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
Introduction: Previous observational and randomized studies suggested potential benefit of therapeutic anticoagulation during hospitalization, but this treatment remains controversial Objective: We aimed to investigate the association of prophylactic and therapeutic anticoagulation with mortality for patients with COVID-19 who were treated with steroids and Remdesivir, which is the current standard treatments. Methods: This retrospective study was conducted by review of the electronic medical records for 9,565 patients with laboratory confirmed COVID-19 hospitalized in the Mount Sinai Health system between March 1 2020 and March 30 2021. The primary outcome of interest was the in-hospital mortality. Acute kidney injury was defined as any increase of creatinine by more than 0.3mg/dL or to more than 1.5 times baseline. A propensity score analysis (matching and weighting by inverse probability treatment weights) and multiple imputation was performed. Results: Of the 1,443 patients, 420 (29.1%) had therapeutic anticoagulation therapy. The 1,023 (70.9%) patients with prophylactic anticoagulation were older and had more comorbidities. After matching by propensity score (N=334 in each group), in-hospital mortality was not significantly different between patients with therapeutic anticoagulation and those with prophylactic anticoagulation (26.9% vs. 22.8%, P=0.24). Furthermore, IPTW and multiple imputation for missing data did not change the result (therapeutic versus prophylactic;odds ratio [95% confidential interval]: 1.14 [0.83-1.59], P=0.40];1.20 [0.84-1.73], P=0.31, respectively). Interestingly, patients with therapeutic anticoagulation had higher rate of acute kidney injury as compared to patients with prophylactic anticoagulation (26.6% vs. 16.8%, P=0.003). Conclusions: In conclusion, prophylactic versus therapeutic anticoagulation showed similar inhospital mortality of COVID-19 patients treated with steroids and remdesivir, but therapeutic anticoagulation increased the risk of acute kidney injury compared to prophylactic anticoagulation.
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.
ABSTRACT
Introduction: Statins are frequently prescribed for patients with hypertension, dyslipidemia and diabetes mellitus. These comorbidities are highly prevalent in COVID-19 patients. Statin's beneficial effect on mortalities in COVID-19 infection has been reported in several studies, but still inconclusive. Hypothesis: The inconclusive study results in association of satin use and COVID-19 can be resulted from variable timing of statins used among the studies. Our aim was to investigate whether consistent use of statins before and during hospitalization was effective to decrease the mortality due to COVID-19. Methods: We conducted a retrospective study among 6,095 patients with COVID-19 hospitalized in New York City between March 1st 2020 and May 7th 2021. Patients were stratified into two groups: statins use prior or during hospitalization (N=2,423) versus no statins (N=3,672). We evaluated inhospital mortality as a primary outcome using propensity score matching and inverse probability treatment weighted (IPTW) analysis. In addition, we compared continuous use of statins (N=1,108) versus no statins. Results: Statins use prior or during hospitalization group were older (70.8±12.7 versus 59.2±18.2, P<0.001) and had more comorbidities compared to no statins group. After matching by propensity score (1,790 pairs), there were no significant differences in in-hospital mortality between patients with statins versus those without (28.9% versus 31.0%, P=0.19, odds ratio (OR) [95% confidence interval (CI)]: 0.91 [0.79-1.05]). This result was confirmed using IPTW analysis (OR [95% CI]: 0.96 [0.81-1.12], P=0.53). As the additional analysis comparing continuous use of statins versus no statins group, in-hospital mortality was significantly lower in continuous use of statins compared to no statins group (26.3% versus 34.5%, P<0.001, OR [95% CI]: 0.68 [0.55-0.82]) after matching by propensity score (944 pairs). IPTW analysis showed the similar result (OR [95% CI]: 0.77 [0.64-0.94], P=0.009). Conclusions: Use of statins prior or during hospitalization was not associated with a decreased risk of in-hospital mortality, however, continuous use of statins might have potential benefit of a decreased risk of in-hospital mortality due to COVID-19.
