ABSTRACT
Although dermatomyositis (DM) patients have been included in studies evaluating for COVID-19 risk and severity in large cohorts of chronic immune mediated disease patients, there have been few studies looking specifically at cohorts of DM patients. We performed a single-center, retrospective cohort study of DM patients seen at the Cleveland Clinic who were diagnosed with COVID-19 via PCR test between March 2020 – July 2021. To assess for risk factors for severe COVID-19 disease course in the DM patient population, we utilized several characteristics known to impact COVID-19 disease course including age, BMI, and medications at time of diagnosis. We additionally included characteristics unique to the DM patient population including DM subtype and autoantibody status. Our results showed that risk factors for COVID-19 hospitalization in our DM cohort include age, BMI, and systemic medication use at time of COVID-19 infection. Despite our small sample size, our study is one of the first to elucidate characteristics important for COVID-19 disease course in DM specifically, rather than having it grouped alongside other disease processes. Awareness of this risk is important for clinicians caring for DM patients in order to optimize their care and protect them from a severe COVID-19 disease course. © 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine.
ABSTRACT
Background: As secondary bacterial infections have been associated with increased mortality in respiratory virus pandemics, we sought to determine if prior pneumococcal vaccination improves clinical outcomes in COVID-19 patients. Methods: We analyzed an observational registry of patients tested for COVID-19 at the Cleveland Clinic because of symptoms or other qualifying criteria from 3/8/2020-5/8/2020. Overlap propensity-score weighted logistic/linear regressions investigated associations between pneumococcal vaccination status and COVID-19- related clinical outcomes. Results: 18,197 patients (median age 50.2 yrs [IQR 30.4], 40% male, 67% white) were included. 2785 (15.3%) tested SARS-CoV-2-positive and 738(26.5%) were hospitalized. Prior pneumococcal vaccination in SARS-CoV-2 positive patients did not reduce ICU admission, oxygen usage, radiographic infiltrates, or need for mechanical ventilation. Pneumococcal vaccine recipients were less likely to test positive for SARSCoV- 2 (OR 0.77, 95% CI [0.68,0.87]). Pneumococcal vaccine recipients aged 15-65 years testing positive for SARS-CoV-2 had increased risk of hospitalization (OR 1.54 [1.001, 2.38] and death (OR 12.51 [1.92,81.36]) compared to non-recipients, and those >65 years were more likely to develop pneumonia (OR 8.45, 95% CI [1.77,40.42]). Conclusions: Pneumococcal vaccination status serves as a marker of underlying co-morbidities with greater risk of hospitalization and death from COVID-19 for those age 15-65 and of pneumonia for those >65, with no impact on other important adverse outcomes. The reduced prevalence of SARS-CoV-2 among pneumococcal vaccine recipients could reflect off-target vaccine effects or patterns of health behavior that persist despite propensity score adjustments. Our study supports evaluation of vaccination status, and vaccination of those at risk.
ABSTRACT
Background: We aimed to compare risk of hospital-acquired sacral pressure injuries (HASPI) in COVID-19+ and COVID-19- patients. Method: Single-institution, multi-hospital, retrospective cohort review of all hospitalizations from March 1st, 2020 to September 1st, 2020. Patients with new-onset HASPI (stage II or greater) were included in our study. Patients with chronic history of sacral ulcerations or patients with ulceration present on admission were excluded. Patient demographics, baseline ulceration risk (based on Braden risk assessment), HASPI characteristics, laboratory parameters, and ulcer-associated morbidity were collected. Results: During our study period, 36 of 59,208 COVID-19- and 13 of 3,488 COVID-19+ hospitalized patients developed a HASPI. COVID-19+ patients had a 5.5x higher relative risk of developing a HASPI compared to COVID-19- patients (46.5 per 100,000 hospitalization days versus 8.4 per 100,000 hospitalization days, 95% CI 3.3-11.5, p<0.0001). Of patients that developed a HASPI: median age, gender distribution, baseline ulceration risk, nursing skin checks per day, and time from admission to HASPI were similar between COVID-19+ and COVID-19- patients. COVID-19+ patients had larger (median ulcer size 85 cm2 vs. 7.5 cm2, p=0.04) and more severe (46.2% Stage 4/Unstageable vs. 19.4%, p=0.03) HASPIs compared to COVID-19- patients. All COVID-19+ patients with HASPI had elevated D-dimer concentrations, with a median peak D-dimer of 6,755 ng/mL that occurred on average 3.5 days before ulcer formation. HASPI led to severe morbidity in 6 of 11 COVID-19+ patients who survived initial hospitalization, including need for debridement or surgery (n=5) and ulcer infection/sepsis (n=5). Conclusions: Hospitalized COVID-19+ patients are at increased risk for developing large and severe HASPI. The etiology of increased HASPI risk is unclear, but may due to poor tissue perfusion secondary to microvasculature occlusion, decreased staffing, and inability to appropriately position hemodynamically unstable patients.