ABSTRACT
New York-Presbyterian Hospital and Columbia University Irving Medical Center were heavily impacted by the COVID-19 pandemic. Various measures were taken in an effort to ensure patient and staff safety. The management of patients with complex dermatological oncologic conditions, such as cutaneous lymphomas was especially challenging. We retrospectively reviewed the charts of the patients with cutaneous lymphomas who had COVID-19 (n=7) as well as those who did not have COVID-19 (n=26) from March to September 2020. Due to safety protocols, 4/7 (57%) patients who contracted COVID-19 experienced a treatment interruption. Three patients had no treatment interruptions because the timing of their COVID-related illness and scheduled treatments did not overlap. Treatment was delayed for a mean 2.1 months (range: 10 days - 4 months). Two out of four (50%) patients with treatment delays experienced disease relapse. Of the patients who did not have COVID-19, 12 patients experienced treatment delays, and ten (83.3%) of those patients experienced disease progression or relapse. Fourteen patients continued in hospital treatments with no delay, and 2 (14.3%) patients experienced disease progression or relapse. Of the total patients included in this review, 16 (48.5%) experienced a treatment. Delay. Twelve patients (12/16 or 75%) had disease relapse or progression following treatment delays. In contrast, among the 17 patients who did not experience treatment delay, 4 (23.5%) patients had relapse or progression of disease. Treatment delay was associated with a significant risk of disease relapse or progression (p=0.0053). No hospital-related cases of COVID-19 were recorded during the six-month capture period. Treatment interruptions are associated with negative clinical outcomes. Established safety protocols are effective in preventing infections during therapy for cutaneous lymphomas. We do not recommend altering treatment regimens for patients with cutaneous lymphomas if safety protocols can be assured.
ABSTRACT
Background: Critically ill patients with COVID-19 have a high incidence of thrombotic complications and dialysis-requiring acute kidney injury (AKI-D). COVID-19 hypercoagulability has been implicated as a possible contributor to AKI-D. Our hypothesis is that pre-existing antiplatelet (APT) or anticoagulation therapy (ACT) is associated with a lower incidence of AKI-D in critically ill patients with COVID-19. Methods: Records of patients with COVID-19 admitted to the ICU from March 13th -April 1st 2020 were reviewed. Exclusion criteria included ESRD status, and ICU discharge or death prior to 14 days of follow-up. Groups were divided based on APT or ACT prior to ICU admission. AKI-D was defined as initiation of renal replacement therapy (RRT) of any kind during the 14 days. Groups were compared using 2-tailed Fisher's exact test and unpaired t tests. Results: A total of 149 records were reviewed, and 98 patients were included (47 died and 4 discharged). Twenty-three patients (23.5%) were on APT or ACT and 39 (40%) required RRT. Table 1 compares characteristics by study group. Hypertension and cardiac conditions were significantly different between groups. Twelve (52%) of patients on APT or ACT required RRT and 27 (36%) not on either required RRT (p=0.22). Conclusions: Pre-existing APT or ACT was not associated with AKI-D in critically ill patients with COVID-19 and 2 weeks of follow up. Our study confirmed a high incidence of AKI-D but was limited by significant differences in cardiac conditions between study groups. Future larger studies examining this association in groups with comparable cardiac conditions are needed.