ABSTRACT
Introduction: Obesity is one of the most frequent comorbidities among COVID-19 patients. Although previous studies have shown higher body mass index (BMI) is associated with higher mortality, steroids as the current standard treatment for moderate to severe COVID-19 infection were not applied in most patients in these studies. Hypothesis: We hypothesized that patients with higher BMI still have higher mortality even on steroids. Methods: We conducted a retrospective study of 4,587 hospitalized patients with COVID-19 who received corticosteroids between March 1 , 2020, and March 30 , 2021. We divided patients into 6 groups by BMI[MOU1] (less 18.5, 18.5-25, 25-30, 30-35, 35-40, 40 or greater, kg/m2 ) and investigated in-hospital mortality as the primary outcome, in-hospital mortality among severe COVID-19 patients which was defined as requiring intensive care unit or endotracheal intubation as a subgroup analysis, and acute kidney injury (AKI) incidence rate as the secondary outcome. Results: Patients with higher BMI were younger and more likely to have a history of asthma, obstructive sleep apnea, diabetes, and less likely to have malignancies. The smooth spline curve showed J curve association of BMI with risk adjusted in-hospital mortality with flexion point at BMI between 25 and 30 kg/m2 (Figure 1). Compared to overweight (25≤BMI<30 kg/m2 ) patients, class III obesity (BMI>40 kg/m2 ) was associated with higher risk adjusted in-hospital mortality overall (Table 1) as well as among patients with severe COVID-19 (OR [95% CI]: 3.21 [1.86-5.66], P<0.001). Class III obesity was also associated with a higher risk adjusted incidence of AKI (OR [95% CI]: 1.52 [1.06-2.18], P=0.024) compared to overweight patients. Conclusions: Class III obesity was associated with higher in-hospital mortality and AKI incidence rate in COVID-19 patients with steroids treatment.
ABSTRACT
Background : Coronavirus disease 2019 (COVID-19) is associated with abnormal hemostasis, autopsy evidence of systemic microthrombosis, and a high prevalence of venous thromboembolic disease (VTE). Tissue plasminogen activator (tPA) has been used in COVID-19 patients with severe hypoxia with high clinical suspicion of pulmonary embolism (PE). Aims : We aimed to describe the clinical outcomes of critically ill COVID-19 patients who received tPA. Methods : A retrospective cohort study was conducted on 6,095 hospitalized COVID-19 patients in the Mount Sinai Health System at 5 hospitals in New York. 57 patients with COVID-19, who were admitted from 3/10 to 4/27, 2020 and received tPA for presumed PE were included in the analysis. Baseline demographic and clinical characteristics, indication for tPA, and overall mortality were reported. Results : Among the 57 patients who received tPA, the mean age was 60.8 ± 10.8 years, and 71.9% (41/57) were male. PE was suspected among 75.4% (43/57) of patients with supporting findings who had rapidly worsening hypoxia or hypotension. Right ventricular (RV) strain was present in 15.8% (9/57), deep venous thrombosis (DVT) in 7.0% (4/57), increased dead space ventilation (V d ) in 31.6% (18/57) of patients. RV strain and RV thrombus were present in 3.5% (2/57), RV strain and DVT in 5.3% (3/57), RV strain and increased V d in 8.8% (5/57), and DVT and increased V d in 3.5% (2/57) of patients. No chest CT angiography was performed for any patients due to clinical instability from critical illness. Following tPA infusion, 49.1% (28/57) of patients demonstrated improvement in either of PaO 2 /FiO 2 ratio, blood pressure or partial arterial carbon dioxide. Bleeding complication was seen in 1 patient. Six patients (10.5%) survived to hospital discharge. Overall mortality was 89.5% (51/57). Conclusions : The overall mortality of critically ill COVID-19 patients who received tPA for presumed PE was 89.5 %. The utility of tPA for this indicaition warrants further studies.
