ABSTRACT
Introduction: COVID19-associated cardio complications occur through different mechanisms including the inflammatory response causing severe issues such as ARDS, sepsis, and coagulopathy. Many points remain unclear regarding the impact of coagulation disorder in patients who are admitted with COVID19 infection. We present an analysis of the cardiovascular outcomes of coagulation disorders in COVID19-related hospitalizations. Method(s): The Nationwide Inpatient Sample database from 2020 was queried to identify COVID-19 patients. Subsequently, we classified COVID hospitalization based on the presence or absence of coagulation disorder. The primary outcome measure was in-hospital mortality. Secondary outcomes were in-hospital cardiovascular outcomes, ICU admissions, bleeding, Stroke, and resource utilization. Result(s): Out of 1,060,885 patients with a diagnosis of COVID, 43905 had coagulation disorder. On adjusted analysis, patients with COVID and coagulation disorder had significantly higher odds of MACCE (aOR 1.57, 95% CI 1.47-1.67, p<0.001), in-hospital mortality (aOR 1.56, 95% CI 1.46-1.67, p<0.001), cardiac arrest (aOR 1.38, 95% CI 1.28-1.57, P<0.001), acute MI (aOR 1.32, 95% CI 1.19-1.47, P<0.001), stroke (aOR 2.11, 95% CI 1.76-2.52, P<0.001), cardiogenic shock (aOR 2.19, 95% CI 1.78-2.70, P<0.001), MCS (aOR 3.98 CI 2.31-6.85 p<0.001), and bleeding (aOR 1.64 CI1.40-1.92 p<0.001) compared to patients without coagulation disorder. The length of stay (11.43 vs 7.27) and mean in-hospital cost was increased ($150,759.70 vs $75321.1) in patients with and without coagulation disorders. Conclusion(s): COVID patients with coagulation disorder have a significantly higher risk of MACCE, in-hospital mortality, cardiac arrest, AMI, stroke, shock, MCS, and bleeding. Large prospective trials are needed to further study these findings. [Formula presented]Copyright © 2023
ABSTRACT
Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]
ABSTRACT
Background/Purpose: Covid-19 vaccine is one of the most effective strategies to control coronavirus disease 2019 (COVID-19) pandemic. However, safety data of these vaccines among patients with autoimmune diseases is limited. We report case series of patients who developed new-onset or flares of autoimmune disease after COVID-19 vaccination. Method(s): We conducted a retrospective chart review of patients treated by rheumatologists for new-onset or flares of autoimmune diseases after COVID-19 vaccination between March 2021-July 2022. Patients who had COVID-19 infection or other explainable causes were excluded. According to World Health Organization's Adverse Event Following Immunization causality assessment, we use 30-day cut off. Patients were divided into 2 groups. The first group had symptom onset within 30 days after vaccination whereas the second group had symptom onset 31-90 days post-vaccination. Patient's demographics, clinical manifestations and laboratory data were collected. Result(s): We identified 18 (46%) patients with new-onset autoimmune diseases, and 21 (54%) patients with autoimmune disease flares after COVID-19 vaccination. Four patients had recurrent flares following subsequent vaccination. The median age was 45 years and 66.7% were females. The median duration from last vaccination to symptom onset was 16 days. Twenty-two (56.4%) of patients developed symptoms within 30 days post-vaccination. Symptoms occurred mostly after the 2nd (44.2%) dose. The most common diagnosis was systemic lupus erythematosus (SLE) (32.6%) with modified Systemic Lupus Erythematosus Disease Activity Index-2000 ranging from 1-21 at diagnosis. Among patients with disease flares, 4 patients had undiagnosed autoimmune diseases before vaccination, 4 patients stopped immunosuppressive medications months prior to disease flares, 5 patients stopped immunosuppressive medications 1 week after vaccination, and 7 patients continued immunosuppressive medications. Fourteen (35.8%) cases required hospitalization, four of which were treated in intensive care units. The remaining patients were treated at outpatient clinic. Seven patients required initiation or adjustment of biologic disease modifying anti-rheumatic drugs, 19 patients received intravenous cyclophosphamide and/or intravenous methylprednisolone, 3 patients received intravenous immunoglobulin, and 5 patients underwent plasmapheresis. One patient improved without intervention. Three (7.9%) patients with new-onset autoimmune diseases died: 2 patients with SLE, and 1 patient with Hemophagocytic lymphohistiocytosis. Conclusion(s): There are cases of patients with new-onset or flare of autoimmune diseases occurring after COVID-19 vaccination. Although previously undiagnosed autoimmune disease or prior discontinuation of immunosuppressive medications partly contributed to disease flares, some cases occurred without other precipitating factors and were severe. Disease awareness and early detection are needed to improve patient outcomes. (Figure Presented).