ABSTRACT
Background: There is limited information on effectiveness of COVID-19 therapies in immunocompromised patients, who are at higher risk of hospitalizations, complications, and mortality due to COVID-19. We examined hospital all-cause mortality for early RDV use vs. no RDV use among immunocompromised COVID-19 patients across several distinct dominant variants of concern (VOC) periods: pre-Delta (Dec'20-Apr'21), Delta (May-Nov'21) and Omicron (Dec'21-Apr'22). Method(s): Using the Premier Healthcare Database, we identified adults with an immunocompromised condition (cancer, solid organ and hematopoietic stem cell transplant, hematologic malignancies, primary immunodeficiencies, asplenia, bone marrow failure/aplastic anemia, severe combined immunodeficiencies or HIV), hospitalized with a primary diagnosis of COVID-19. Patients treated with RDV in first 2 days of admission vs. those not treated with RDV during the hospitalization were matched using 1:1 preferential withinhospital propensity matching with replacement. Patients were excluded if discharged within 3 days of RDV initiation. Cox Proportional Hazards Model was used to examine time to 14-and 28-day mortality. Result(s): Overall (Dec'20-Apr'22), 14,169 RDV-treated patients were matched to 5,341 unique non-RDV patients. Post-matching balance was achieved with 59% being 65+ years, 40.5% with no supplementary oxygen charges, 39% received low-flow oxygen, 19% on high-flow oxygen/non-invasive ventilation and 1.5% on invasive mechanical ventilation/ECMO at baseline. During the study period, unadjusted mortality rate was significantly lower for RDV patients at 14 days (11% [95% CI: 11%-12%] vs 15% [15%-16%];p< .0001) and 28 days (18% [17%-18%];p< .0001 vs 22% [22%-23%];p< .0001) as compared to patients that did not receive RDV. After adjusting for baseline and clinical covariates, 14-day results showed that RDV had significantly lower mortality risk compared to non-RDV across all VOC periods [overall (30% lower risk), pre-delta (41%), Delta (23%), Omicron (25%)]. Similarly, 28-day results showed that RDV had significantly lower mortality risk compared to non-RDV across all VOC periods [overall (25%), pre-delta (35%), Delta (21%), Omicron (16%)] (Fig). Conclusion(s): Timely initiation of RDV in first two days of hospital admission demonstrated significant mortality reduction in immunocompromised patients hospitalized with primary diagnosis of COVID-19. RDV demonstrated consistent benefit in an immunocompromised cohort across all variant periods of the pandemic.
ABSTRACT
Background: Clinical management of COVID-19 based on oxygenation requirements continues to change over time as variants of concern (VOC) evolve. We examine hospital all-cause mortality for early hospital RDV use vs. no RDV use across dominant VOC periods: pre-Delta (Dec'20-Apr'21), Delta (May-Nov'21) and Omicron (Dec'21-Apr'22). Method(s): We examined adults with a primary discharge diagnosis of COVID-19 (ICD-10: U07.1) using the Premier Healthcare Database. Patients treated with RDV in the first 2 days of admission vs. those not treated with RDV during the hospitalization were matched using a 1:1 preferential within-hospital propensity matching with replacement. Patients were excluded if discharged within 3 days of RDV initiation. Time to mortality at 14-and 28-days was examined for patients with no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) at baseline. Baseline was defined as first 2 days of hospitalization. Result(s): 164,791 RDV-treated patients were matched to 48,473 unique non-RDV patients. Post-matching balance was achieved across groups with different baseline oxygenation levels and VOC periods. In the matched weighted cohort, 35% required NSOc, 41% LFO, 21% HFO/NIV and 3% IMV/ECMO. During the overall study period (Dec'20-Apr'22), unadjusted mortality rate was significantly lower for RDV patients across all oxygenation levels at 14 days (NSOc: 5.4% vs. 7.3%, LFO: 6.4% vs. 8.8%, HFO/NIV: 16.8% vs. 19.4%, IMV/ECMO: 27.8% vs. 35.3%) and 28 days (NSOc: 8.0% vs. 9.8%, LFO: 9.8% vs. 12.3%, HFO/ NIV: 25.8% vs. 28.3%, IMV/ECMO: 41.4% vs. 50.6%). After adjusting for baseline and clinical covariates, 14-day mortality results showed that RDV significantly lower risk compared to non-RDV across all oxygenation levels at baseline [NSO (26%), LFO (28%), HFO/NIV (17%), IMV/ ECMO (27%)]. Similarly, 28-day mortality results showed that RDV significantly lower risk compared to non-RDV across all oxygenation levels at baseline [NSO (19%), LFO (21%), HFO/NIV (12%), IMV/ECMO (26%)]. This lower mortality risk associated with RDV was consistently observed across all variant periods (Figure). Conclusion(s): Timely initiation of RDV within first two days of hospital admission demonstrated significant mortality reduction in patients hospitalized for a primary diagnosis of COVID-19 across all oxygenation levels. Remdesivir demonstrated consistent benefit across all variant periods of the pandemic to-date.