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Inhaled corticosteroids (ICS) are widely used in patients with asthma and chronic obstructive pulmonary disease (COPD). The pooled epidemiological studies have shown that patients with asthma or COPD are at lower hospitalization risk, which could be related to the protective effect of ICS. However, some studies showed no protective effects of ICS on the prognosis of COVID-19. The very recent study suggested that the use of ICS, within 2 weeks of admission, improved survival only for patients aged 50 years and older with asthma, but not for those with chronic pulmonary disease. Herein, we are highly concerned about whether the use of ICS affects the prognosis of COVID-19. METHODS: We retrospectively analyzed over 6,095 hospitalized patients with laboratory confirmed COVID-19 at the Mount Sinai Health System in New York between March 1stand May 2nd, 2020. Patients were stratified into those with or without ICS before admission and were assessed for in-hospital mortality as a primary outcome. Patients were matched by propensity score using 1:1 matching scheme without replacement. We performed this analysis with and without multiple imputation for missing data and then performed an inverse probability weighted analysis. All statistical calculations and analyses were performed in R, with p-values <0.05 considered statistically significant. RESULTS: Of the 6,095 patients admitted due to COVID-19 infection, 333 patients (5.5%) used ICS before admission. The patients with ICS were older and had more comorbidities compared to the patients without ICS. However, in-hospital mortality, intensive care unit admission, and endotracheal intubation rate were not significantly different, although the d-dimer levels were significantly lower in patients with ICS compared to those without (1.48 [0.88, 2.76] versus 1.66 [0.88, 3.51] mg/mL, P=0.043). After matching by propensity score (N=204 in each group), in-hospital mortality and intensive care unit admission rate were not different, while endotracheal intubation rate was significantly decreased in the patients with ICS. Multiple imputation for missing data and inverse probability weighted analysis revealed no significant difference in in-hospital mortality between the groups (odds ratio [95% confidential interval]: 0.90 [0.61-1.34], P=0.63;odds ratio [95% confidential interval]: 0.83 [0.54-1.29], P=0.42). To identify the population ICS improves the prognosis of COVID-19, we performed a subgroup analysis among patients with asthma and COPD (N=378). There was no significant difference in in-hospital mortality between patients with ICS and those without even after propensity score matched analysis or inverse probability weighted analysis (odds ratio [95% confidential interval]: 0.86 [0.47-1.60], P=0.64) (Table 1). CONCLUSIONS: In our study, antecedent ICS use showed numerically better outcomes in the propensity score matching analysis and the subgroup analysis of patients with asthma and COPD even though the patients with antecedent ICS use had more comorbidities. Particularly, our propensity score matching analysis revealed that patients with antecedent ICS use showed decreased endotracheal intubation rate. CLINICAL IMPLICATIONS: The potential benefit of antecedent ICS use on COVID-19 patients needs to be examined with larger sample size. DISCLOSURES: No relevant relationships by Natalia Egorova, source=Web Response No relevant relationships by Hiroki Kabata, source=Web Response no disclosure on file for Toshiki Kuno;No relevant relationships by Matsuo So, source=Web Response No relevant relationships by Mai Takahashi, source=Web Response
ABSTRACT
Rationale: The coronavirus diseas e 2019 (COVID-19) causes a wide spectrum of lung manifestations ranging from mild asymptomatic disease to severe respiratory failure. Recently, it has been suggested that respiratory damage remains for a long time after recovery from COVID-19. We aimed to clarify the characteristics of radiological and functional lung sequelae of COVID-19 patients described in follow-up period. Method: sPubMed and EMBASE were searched on October 20th, 2020 to investigate characteristics of lung sequelae in COVID-19 patients through retrospective studies according to PRISMA guidelines. Radiological and pulmonary function test (PFT) data were collected and analyzed using one-group meta-analysis in a random-effects model. Results: Our search identified 9 eligible retrospective studies with follow-up period up to 3 months. A total of 581 discharged patients were evaluated by chest CT scans or PFT. The frequency of residual CT abnormalities after hospital discharge was 61.5% ([95% confidential interval (CI)]: [41.3-81.7], I2=96.0%, 243/421 patients). Pulmonary fibrosis and ground glass opacity was found in 42.7% ([95% CI]: [10.4-74.9], I2=96.31%, 56/166 patients) and 42.4% ([95% CI]: [33.3-51.5], I2=43.0%, 107/250) of patients, respectively. The frequency of abnormal pulmonary function test was 39.2% ([95% CI]: [19.8-58.6], I2=79.4%, 48/123 patients) and impaired diffusion capacity was most frequently observed in 32.8% ([95% CI]: [18.2-47.4], I2=86.2%, 93/272 patients) of patients. Restrictive pattern and obstructive pattern were observed in 10.5% ([95% CI]: [6.9-14.0], I2=0%, 31/290 patients) and 4.8% ([95% CI]: [0.9-8.6], I2=45.8%, 14/240 patients), respectively. Conclusion: This systematic review analyzed the frequency of chest CT and PFT abnormalities after hospital discharge. 61.5% and 39.2% of patients had abnormal chest CT and PFT results within a period of 3 months after hospital discharge. The most frequent PFT abnormality was impaired diffusion capacity which is potentially suggestive of residual impact of microthromboembolism in lung vasculature due to hypercoagulability. Further studies with longer follow-up term are warranted to elucidate long term consequences of COVID-19 disease.
