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Although protection of vaccines against COVID-19 has been reported, very little is known about the clinical characteristics of hospitalized vaccinated patients. Method(s): This single-center cohort study of 1888 COVID-19 patients hospitalized at the "Enfermera Isabel Zendal" Emergencies Hospital, Madrid (Spain) was performed between July and September, 2021. It compared the results of 1327 unvaccinated patients to 209 fully vaccinated and 352 partially vaccinated. Vaccines administered were: BNT162b2, ChAdOx1 nCoV-19, mRNA-1273, Ad26.COV2.S. Finding(s): Hospitalized patients' median age was 41 years (IQR 33.0-50.0) for the unvaccinated and 61.0 years (IQR 53.0-67.0) for the fully vaccinated ones. The main comorbidities were obesity, hypertension and diabetes mellitus. The fully vaccinated patients obtained higher C-reactive protein values (median 48.9 mg/l [IQR 21.7-102.9]) and significantly lower for ferritin (median 367.0 ng/ml [IQR 182.0-731.0]) and lactate dehydrogenase (median 269.0 units/l [IQR 218.5-330.5]) values. 266 unvaccinated patients required noninvasive respiratory care, as did 51 partially vaccinated and 30 fully vaccinated patients;78 of the unvaccinated patients also needed invasive respiratory care, as did 16 partially vaccinated and 11 fully vaccinated patients. The fully vaccinated patients were 84% less likely to be admitted to hospital, and protection for those aged <50 years. Interpretation(s): Once hospitalized, the vaccinated patients displayed more protection against requiring respiratory care than the unvaccinated ones, despite being older and having more comorbidities. No differences appeared for the four studied vaccine types.
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OBJECTIVES: The objective of this study was to compare the temporal dynamics of two viral-induced inflammatory proteins interferon gamma inducible protein-10 (IP-10) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), as well as C-reactive protein (CRP) among patients hospitalized for COVID-19 and examine their prognostic significance. DESIGN: Prospective observational cohort study. SETTING: Multicenter, inpatient. PATIENTS: Adult patients infected with severe acute respiratory syndrome coronavirus 2 between March 2021 and October 2021. INTERVENTIONS: Patient sera were collected on days 1, 3, 5, and 7 of hospitalization. Levels of IP-10, TRAIL, and CRP were measured using a point-of-need diagnostic immunoassay platform (MeMed BV, MeMed, Haifa, Israel) and compared between patients grouped by disease severity (severe vs nonsevere). MEASUREMENTS AND MAIN RESULTS: Baseline characteristics were similar regardless of severity except for a higher prevalence of diabetes and heart failure among severe patients. The immune profile at admission was similar between groups;IP-10 and CRP levels generally decreased while TRAIL levels increased over time in all patients. However, the severe group had higher IP-10 (median 713 vs 328 pg/mL;p = 0.045) and lower TRAIL levels (median 21 vs 30 pg/mL;p = 0.003) on day 3 compared with nonsevere patients. A breakpoint IP-10 level of greater than or equal to 570 pg/mL and TRAIL level of less than 25 pg/mL on day 3 were associated with COVID-19 severity. Patients with elevated day 3 IP-10 levels (≥ 570 pg/mL) were more likely to experience prolonged recovery time (median 12 vs 3 d;p < 0.001). The severe group had prolonged use of corticosteroids (12 vs 5 d;p < 0.001) and had a higher rate of secondary infections (20% vs 6%;p = 0.04) and in-hospital mortality (20% vs 0%;p < 0.001) as compared with nonsevere patients. CONCLUSIONS: The observed patterns in host immune response revealed a turning point in COVID-19 disease on hospital day 3 and the potential utility of IP-10 and TRAIL as sensitive markers associated with disease severity and time to recovery. © 2022 Wolters Kluwer Health. All rights reserved.
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Background: The study aimed to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on the healthcare quality of acute ischemic stroke (AIS) patients and summarize the potential experience in response to the COVID-19 outbreak. Methods: We continuously included AIS patients registered in the CASE-II before and during the COVID-19 pandemic. We investigated the changes of 15 key performance indicators (KPIs),the composite score developed from these KPIs, and in-hospital outcomes of AIS during the COVID-19 outbreak and analyzed potential causes of these changes. Results: There were 5,854 AIS patients admitted in pandemic period (January 23 to April 30, 2020) and 6,807 patients in pre-pandemic period (November 1, 2019 to January 22, 2020) among 52 hospitals. The median onset-to-door time was 28 minutes longer in pandemic than in prepandemic period (189 [90-585] versus 161 [87-417] minutes;P=0.001), but the proportion of patients receiving reperfusion treatment and the door-to-treatment time did not differ between the two groups. The composite measure (92.5% versus 91.4%;P=0.165) and all-or-none measure (54.4% versus 50.6%;P=0.893) did not significantly differ between the two periods. The rate of antithrombotic at discharge, smoking cessation and stroke education increased by 1.2% (P=0.025) and 1.5% (P=0.001), respectively during pandemic. There was also no significant difference between the two groups in mRS score at discharge (P=0.532) and new clinical vascular events (P=0.069). Conclusions: Although AIS inpatients decreased during COVID-19 pandemic, the healthcare quality for hospitalized stroke patients was not significantly affected. This might be attributed to the health information technology and the effective prevention measures of COVID-19.
