ABSTRACT
Purpose: The COVID-19 pandemic has affected psychological health related to quality of life, anxiety, and alcohol use. To assess differences in pandemic response related to clinical status and sex, we used prospective data collected in a clinical sample of adults with Alcohol Use Disorder (AUD), HIV infection, or both diagnoses (AUD+HIV) and a control group. Methods: Data were collected between 2015-2018 during pre-COVID laboratory visits and later with an online survey to assess psychological health during COVID. Change scores (COVID score - pre- COVID score) evaluated differences in quality of life (QoL;Short-Form-21), state anxiety (State- Trait-Anxiety Inventory), and alcohol use (Alcohol Use Disorders Identification Test, AUDIT). Of the 218 participants we attempted to contact, 89 completed the survey. The clinical sample included 18 AUD (9M, 9F), 22 HIV (15M, 7F), and 15 AUD+HIV (6M, 9F);the Control group included 17M and 17F. Results: All groups reported decreases in QoL during COVID (X2 = 8.26, p = .04). Women in the clinical sample (regardless of diagnosis) reported an even greater decrease in QoL during COVID than clinical men (Z = 2.12, p = .016), control women (Z = 2.38, p = .017), or control men (Z = 2.41, p = .034). The greater decrease in QoL in clinical women was supported by analysis of the separate AUD, HIV, and AUD+HIV sub-samples. Regarding state anxiety, the clinical sample showed a greater increase during COVID than the control group (X2 = 5.64, p = .018). Regardless of group or sex, however, participants did not report significant change in pandemic alcohol use. Nonetheless, for clinical women, correlational analyses indicated that greater decline in QoL was related to increased anxiety (rho = -.49, p = .03) and increased alcohol use (rho = -.49, p = .02), and that increase in anxiety was related to increase in alcohol use (rho = .46, p = .04). By contrast, in clinical men, change in anxiety was related to change in QoL (rho = -.49, p = .02) but not alcohol use (rho = -.26, p = .24). Conclusions: Clinical men and women reported greater increase in anxiety and decrease in QoL than controls during COVID vs. pre-COVID assessment. The relation between increase in self-reported alcohol use and increased anxiety and decline in QoL in the clinical women suggests greater drinking-to-cope motivation to relieve emotional distress during COVID in women already burdened with a clinical diagnosis.
ABSTRACT
Background : D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19. Aims : Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage. Methods : We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set ( n = 337), and its safety assessed in an independent validation set ( n = 337). Results : According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm's sensitivity was 98.2% (95% CI: 94.7-100.0), and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the AUC was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI: 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64-0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusions : The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.