Effects of COVID-19 pandemic on autoimmunity testing requests, rate of positivity and rheumatological clinical practices

Background: Autoimmune diagnosis plays an important role in the diagnosis, classification and prognosis of systemic autoimmune rheumatic diseases (SARD). The coronavirus disease 2019 (COVID-19) pandemic has a profound impact on clinical and diagnostic practices on a global scale. In the current study we aimed to provide reliable data on the effects of COVID-19 pandemic on autoimmunity testing requests, rate of positivity and rheumatological clinical practices. Methods: Data on autoimmunity test numbers, positive results, first rheumatological visits and new diagnosis have been collected from medical records and laboratory information system for the COVID-19 pandemic phase (January-December 2020) and compared with those obtained during the corresponding period in 2019. The list of autoantibodies included: anti-nuclear antibody, anti-extractable nuclear antigens, anti-dsDNA, rheumatoid factor, anti-citrullinated protein-peptide antibodies and antineutrophil cytoplasmic antibodies (anti-myeloperoxidase and anti-serine proteinase 3). Results: A statistically significant reduction of all laboratory parameters investigated were found during the pandemic period (9912 vs. 14,100 for all patients, P<0.05;1547 vs. 2276 for selected outpatients only, P<0.05). A significant reduction in first rheumatological visits and new diagnosis was also observed with an absolute difference between study periods equal to 1064 rheumatological visits (1272 vs. 2336, P<0.05) meaning a total visits decreasing of 48%. The decline was more sustained during the first wave of the pandemic and less pronounced during the second wave. However, an equivalent or higher percentage of positive test results from outpatients were recorded during 2020 when compared to prepandemic state and the decline in new diagnosis mainly affected less severe diseases. In contrast, SARD with systemic involvement were diagnosed without significant differences. Conclusions: Our data showed a greater appropriateness of autoantibodies request and rheumatological visits during the COVID-19 pandemic compared to prepandemic period, as demonstrated by a higher percentage of positive results and new diagnosis of more severe SARD.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic.

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy.

OBJECTIVE: We aimed to assess the correlation between LUS Soldati proposed score and clinical presentation, course of disease and the possible need of ventilation support/intensive care. PATIENTS AND METHODS: All consecutive patients with laboratory confirmed SARS-CoV-2 infection and hospitalized in two COVID Centers were enrolled. All patients performed blood gas analysis and lung ultrasound (LUS) at admission. The LUS acquisition was based on standard sequence of 14 peculiar anatomic landmarks with a score between 0-3 based on impairment of LUS picture. Total score was computed with their sum with a total score ranging 0 to 42, according to Soldati LUS score. We evaluated the course of hospitalization until either discharge or death, the ventilatory support and the transition in intensive care if needed. RESULTS: One hundred and fifty-six patients were included in the final analysis. Most of patients presented moderate-to-severe respiratory failure (FiO2 <20%, PaO2 <60 mmHg) and consequent recommendation to invasive mechanic ventilation (CPAP/NIV/OTI). The median ultrasound thoracic score was 28 (IQR 18-36) and most of patients could be ascertained either in a score 2 (40%) or score 3 pictures (24.4%). The bivariate correlation analysis displayed statistically significant and high positive correlations between the LUS score and the following parameters: ventilation (rho=0.481, p<0.001), lactates (rho=0.464, p<0.001), dyspnea (rho=0.398, p=0.001) mortality (rho=0.410, p=0.001). Conversely, P/F (rho= -0.663, p<0.001), pH (rho = -0.363, p=0.003) and pO2 (rho = -0.400 p=0.001) displayed significant negative correlations. CONCLUSIONS: LUS score improve the workflow and provide an optimal management both in early diagnosis and prognosis of COVID-19 related lung pathology.