticosteroid therapy and tailor the treatment for COVID-19.
ABSTRACT
Background. The risk and benefits of coronavirus disease 2019 (COVID-19) vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in relation to COVID-19 vaccination during pregnancy is scarce. Methods. We searched PubMed and EMBASE databases in April 2022 without language restrictions. We included Prospective trials and observational studies comparing the women who received at least one COVID-19 vaccination during pregnancy with those who did not and reporting neonatal outcomes. Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using random-effects models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The primary outcomes were the neonatal outcomes, including preterm birth, small-for-gestational-age (SGA), low Apgar score (< 7 at 5 min), neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD). The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis. Results. Nine observational studies involving 81,349 vaccinated (mean age, 32.0 +/-4.6 years) and 255,346 unvaccinated women during pregnancy (mean age, 30.5+/-5.1 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88;95% confidence intervals [CI], 0.80-0.97) and IFD (OR, 0.73;95% CI, 0.57-0.94), whereas it was not associated with preterm birth (OR, 0.89;95% CI, 0.76-1.04), SGA (OR, 0.99;95% CI, 0.94-1.04), and low Apgar score (OR, 0.94;95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46;95% CI, 0.22-0.93), but not associated with increased risk of cesarean delivery (OR, 1.05;95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95;95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95;95% CI, 0.83-1.07). Flowchart of study selection Forest plots showing the odds ratio of neonatal outcomes a: neonatal intensive care units admission, b: intrauterine fetal death, c: preterm birth, d: small for gestational age, e: low Apgar score Forest plots showing the odds ratio of maternal outcomes a: maternal SARS-CoV-2 infection, b: cesarean delivery, c: postpartum hemorrhage, d: chorioamnionitis Conclusion. COVID-19 vaccination during pregnancy did not increase the risk of peripartum outcomes but decreased the risk of NICU admission, IFD, and maternal COVID-19 infection. COVID-19 vaccination should be encouraged for pregnant women.
ABSTRACT
SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) often causes radiological and functional pulmonary sequelae. However, evidence on 1-year follow-up of pulmonary sequelae is limited. This study aimed to elucidate (1) the proportion of residual computed tomography (CT) abnormalities 1 year after COVID-19 recovery;(2) characteristics of the remaining CT findings at 1-year follow-up;and (3) the relationship between the disease severity and time course of radiological sequelae. METHODS: We searched PubMed and EMBASE databases on February 25, 2022, and included studies with CT findings at the 1-year follow-up. We collected CT and pulmonary function tests (PFT) data at 1-year follow-up. The residual findings at mid-term (4-7 months) follow-up were also collected when available. The extracted data on CT and PFT findings were analyzed using a one-group meta-analysis. We further analyzed the data in relation to the COVID-19 severity, improvement rate, and lung function. RESULTS: Fifteen eligible studies (N = 3,134) were included. One year after COVID-19, 1,495 patients underwent CT, and 46.0% (95% confidence interval [CI] 32.7-59.4, I2 = 96.9%) presented with residual CT abnormalities. Ground-glass opacity (GGO) and fibrotic-like changes were frequently observed in 27.3% (95% CI 20.1-34.4, I2 =86.7%) and 26.1% (95% CI 14.2-38.0, I2 =94.6%) of the patients, respectively. While the proportion of GGO decreased from the mid-term to long-term follow-up (34.0% [23.4-44.5] to 27.3% [20.1-34.4]), fibrotic-like changes (14.9% [5.1-24.8] to 26.1% [14.2-38.0]), bronchiectasis (12.5% [4.1-20.9] to 13.3% [7.7-18.9]), and interlobular septal thickening (13.2% [2.9-23.5] to 12.8% [7.1-18.5]) did not improve. Furthermore, the frequency of CT abnormalities at 1-year follow-up was higher in the severe/critical cases than in the mild/moderate cases (54.8% [40.6-69.0] vs. 32.2% [1.6-62.7]). In particular, fibrotic-like changes were frequently observed among severe/critical patients 1 year after COVID-19 (30.4% [11.3-49.5]). Regarding pulmonary function tests, 29.9% (22.5-37.3) and 8.0% (5.4-10.6) of the patients presented reduced (< 80% of predicted value) diffusing capacity of the lung for carbon monoxide (DLCO) and total lung capacity (TLC) at 1-year follow-up. These residual PFT abnormalities were more prevalent in severe/critical cases (DLCO: 30.1% [21.1-39.0], TLC: 10.5% [5.0-16.0]) than mild/moderate cases (DLCO: 21.5% [9.6-33.3], TLC: 