ABSTRACT
Objectives. The aim is to describe the phenotypic, biological and clinical characteristics of hospitalized patients with COVID-19 and diabetes, and the association with the clinical outcome of the patients. Material and methods. This single-center, retrospective study was conducted on 200 patients. The primary endpoint was death observed within day 7, 14 and beyond day 14 of hospitalization, and secondary objective was to compare the survival group with non-survival group. The variables that demonstrated significant association with primary endpoint were subject to multivariate binary logistic regression analysis. Outcomes. The estimated prevalence was 17.87% of the total COVID-19 hospitalizations during this period (n=1119). The majority of the patients were with diabetes mellitus type 2 with a median age of 67 years and BMI of 27.8 kg/m2. On admission, 156 patients (78%) presented with severe/critical illness. A total of 93 patients (46.5%) met the primary end-point, with most deaths occurring within day 7 of hospital stay. Non-survival group showed significantly higher levels of leucocytes count, more pronounced lymphopenia, higher CRP, LDH and D-dimer levels. Multivariate analysis identified four independent risk factors associated with death: age OR 1.05 (CI 95% 1.01-1.09), severity of disease at admission OR 0.22 (CI 95, 0.07-0.65), COVID-19 vaccination status OR 3.07 (CI 95%, 1.36-6.91) and LDH levels OR 1.00 (CI 95%,1.002-1.008). Conclusions. Diabetic patients admitted to hospital for COVID-19 infection tend to have high mortality rate. Severity of disease at admission, advanced age, not completed vaccination and increased LDH levels are independent risk factors for lethal outcome, irrespective of diabetes status. © 2022, Amaltea Medical Publishing House. All rights reserved.
ABSTRACT
Background: Vaccination for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has already resulted in a reduction in new infection and mortality cases. Preliminary reports indicate variable and reduced antibody response in multiple sclerosis (MS) patients treated with different disease-modifying therapies (DMTs). Objective and Aim: To determine the effects of different DMT on the humoral response after COVID-19 vaccination in MS patients. Methods: A total of 154 MS patients were vaccinated with one of three available SARS-CoV-2 vaccines (BNT162b2, mRNA-1273, and Ad26.COV2.S). The humoral response was determined by measurement of either unspecific IgG antibodies or anti-spike IgG antibodies. The time between vaccination and serological testing and time from the last infusion date (if applicable) to testing were determined. Humoral response greater than 1.0 was considered as positive and suggestive of acquired immunity. Results: Overall, 89 out of 127 (70.1%) and 15 out of 27 (55.6%) MS patients had a positive anti-S1 test and unspecific IgG test, respectively. Excluded from the analysis were two patients who had only one dose of the mRNA vaccine with negative seroconversion and four patients with a history of SARS-CoV-2 PCRpositive test and positive seroconversion. In the remaining sample, there were no sex and age differences in seroconversion (both p>0.05). Based on DMT groups, seroconversion was seen in 22/26 (84.6%) patients treated with interferon-β, 18/19 (94.7%) on glatiramer acetate, 14/16 (87.5%) on natalizumab, 6/10 (60%) on teriflunomide, 3/8 (37.5%) on sphingosine-1-phosphate (S1P) modulators, 9/9 (100%) on dimethyl fumarate, 0/3 (0%) on cladribine (but all of these patients had prior ocrelizumab from 8 to 9 months prior), 4/28 (14.3%) on anti-CD20 depleters, and 3/5 (60%) on off-label medications. 87.5% (21/24) of non-treated MS patients had positive seroconversion. Seroconverted MS patients treated with anti-CD20 had numerically greater time from the last infusion to the first vaccination (162.3 vs. 80.9 days). Conclusion: MS patients treated with B-cell depleting medications and S1P modulators have significantly lower seroconversion after COVID-19 vaccination when compared to DMT-naive patients and other DMT groups. Future studies should determine the risk of severe clinical outcomes in vaccinated patients with no evidence of seroconversion.