Outcomes of SARS-CoV-2 infection in patients with celiac disease: a multicenter research network study.

Background: Celiac disease (CD) is associated with an increased risk for respiratory infections and severe outcomes. No data have been reported in the scientific literature regarding the outcomes of COVID-19 in this population. The aim of this study was to report matched clinical outcomes in a large cohort of 930 patients with COVID-19 in the setting of known CD. Methods: Analysis of a multicenter research network TriNETX was performed, including COVID-19 patients aged more than 16 years. Outcomes of COVID-19-positive patients with concurrent CD were compared with a propensity-matched cohort of patients without CD. Results: A total of 341,499 patients with SARS-CoV-2 infection were identified on the research network: 930 (0.27%) with CD and 340,569 (99.73%) without CD. In the 30- and 60-day periods post SARS-CoV-2 infection, 12 (1.29%) and 13 (1.40%) deaths, respectively, were reported in the CD group. Fewer patients in the CD group reached the composite outcome of either mechanical ventilation or mortality at 60 days (risk ratio 0.58, 95% confidence interval 0.36-0.95). After propensity matching, no difference in clinical outcomes was observed. Conclusion: Our data suggest that patients with CD are not at increased risk of COVID-19-related morbidity or mortality.

Outcomes of SARS-CoV-2 infection in patients with pulmonary sarcoidosis: A multicenter retrospective research network study.

BACKGROUND: Analyses of COVID-19 infection outcomes in patients with preexisting pulmonary sarcoidosis are lacking and are limited to case reports or small case series with the largest study reporting outcomes of 37 patients. RESEARCH QUESTION: Retrospective cohort study to assess clinical outcomes of 945 patients with pulmonary sarcoidosis, presenting with COVID 19, compared to a propensity matched cohort of patients without sarcoidosis. STUDY DESIGN AND METHODS: Analysis of a multi-center research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes in COVID-19 positive patients with concurrent pulmonary sarcoidosis were compared with a propensity score matched cohort of patients without pulmonary sarcoidosis. RESULTS: A total of 278,271 patients with COVID-19 on the research network were identified, 954 patients (0.34 %) carried a diagnosis of pulmonary sarcoidosis. Mean age of patients with sarcoidosis was 56.3 ± 13.2 years, with female predominance (n = 619, 64.89 %). 49.69 % of the participants were African American (n = 474). Co-morbidities including hypertension, chronic lower respiratory diseases, diabetes mellitus, ischemic heart disease, nicotine dependence, and chronic kidney disease were more common in patients with pulmonary sarcoidosis when compared to the non-pulmonary sarcoidosis cohort (all p values < 0.01). In unmatched analysis, pulmonary sarcoidosis group had higher mortality, increased risk for hospitalization, intubation and need for renal replacement therapy. After propensity score matching, no difference in any of the outcome measures was observed. INTERPRETATION: Crude COVID-19 mortality and other clinical outcome measures are poor in pulmonary sarcoidosis cohort; however, propensity-matched analyses revealed no difference in outcomes, showing that higher mortality is driven by higher burden of comorbidities.

Outcomes of SARS-CoV-2 infection in patients with cystic fibrosis: A multicenter retrospective research network study.

BACKGROUND: In this study, we report clinical outcomes in COVID-19 infection in a large cohort of people with cystic fibrosis (pwCF) and compare these outcomes to a propensity score matched cohort of people without CF. METHODS: Analysis of a multicenter research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes in COVID-19 positive pwCF were compared with a propensity-matched cohort of people without CF. RESULTS: A total of 507,810 patients with COVID-19 were included (422 patients, 0.08% with CF; 507,388 patients, 99.92% without CF. Mean age at COVID-19 diagnosis in CF cohort was 46.6 ± 19.3 years, with female predominance (n = 225, 53.32%). Majority of the participants were Caucasian (n = 309, 73.22%). In the crude, unmatched analysis, mortality, hospitalization, critical care need, mechanical ventilation, acute kidney injury and composite (combination of intubation and mortality) outcome at 30 days was higher in the pwCF. Following robust propensity matching, pwCF had higher hospitalization rate (RR 1.56, 95% CI 1.20-2.04), critical care need (RR 1.78, 95% CI 1.13-2.79), and acute renal injury (RR 1.60, 95% CI 1.07-2.39) as compared to patients without CF. CONCLUSION: People with CF are at risk of poor outcomes with COVID-19.5.2% of these patients died within one month of COVID-19 diagnosis, and more than one in 10 patients required critical care. Therefore, the relatively young median age of cystic fibrosis patients, and lower prevalence of obesity do not protect these patients from severe disease contrary to prior reports.