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Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
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Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM–coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
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Background and Aims: Rapid intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is crucial for improving outcomes. However, randomized trials to reduce in-hospital delay are clearly limited in China. We aimed to evaluate the effect of a multi-component intervention on thrombolytic door-to needle time (DNT) of AIS patients via video teleconference based on the Behavior Change Wheel method. Methods: This trial randomly allocated 22 hospitals equally to PEITEM (Persuasion Environment reconstruction Incentivisation Training Education Modeling) intervention or routine care plus stroke registry and subsequently enrolled 1634 AIS patients who receiving IVT within 4.5 hours upon stroke onset from participant hospitals. The PEITEM group received a one-year PEITEM intervention based on the behavioral theory monthly via video teleconference. Results: A total of 1, 634 patients from the 22 hospitals were enrolled. The proportion of DNT ≤ 60 minutes was 82.0% in the PEITEM group and 73.7% in the control group (adjusted odds ratio, 1.85;95% confidence interval [CI], 1.42 to 2.42, P<0.001). The average DNT was 43 minutes in the PEITEM group and 50 minutes in the control group (β: -9.00;95% CI, -11.37 to ≤6.63, P<0.001). Favorable neurological outcomes were achieved in 55.6% patients in the PEITEM group and 50.4% patients in the control group (adjusted odds ratio, 1.34;95% CI, 1.02 to 1.75;P=0.04). Conclusions: The teleconference-delivered PEITEM intervention resulted in a moderately but clinically relevant shorter DNT and better neurological outcomes in the AIS treated with the IVT. Video teleconference may be more appropriate and easier for quality improvement in the current global COVID-19 public health crisis disrupting healthcare services.
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BACKGROUND: There are limited data on the characteristics of 30-day readmission after hospitalization with coronavirus disease 2019 (COVID-19). OBJECTIVES: To examine the rate, timing, causes, predictors and outcomes of 30-day readmission after COVID-19 hospitalization. METHODS: From 13 March to 9 April 2020, all patients hospitalized with COVID-19 and discharged alive were included in this retrospective observational study. Multivariable logistic regression was used to identify the predictors of 30-day readmission, and a restricted cubic spline function was utilized to assess the linearity of the association between continuous predictors and 30-day readmission. RESULTS: A total of 1062 patients were included in the analysis, with a median follow-up time of 62 days. The mean age of patients was 56.5 years, and 40.5% were women. At the end of the study, a total of 48 (4.5%) patients were readmitted within 30 days of discharge, and a median time to readmission was 5 days. The most common primary diagnosis of 30-day readmission was a hypoxic respiratory failure (68.8%) followed by thromboembolism (12.5%) and sepsis (6.3%). The patients with a peak serum creatinine level of ≥1.29 mg/dL during the index hospitalization, compared to those with a creatinine of <1.29 mg/dL, had 2.4 times increased risk of 30-day readmission (adjusted odds ratio: 2.41; 95% CI: 1.23-4.74). The mortality rate during the readmission was 22.9%. CONCLUSION: With 4.5% of the thirty-day readmission rate, COVID-19 survivors were readmitted early after hospital discharge, mainly due to morbidities of COVID-19. One in five readmitted COVID-19 survivors died during their readmission.
Subject(s)
COVID-19/therapy , Hospitalization , Patient Readmission/statistics & numerical data , Pneumonia, Viral/therapy , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time FactorsABSTRACT
High prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The primary aim of this study was to test whether rotational thromboelastometry (ROTEM) at admission indicates hypercoagulopathy and predicts the disease severity, assessed as care level, in COVID-19 patients. The study was designed as a prospective, observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: (1) regular wards or (2) wards with specialized ventilation support. Conventional coagulation tests, blood type and ROTEM were taken at admission. 60 patients were included; age 61 (median), 67% men, many with comorbidities (e.g. hypertension, diabetes). The ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with in healthy controls (p < 0.001) and higher in severely ill patients compared with in patients at regular wards (p < 0.05). Our results suggest that hypercoagulopathy is present early in patients with mild to moderate disease, and more pronounced in severe COVID-19 pneumonia. Non-O blood types were not overrepresented in COVID-19 positive patients. ROTEM variables showed hypercoagulopathy at admission and this pattern was more pronounced in patients with increased disease severity. If this feature is to be used to predict the risk of thromboembolic complications further studies are warranted.
Subject(s)
COVID-19 , SARS-CoV-2 , Thrombosis , Adult , Aged , COVID-19/blood , COVID-19/complications , Female , Humans , Male , Middle Aged , Prospective Studies , Thrombelastography , Thrombosis/blood , Thrombosis/etiologyABSTRACT
BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. ConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.