Outcome of COVID-19 patients with haematological malignancies after the introduction of vaccination and monoclonal antibodies: results from the HM-COV 2.0 study (preprint)

Purpose. Patients with hematological malignancies (HM) and SARS-CoV-2 infection present a higher risk of severe COVID-19 and mortality. The aim of the study was to investigate whether vaccination and monoclonal antibodies (mAbs) have modified the outcomes of HM patients with COVID-19. Methods. Single-center retrospective study in HM patients hospitalized due to SARS-CoV-2 infection from March 2020 to April 2022. Patients were divided into PRE-V-mAb group (patients hospitalized before the introduction of vaccination and mAbs) and POST-V-mAb group (patients hospitalized after the use of vaccine and mAbs). Results. A total of 126 patients were included (65 PRE-V-mAb and 61 POST-V-mAb). POST-V-mAb patients showed a significantly lower risk of Intensive Care Unit (ICU) admission (8.2% vs 27.7%, p=0.005), shorter viral shedding [17 (IQR 10-28) vs 24 days (IQR 15-50), p=0.011] and shorter hospitalization length [13 (IQR 7-23) vs 20 (IQR 14-41) days, p=0.0003] compared to the PRE-V-mAb group. Nevertheless, both in-hospital and 30-day mortality rates did not significantly differ between the two groups (29.5% POST-V-mAb vs 36.9% PRE-V-mAb and 21.3% POST-V-mAb vs 29.2% PRE-V-mAb, respectively). At the multivariable analysis an active malignancy (p=0.042), a critical COVID-19 at admission (p=0.025) and the need for high-level of oxygen support at respiratory worsening [either HFNC/CPAP (p=0.022) or Mechanical Ventilation (p=0.011)] were independently associated with in-hospital mortality. In the subgroup of POST-V-mAb patients, receiving therapy with mAbs was a protective factor (p=0.033). Conclusion. Despite the new therapeutic and preventive strategies available, HM patients with COVID-19 disease represent an extremely vulnerable group with still high mortality rates.

Chest CT for early detection and management of coronavirus disease (COVID-19): a report of 314 patients admitted to Emergency Department with suspected pneumonia.

PURPOSE: The purpose of our study was to assess the potential role of chest CT in the early detection of COVID-19 pneumonia and to explore its role in patient management in an adult Italian population admitted to the Emergency Department. METHODS: Three hundred and fourteen patients presented with clinically suspected COVID-19, from March 3 to 23, 2020, were evaluated with PaO2/FIO2 ratio from arterial blood gas, RT-PCR assay from nasopharyngeal swab sample and chest CT. Patients were classified as COVID-19 negative and COVID-19 positive according to RT-PCR results, considered as a reference. Images were independently evaluated by two radiologists blinded to the RT-PCR results and classified as "CT positive" or "CT negative" for COVID-19, according to CT findings. RESULTS: According to RT-PCR results, 152 patients were COVID-19 negative (48%) and 162 were COVID-19 positive (52%). We found substantial agreement between RT-PCR results and CT findings (p < 0.000001), as well as an almost perfect agreement between the two readers. Mixed GGO and consolidation pattern with peripheral and bilateral distribution, multifocal or diffuse abnormalities localized in both upper lung and lower lung, in association with interlobular septal thickening, bronchial wall thickening and air bronchogram, showed higher frequency in COVID-positive patients. We also found a significant correlation between CT findings and patient's oxygenation status expressed by PaO2/FIO2 ratio. CONCLUSION: Chest CT has a useful role in the early detection and in patient management of COVID-19 pneumonia in a pandemic. It helps in identifying suspected patients, cutting off the route of transmission and avoiding further spread of infection.

Chest CT For Early Detection And Management Of Coronavirus Disease (COVID-19): A Report Of 314 Patients Admitted To Emergency Department With Suspected Pneumonia (preprint)

PURPOSE: The purpose of our study was to assess the potential role of chest CT for the early detection of COVID-19 pneumonia and to explore its role in patient management in an adult Italian population admitted to the Emergency Department.METHODS: 314 patients presented with clinically suspected COVID-19, From March 3 rd to 23 th 2020, were evaluated with PaO2/FIO2 ratio from arterial blood gas, RT-PCR assay from nasopharyngeal swab sample and chest CT. Patients were classified as COVID-19 negative and COVID-19 positive according to RT-PCR results, considered as a reference. Images were independently evaluated by two radiologists blinded to the RT-PCR results and classified as “CT positive” or “CT negative” for COVID-19, according to CT findings.RESULTS: According to RT-PCR results, 152 patients were COVID-19 negative (48%) and 162 were COVID-19 positive (52%). We found substantial agreement between RT-PCR results and CT findings (p<0.000001), as well as an almost perfect agreement between the two readers. Mixed GGO and consolidation pattern with peripheral and bilateral distribution, multifocal or diffuse abnormalities localized in both upper and lower lung, in association with interlobular septal thickening, bronchial wall thickening and air bronchogram, showed higher frequency in COVID positive patients. We also found a significant correlation between CT findings and patient’s oxygenation status expressed by PaO2/FIO2 ratio.CONCLUSION: Chest CT is a vital component in the early detection and in patients management of COVID-19 pneumonia in a pandemic. It allows to identify suspected patients, cutting off the route of transmission and avoiding further spread of infection.