ABSTRACT
INTRODUCTION: Since cytokine release syndrome is considered to be associated with severe cases of COVID-19, steroids are expected to be effective for its treatment. We aimed to investigate the use of steroids and its impact. METHODS: We conducted a retrospective chart review and analysis of 226 consecutive hospitalized patients with confirmed COVID-19. Patients were divided into those who received steroids (steroid group) and those who did not (no steroid group). Inverse weighted probability weighted analysis was performed to assess the effect of steroids for in-hospital mortality. RESULTS: The steroid group had higher rates of preexisting hypertension and peripheral vascular disease than no steroid group and also had higher lactate dehydrogenase, d-dimer, and inflammatory makers compared to no steroid group (all P<0.05). The steroid group had significantly higher rates of multifocal pneumonia than no steroid group at admission (75.4% versus 50.3%, P=0.001). Notably, steroid group had higher rates of bacterial infection (25.5% versus 12.4%, P=0.025) and fungal infection (8.7% versus 0.6%, P<0.001) during hospital course. After adjustment, steroid did not decrease or increase in-hospital mortality (OR [95% CI]: 1.02 [0.60-1.73, P=0.94]). CONCLUSIONS: Steroid did not show decrease risk of inhospital mortality. There were increased bacterial and fungal infections with steroid use.
ABSTRACT
SESSION TITLE: Cultural Diversity Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Coronavirus disease 2019 (COVID-19), has emerged as a global public health emergency with its first known case in December 2019. As of May 2nd, 2020, New York City, known as a “melting pot,” is the epicenter of this pandemic. The data regarding race/ethnicity and COVID-19, however, remains scarce. We aimed to evaluate the difference in patients’ characteristics affected by the disease including race and ethnicity. METHODS: Consecutive 219 hospitalized patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into white group (N=79, 36.1%) versus non-white group (N=140, 63.9%) and analyzed. RESULTS: Among total cohort, the mean age was 63.2±16.9 and 56.2% were male. 4.6% were undomiciled, and 93.6% had health insurance including Medicare (49.3%) and Medicaid (35.6%). Among non-white group, 30.7% are African American, 19.2% were Asian. The proportions of Hispanic were 39.2% in white group and 47.9% of non-white group. Characteristics of insurance, undomiciled, symptoms onset to admission date were not significantly different between two groups. Non-white group had significantly higher d-dimer, interleukin-6 (P<0.05). Rapid response team was less frequently activated among white group than non-white group (1.3% versus 8.6%, P=0.027). Regarding treatments, both groups had similar treatments such as hydroxychloroquine, azithromycin, steroids, tocilizumab, non-invasive positive pressure ventilation and invasive mechanical ventilation. Death rates were also similar between both groups (15.2% versus 20.6%, P=0.33). CONCLUSIONS: We reported the detailed description of clinical characteristics with the association of race/ethnicity in the diverse urban population of New York City. CLINICAL IMPLICATIONS: Our study describes the diversity of COVID-19 patient characteristics as well as the population it impacts in New York City. Notably, we investigated the association of race/ethnicity, homelessness, and insurance status (potential surrogate for access to healthcare), which showed non-significant differences between white group and non-white group. Although we could not show non-white group was an independent predictor for in-hospital mortality after adjustment including d-dimer, higher d-dimer and inteleukin-6 in non-white group are valuable since d-dimer is known to be associated with higher mortality and interleukin-6 is a reflection of cytokine release syndrome of COVID-19. The findings that rapid response was activated more frequently suggests that there may be other factors such as language barrier which might contribute delayed recognition of symptoms. DISCLOSURES: No relevant relationships by Toshiki Kuno, source=Web Response No relevant relationships by Tetsuro Maeda, source=Web Response No relevant relationships by Reiichiro Obata, source=Web Response No relevant relationships by Dahlia Rizk, source=Web Response