5.6% [2.6-8.6]). CONCLUSIONS: Our meta-analysis indicated that residual CT abnormalities were common in COVID-19 patients 1 year after recovery, especially fibrotic changes in severe/critical cases. CLINICAL IMPLICATIONS: Physicians should be aware of the high frequency of lung sequelae even 1 year after COVID-19. As these sequelae may last for a long time, vigilant observations and more extended follow-up periods are warranted. DISCLOSURES: no disclosure on file for Koichi Fukunaga;No relevant relationships by Masao Iwagami No relevant relationships by Hiroki Kabata No relevant relationships by Toshiki Kuno No relevant relationships by Matsuo So No relevant relationships by Hisato Takagi No relevant relationships by Atsuyuki Watanabe
ABSTRACT
Rationale. Invasive fungal infection secondary to the coronavirus disease 2019 (COVID-19) has been increasing. Whereas COVID-19-associated pulmonary aspergillosis has been shown to be associated with high mortality, less is known about COVID- 19-associated mucormycosis (CAM). The overall mortality of non-COVID-19 mucormycosis ranges from 20% to 100%, depending on the infection site. Delayed diagnosis, neurological symptoms, and pre-existing malignancies are associated with worse outcomes. Herein, our study aimed to elucidate the characteristics, risk factors, and outcomes of CAM. Methods. We searched all observational studies reporting CAM through PubMed and EMBASE on September 13th, 2021. Case reports, case series, and observational studies without clearly documented diagnostic criteria for COVID-19 or mucormycosis were excluded. We collected data on the comorbidities, initial symptoms, site of infection, treatment for COVID-19, frequency of orbital exenteration, and mortality. One-group meta-analyses were performed for the potential risk factors, orbital exenteration, and mortality. Results. Our systematic review identified 32 eligible observational studies. The largest number of studies were conducted in India, followed by Egypt, Iran, and Turkey. A total of 4,463 patients were included in the analysis. The most common initial presentation was ocular symptoms: 78%, followed by facial: 48%, nasal: 21%, constitutional: 12%, oral: 4.4%, neurological: 1.1%, and others: 0.4%. Diabetes mellitus (DM) and glucocorticoid therapy were present in 81% (95% CI, 76-86;I2=96%) and 79% (95% CI, 75-84;I2=91%), respectively. Among those with DM, the percentage of newly-diagnosed DM was 30% (216/711). Diabetic ketoacidosis, malignancy, and immunosuppression were found in 4.9% (165/3353), 0.7% (25/3471), and 0.6% (18/2921), respectively. Regarding the outcomes, orbital exenteration was performed in 17% (95% CI, 13-21;I2=83%) of the patients. Pooled estimate of mortality of CAM was 29% (95% CI, 22-36;I2=94%). Conclusion. The most prevalent type of CAM was rhino-orbital-cerebral mucormycosis. In addition to DM, severe hyperglycemia and immune dysregulation provoked by excessive corticosteroid therapy may have played a critical role in the recent rise of mucormycosis cases among COVID-19 patients. This systematic review and meta-analysis revealed a high frequency of orbital exenteration and mortality. The development of CAM can be associated with poorer prognoses in COVID-19 patients. Keeping the possible risk factors in mind and paying attention to the usual clinical presentation will be crucial to suspect CAM as early as possible.
ABSTRACT
Background: Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy. Objective: We aimed to investigate whether hemoglobin drop associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19. Methods: This retrospective study was conducted by review of the medical records of 6,683 patients with laboratory confirmed COVID-19 hospitalized in the Mount Sinai Health system between March 1 , 2020 and March 30 2021. We compared patients with and without hemoglobin drop >3g/dL during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as increased of creatine 1.5 times or 0.3mg/dL. Results: Of the 6,683 patients admitted due to COVID-19, 750 (11.2%) presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within two days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% versus 20.0%, P<0.001) as well as AKI (51.4% versus 23.9%, P<0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P<0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P<0.001). Finally, the smooth spline curve showed the association of hemoglobin drop and adjusted odds ratio for in-hospital mortality, which reflected the association of hemoglobin drop and in-hospital mortality (Figure). Conclusions: Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality. Figure Legends: Smooth spline curve of the association of hemoglobin drop and adjusted odds ratio of in-hospital mortality.