ABSTRACT
The Coronavirus pandemic has caused significant disruption and change in most aspects of society, and there are concerns that disabled people may be particularly disadvantaged. This article, written by disabled activists and non‐disabled allies, shares data extrapolated from focus groups regarding the lived experiences of twelve disabled people and disability allies during the Covid‐19 pandemic, eleven of whom were based in the UK, and one based in Iraq. We describe the key issues and learning points from this data, arguing that the measures taken by the government and organisations to protect the public during the pandemic have instead brought to the fore long‐standing ableist narratives regarding which bodies are valuable in society. This ableist agenda has acted to control and silence the voices of disabled people by objectifying disability and defining "pre‐existing health conditions” as being more expendable, and therefore less worthy of attention during the pandemic. In presenting our position for change and call to action, we will argue that it is only when disabled peo-ple's experiences and voices are heard in decision‐making that policymakers can begin to learn from the inequalities that have been demonstrated through the pandemic. Here, we will introduce our Wellcome Trust‐funded "We Are the People” Disability Research Collective programme (2021–2026). This programme develops a new disability activist‐led research network, whereby disabled people can conduct research into topics that are important to them. © 2023 by the author(s);licensee Cogitatio (Lisbon, Portugal).
ABSTRACT
Background and Aim: The Baveno VI guidelines recommend that screening for high-risk varices (HRV) by endoscopy can be safely avoided in patients with compensated advanced chronic liver disease (cACLD) with a liver stiffness measurement (LSM) < 20 kPa and a platelet count > 150 x 109. We aimed to validate these criteria in a real-world cohort in western Sydney, Australia. Method(s): This retrospective study included patients with cACLD who underwent screening endoscopy for varices in the Western Sydney Local Health District. Inclusion criteria included a FibroScan no more than 12 months before screening endoscopy. Exclusion criteria were splanchnic vein thrombosis, non-cirrhotic portal hypertension, use of beta-blockers, and history of esophageal varices. Result(s): Based on the study criteria, 108 patients qualified. The main etiology of cirrhosis was hepatitis C (54.6%), with 91.7% of patients classified as Child-Pugh A. Varices were present in 38% of cases, with a 13.9% prevalence of HRV. In total, 38/108 patients (35.2%) satisfied the Baveno VI criteria. Within this group, 10.5% had varices and 2.6% had HRV, representing 6.7% of all HRV. The Baveno VI criteria had a sensitivity of 0.93, specificity of 0.4, positive predictive value of 0.2, negative predictive value of 0.97, positive likelihood ratio of 1.55, and negative likelihood ratio of 0.18. The area under the receiver operating characteristic curve for LSM and platelet count combined was 0.715 (P = 0.008) (Fig. 1). Conclusion(s): The Baveno VI criteria performed well with good accuracy in excluding HRV in a real-world Western Sydney cohort. Formal implementation of Baveno VI guidelines could have resulted 35.2% of less endoscopies. Given the resource restraints and long waiting times in the public health system, particularly in the COVID era, such strategies should be considered to improve access for essential screening procedures, while avoiding unnecessary overservicing.