ABSTRACT
BACKGROUND: Testing, traceability, and isolation actions are a central strategy defined by the World Health Organization to contain the COVID-19 pandemic. In this sense, the countries have had difficulties in counting the number of people infected with SARS-CoV-2. Errors in reporting results are a common factor, as well as the lack of interoperability between laboratories and governments. Approaches aimed at sending spreadsheets via email expose patients' privacy and have increased the probability of errors due to retyping, which generates a delay in the notification of results. OBJECTIVE: This study aims to design and develop an interoperable platform to report polymerase chain reaction (PCR) SARS-CoV-2 tests from laboratories to the Chilean government. METHODS: The methodology to design and develop the interoperable platform was comprised of six well-structured stages: (1) creation of a minimum data set for PCR SARS-CoV-2 tests, (2) modeling processes and end points where institutions interchange information, (3) standards and interoperability design, (4) software development, (5) software testing, and (6) software implementation. RESULTS: The interoperable Fast Healthcare Interoperability Resources (FHIR) platform to report PCR SARS-CoV-2 tests from laboratories to the Chilean government was successfully implemented. The platform was designed, developed, tested, and implemented following a structured methodology. The platform's performance to 1000 requests resulted in a response time of 240 milliseconds, throughput of 28.3 requests per second, and process management time of 131 milliseconds. The security was assured through a private network exclusive to the Ministry of Health to ensure confidentiality and integrity. The authorization and authentication of laboratories were implemented with a JavaScript Object Notation Web Token. All the PCR SARS-CoV-2 tests were accessible through an application programming interface gateway with valid credentials and the right access control list. CONCLUSIONS: The platform was implemented and is currently being used by UC Christus Laboratory. The platform is secure. It was tested adequately for confidentiality, secure authorization, authentication, and message integrity. This platform simplifies the reporting of PCR SARS-CoV-2 tests and reduces the time and probability of mistakes in counting positive cases. The interoperable solution with FHIR is working successfully and is open for the community, laboratories, and any institution that needs to report PCR SARS-CoV-2 tests.
ABSTRACT
Introduction and objectives: Coronavirus disease 2019 (COVID-19) has become a pandemic infection. Retrospective data showed worse outcomes in patients with cardiovascular disease (CVD) and cardiovascular (CV) risk factors. We sought to evaluate the link between CVD and CV risk factors with in-hospital outcomes in COVID-19. Methods: We designed a prospective registry that included consecutive COVID-19 patients admitted at our institution. The inclusion period was from 27 February to 7 April 2020. Clinical outcomes were monitored up to 2 May 2020. Results: A total of 876 patients were included. Mean age was 62 ± 18 years old;47% were > 65 years of age. A total of 69% of patients had at least one CV risk factor;15% of the patients had previous history of CVD. Patients with previous CVD were significantly older (77 ± 11 vs 60 ± 18 years old;P < .01), with a higher proportion of men (64 vs 54%;P = .021) and showed a higher proportion of rise in both high-sensitivity cardiac-specific troponin-T (hs-cTnT) (78 vs 27%;P < .01) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (74 vs 29%;P < .01) on admission. Those patients with CV risk factors were also significantly older (68 ± 16 vs 49 ± 16 years old;P < .01), showing a higher percentage of patients fulfilling acute distress respiratory syndrome criteria (28 vs 21%;P = .021) and more need of mechanical ventilation (9 vs 4%;P < .01). Levels of hs-cTnT (44 vs 9%;P < .01) and NT-proBNP (43 vs 15%;P < .01) were more frequently elevated in patients with CV risk factors. Risk of death was significantly higher in patients with CVD (33 vs 8%;P < .01) or CV risk factors (16 vs 1%;P < .01). We found age > 65 years old (OR, 15;95%CI, 5-43), chronic congestive heart failure (OR, 3.27;95%CI, 1.38-7.72) and chronic kidney disease (OR, 8.55;95%CI, 1.47-5.46) as independent predictors of death. Conclusions: In patients admitted for COVID-19, CVD or CV risk factors are associated with an increased risk of death during hospitalization. We found that older age, history of congestive heart failure and chronic kidney disease are independent predictors of death in COVID-19. Resumen Introducción y objetivos: La enfermedad por coronavirus 2019 (COVID-19) se ha convertido en una enfermedad pandémica. Datos de estudios retrospectivos han mostrado una peor evolución en pacientes con enfermedad cardiovascular (ECV) y factores de riesgo cardiovascular (FRCV). Nuestro objetivo fue evaluar la relación entre la ECV y los FRCV con la evolución hospitalaria de pacientes con COVID-19. Métodos: Se diseñó un registro prospectivo que incluyó a pacientes consecutivos con COVID-19 ingresados en nuestro centro hospitalario. El periodo de inclusión abarcó desde el 27 de febrero al 7 de abril de 2020. Se monitorizaron los eventos clínicos hasta el 2 de mayo de 2020. Resultados: Se incluyó un total de 876 pacientes. La edad media fue de 62 ± 18 años;un 47% fueron > 65 años. Un 69% de los pacientes tenían al menos un FRCV;un 15% tenían ECV previa. Aquellos pacientes con ECV fueron significativamente más mayores (77 ± 11 frente a 60 ± 18 años;p < 0,01), con una mayor proporción de varones (64 frente a 54%;p = 0,021) y mostraron en mayor proporción, en el momento del ingreso hospitalario, elevación de troponina T ultrasensible (hs-cTnT) (78 frente a 27%;p < 0,01) y de fracción aminoterminal del propéptido natriurético cerebral tipo B (NT-proBNP) (74 frente a 29%;p < 0,01). Aquellos pacientes con FRCV fueron significativamente más mayores (68 ± 16 frente a 49 ± 16 años;p < 0,01), mostrando un mayor porcentaje de pacientes que cumplían criterios diagnósticos de síndrome de distrés respiratorio agudo (28 frente a 21%;p = 0,021) y un mayor porcentaje de necesidad de ventilación mecánica invasiva (9 frente a 4%;p < 0,01). Los pacientes con FRCV presentaron con mayor frecuencia elevación de los niveles de hs-cTnT (44 frente a 9%;p < 0,01) y NT-proBNP (43 frente a 15%;p < 0,01). El riesgo de muerte fue significativamente mayor en los pacientes con ECV (33 frente a 8%;p < 0,01) o FRCV (16 frente a 1%;p < 0,01). La edad > 65 años (OR = 15;IC95% 5-43), la insuficiencia cardiaca (OR = 3.27;IC95%, 1.38-7.72) y la insuficiencia renal crónica (OR = 8.55;IC95%, 1.47-5.46) fueron predictores independientes de mortalidad hospitalaria por COVID-19. Conclusiones: En pacientes ingresados por COVID-19, la presencia de ECV o FRCV se asocia con un mayor riesgo de muerte durante la hospitalización. Una mayor edad, la historia de insuficiencia cardiaca y la insuficiencia renal crónica fueron predictores independientes de muerte por COVID-19.
ABSTRACT
BACKGROUND: The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known. OBJECTIVE: To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients. METHODS: Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020. RESULTS: Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, p < 0.001, multivariable HR 2.68 (1.58-4.55), p < 0.001). CONCLUSIONS: Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.