Patients with idiopathic pulmonary fibrosis have poor clinical outcomes with COVID-19 disease: a propensity matched multicentre research network analysis.

INTRODUCTION: Outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with pre-existing idiopathic pulmonary fibrosis (IPF) remain understudied, and it is unknown if IPF is an independent predictor of worse disease course. Herein, we report the clinical outcomes in a large cohort of 251 patients with COVID-19 in the setting of known IPF. Outcomes were compared with a propensity matched cohort of patients with COVID-19 without IPF. METHODS: Analysis of a federated multicentre research network TriNetX was performed including patients more than 16 years of age diagnosed with SARS-CoV-2 infection. Outcomes in patients diagnosed as positive for SARS-CoV-2 infection with concurrent IPF were compared with a propensity matched cohort of patients without IPF. RESULTS: A total of 311 060 patients with SARS-CoV-2 infection on the research network were identified, 251 patients (0.08%) carried a diagnosis of IPF. Mean age of patients with IPF was 68.30±12.20 years, with male predominance (n=143, 56.97%). Comorbidities including chronic lower respiratory diseases, diabetes mellitus, ischaemic heart disease and chronic kidney disease were more common in patients with IPF when compared with the non-IPF cohort. After propensity matching, higher rates of composite primary outcome (death or mechanical ventilation) at 30 and 60 days, as well as need for hospitalisation, critical care, and acute kidney injury were observed in the IPF cohort. CONCLUSION: Poor outcomes of COVID-19 disease were observed in patients with IPF after robust matching of confounders. Our data confirm that patients with IPF constitute a high-risk cohort for poor outcomes related to COVID-19 disease.

Acute pericarditis in a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a case report and review of the literature on SARS-CoV-2 cardiological manifestations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is known to cause a cluster of flu-like illnesses and pneumonia with evolving understanding of other systemic manifestations. Currently, the known cardiac manifestations of COVID-19 include myocardial injury, acute coronary syndrome, and arrhythmias. In this report, we describe a case of pericarditis-an unusual cardiac manifestation observed in a patient with COVID-19. A 63-year-old male presented with history of fever, cough and chest pain. Electrocardiogram (EKG) demonstrated diffuse ST-T wave changes on all the leads, with normal troponin-T levels. Echocardiograph showed mild pericardial effusion without any regional wall motion abnormality. Subsequent chest radiograph and coronary angiography were normal. In view of ongoing COVID-19 pandemic, nasopharyngeal swab was performed, which was positive. Detailed etiological workup for pericarditis, including infectious and inflammatory causes were unremarkable. Viral pericarditis (possibly caused by COVID-19) was diagnosis of exclusion and patient was treated with hydroxychloroquine 200 mg twice a day, colchicine 0.5 mg twice a day, and lopinavir/ritonavir 200 mg/50 mg tablet twice a day for 10 days during admission. He was discharged with hydroxychloroquine 200 mg twice daily and colchicine 0.5 mg once daily for 15 days. On subsequent follow-up clinic visit, he reported resolution of symptoms. The purpose of this report is to add a potential cardiovascular complication of COVID-19 to the literature. Awareness of this manifestation can lead to timely laboratory and imaging examinations with potential to provide correct treatment and good outcome.

Multiple embolic stroke on magnetic resonance imaging of the brain in a COVID-19 case with persistent encephalopathy.

The pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) are well known. The literature on neurological manifestations and complications in patients with COVID-19 has been increasing but is still sparse. At present, there are only a few reported case reports and clinical studies on neurological manifestations of COVID-19, of which ischemic stroke is one of the most common ones. Coagulopathy and vascular endothelial dysfunction have been proposed as the complications of COVID-19 which can ultimately lead to ischemic stroke. In this case report, we present a case of multifocal ischemic stroke in a patient with COVID-19. This patient had persistent encephalopathy and dysarthria after recovering from hypoxic respiratory failure and subsequently developed ischemic stroke in multiple vascular territories during hospital admission.