ABSTRACT
BackgroundPatients with autoimmune inflammatory rheumatic diseases are at higher risk for coronavirus disease (COVID)-19 hospitalization and worse clinical outcomes compared with the general population. However, data on the association between COVID-19 outcomes and gout, or gout-related medications are still lacking.ObjectivesWe aimed to compare COVID-19 related clinical outcomes in gout vs. non-gout patients.MethodsWe conducted a retrospective cohort study using the electronic health record-based databases of Seoul National University hospital (SNUH) from January 2021 to April 2022 mapped to a common data model. Patients with gout and without gout were matched using a large-scale propensity score (PS) algorithm. The clinical outcomes of interest were COVID-19 infection, severe COVID-19 outcomes defined as the use of mechanical ventilation, tracheostomy or extracorporeal membrane oxygenation, and death within 30 days of COVID-19 diagnosis. The hazard ratio (HR) for gout vs. non-gout patients derived by Cox proportional hazard models were estimated utilizing a 1:5 PS-matched cohort.Results2,683 patients with gout and 417,035 patients without gout were identified among the patients who visited SNUH. After 1:5 PS matching, 1,363 gout patients and 4,030 non-gout patients remained for the analysis. The risk of COVID-19 infection was not significantly different between patients with gout and those without gout (HR 1.07 [95% CI 0.59-1.84]). Within the first month after the COVID-19 diagnosis, there was also no significant difference in the risk of hospitalization (HR 0.57 [95% CI 0.03-3.90], severe COVID-19 outcomes (HR 2.90 [95% CI 0.54-13.71]), or death (HR 1.35 [95% CI 0.06-16.24]).ConclusionPatients with gout did not have an increased risk of COVID-19 infection or worse clinical outcomes. Updates of temporal trends of COVID-19 outcomes in gout patients are yet warranted as new SARS-CoV-2 variants emerge.References[1]Shin YH, et al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. Lancet Rheumatol. 2021 Oct;3(10):e698-e706.[2]Topless RK, et al. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. Lancet Rheumatol. 2022 Apr;4(4):e274-e281.[3]Xie D, et al. Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study. Arthritis Rheumatol.2023 Jan;75(1):122-132.Table 1.Clinical outcomes of COVID-19 infection in patients with goutOutcomesUnmatched populationPopulation with PS stratification using 10 strata1:5 PS matched populationHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueCOVID-19 infection1.68 (1.03-2.57)0.031.20 (0.72-1.87)0.461.07 (0.59-1.84)0.82Hospitalization due to COVID-191.92 (0.32-6.05)0.391.63 (0.26-5.77)0.540.57 (0.03-3.90)0.66Severe COVID-19 infection4.72 (1.44-11.28)<0.014.22 (1.17-12.21)0.022.90 (0.54-13.71)0.20Death due to COVID-191.15 (0.07-5.18)0.900.77 (0.04-3.81)0.821.35 (0.06-16.24)0.84Acknowledgements:NIL.Disclosure of InterestsNone Declared.
ABSTRACT
Background: Bronchoalveolar lavage (BAL) cytology is a commonly used test in hospitalized patients with SARS-CoV-2 and its demand has dramatically increased in large medical centers. Currently, there are no standard guidelines for using BAL cytology in SARS-CoV-2. Findings such as lymphocytosis, giant cells, hyaline membranes, and intranuclear inclusions have been reported in BALs from patients with SARS-CoV-2 with varying frequencies. The aim of our study is to evaluate the frequency of these reported morphologic findings and to assess the utility and cost-effectiveness of BAL in the management of SARS-CoV-2 patients. Design: We performed a retrospective review of all BAL specimens from patients with positive SARS-CoV-2 nasopharyngeal PCR at our tertiary care medical center between March 2020 and February 2021. Chart review was performed for clinical findings and microbial culture data. BAL Papanicolaou stained thin prep, as well as special stains (PAS, Fite & GMS) on each case, were reviewed by a board-certified cytopathologist. Billing data was acquired from the laboratory manager. Results: A total of 37 patients were included ranging in age from 27-84 years (median: 58 years). Their clinical findings are summarized in Table 1. The majority of the BALs showed no specific findings that would help guide or alter the clinical management. 12 cases(33%) showed no significant cytologic findings, 16(43%) showed a relative increase in neutrophils, 7(19%) a relative increase in lymphocytes including one with markedly activated forms, and 4(11%) showed non-specific pneumocyte hyperplasia. PAS+ hyaline membranes, giant cells, intranuclear inclusions, and necrotic debris were each seen in 3% of cases. Special stains were negative for microorganisms in all cases. The cost of BAL thin prep and special stains (professional+techinal components) at our institution was $295 and $265, respectively. The total cost of BAL/patient was $1090 (295+265x3) and the overall cost for 37 patients was $40330. Conclusions: In the majority of the cases, BAL specimens from patients with SARS-CoV-2 showed non-specific findings such as a relative increase in neutrophils and lymphocytes, and pneumocyte hyperplasia. More specific morphologic findings such as intranuclear inclusions, PAS+ hyaline membranes, and activated lymphocytosis are only seen in rare instances. Overall, the use of BAL cytology in SARS-CoV-2 is time-consuming, not cost-effective, and does not help guide or alter patient management significantly.