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1.
Open Forum Infectious Diseases ; 8(SUPPL 1):S330, 2021.
Article in English | EMBASE | ID: covidwho-1746541

ABSTRACT

Background. COVID-19 infection is associated in some individuals with a rapid onset of systemic proinflammatory state leading to cytokine storm followed by multisystem organ failure. We are interested in studying the prognostic value of complete blood count parameters in different stages of the diseases based on the serology. Methods. This is a retrospective cohort study of patients with confirmed COVID-19 admitted to our hospital between 10/1/2020 to 2/28/2021. Study individuals had complete CBC profile and COVID-19 serology with well-defined clinical outcome (discharged alive or expired). They were divided in 3 groups based on serology results: group 1 (early disease) had no antibodies, group 2 (immune phase) had + IgM, and group 3 (late phase) had only + IgG. Demographic, clinical and laboratory data were reviewed. Simple t-test was used for continuous variables and chi-square test was used for categorical variables. Anova test was used to compare the difference across multiple groups. GraphPad PRISM was used for all analysis. Results. A total of 202 confirmed covid 19 cases were included in the study. There was no difference between the 3 groups in terms of age, gender, and body mass index (BMI). We did observe an increase in incidence in Latinx (group 1, 34%;group 2, 51%;group 3, 38%). Hypertension and diabetes were major co-morbidities in these patients. Absolute neutrophil count (ANC) and platelet count (PC) showed significant changes across the 3 groups: mean ANC for group 1, 4.868 (SD 3.117);group 2, mean 6.951 (SD 3.843);and group 3 mean 5.59 (SD 3.236). PC in group 1 mean 193.2 (SD 90.25);group 2 mean 271.1 (SD 143.4);and group 3 mean 228.6 (SD 75.33) p-value 0.0008. The difference can be seen in the derived monocyte platelet rationMPR, neutrophil lymphocyte ratio NLR, platelet lymphocyte ratio PLR and aggregate index of systemic inflammation AISI values and they tend to be higher in group 2 (MPR p-value 0.0067, NLR p-value 0.0123, PLR p-value 0.0294, AISI p-value of 0.0190). Conclusion. The study demonstrates that MPR, NLR, PLR and AISI have a potential role in categorizing the disease stage based on only CBC profiling.Properly designed prospective studies with a larger sample size should be performed to confirm the disease stratification ability of derived CBC indices like MPR, NLR, PLR and AISI.

3.
British Columbia Medical Journal ; 63(7):292-295, 2021.
Article in English | Scopus | ID: covidwho-1400062
6.
Open Forum Infectious Diseases ; 7(SUPPL 1):S342, 2020.
Article in English | EMBASE | ID: covidwho-1185913

ABSTRACT

Background: The novel coronavirus (COVID-19) has resulted in substantial morbidity and mortality worldwide. Infection with COVID-19 has been associated with coagulopathy and inflammation. This prothrombotic state has been identified in the literature as an indicator of poor prognosis and those with COVID-19 who receive anticoagulation therapy may have better outcomes. Due to this prothrombotic state, patients who are currently receiving anticoagulation therapy for other indications prior to infection with COVID-19 may have better outcomes. Methods: This was a retrospective case control study conducted at an inner city hospital. Patients were eligible if they were hospitalized between March 15, 2020 and May 15, 2020 and had confirmed infection due to COVID-19. Patients were matched by age, sex, body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and estimated glomerular filtration rate (eGFR) by chronic kidney disease (CKD) state. This study evaluated morality in patients who were receiving long term anticoagulation therapy prior to infection with COVID-19 compared to those who were not. Results: Of the 436 patients hospitalized with confirmed infection due to COVID-19, 400 were eligible for analysis. Twenty-two were on anticoagulation therapy prior to admission. Among those patients, 68% were male and 32% were female. The majority of the patients were greater than 60 years of age (82%). Comorbidities were present in 21 patients and were as follows: HTN (95%), CKD (67%), DM (57%), obesity (36%). Of the 22 patients, five expired due to COVID-19 infection compared to 52 patients from the 149-patient matched cohort [z-score 1.13, p = 0.26;odds ratio (OR) 1.82;95% confidence interval [CI], 0.69-4.71]. Conclusion: Prior long-term anticoagulation use does not appear to have a protective effect in patients with COVID-19 infection. Studies with larger sample size will be needed to answer this important question.

7.
Open Forum Infectious Diseases ; 7(SUPPL 1):S262, 2020.
Article in English | EMBASE | ID: covidwho-1185753

ABSTRACT

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods: A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results: The total number of confirmed COVID-19 patients during the study period was 350;37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired;29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74;95% confidence interval 0.53-0.93). Conclusion: This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter.

8.
Open Forum Infectious Diseases ; 7(SUPPL 1):S250-S251, 2020.
Article in English | EMBASE | ID: covidwho-1185727

ABSTRACT

Background: Little is known regarding outcome of patients living with HIV (PLWH) when they get admitted to a hospital for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. We decided to conduct a case-controlled study to try to answer the question if PLWH are at higher risk of mortality compared to individuals without HIV infection but with the same risk factors that affects outcome in COVID-19 disease. Methods: A retrospective case matched control study was performed from 03/15/2020 to 05/15/2020. We reviewed all confirmed SARS-CoV-2 infected patients who were admitted to our hospital during the study period and retrieved 7 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), body mass index (BMI), chronic kidney disease (CKD), HIV status. We divided the age in 3 groups (< 30, 30 to 60, > 60), we defined the presence of DM and HTN by reviewing the admission medications, BMI > 30 defined obesity, and CKD was present if eGFR < 45 ml/min prior to the current admission. We found 12 PLWH, we matched them for the 6 variables, we found 94 controls. The primary endpoint was percentage of inpatient mortality. Results: Of the 436 confirmed SARS-CoV-2 infection admitted between 03/15/20 and 05/15/20, 36 were still hospitalized. Twelve were PLWH out of the 400 patients with known outcome;7 patients (58%) have the age range between 30 to 60 years old while the rest (42%) have age > 60 years old. Male to female ratio was 1:1 (6 patients each). Comorbidities were present in 10 patients (83%) with HTN (83%) being the most common, followed by CKD (58%), obesity (33%), and DM (33%). Only 1 patient expired out of the 12 PLWH (8%) admitted with COVID-19, as compared to 26 patients from the 98 matched cohort (27%) (z-score 1.38, p=0.17;odds ratio [OR], 3.972;95% confidence interval [CI], 0.62-44.37). Conclusion: Our study suggests that PLWH do not have a worse prognosis than their matched controls for the most significant comorbid conditions affecting outcome in COVID-19 disease. Further studies with a larger sample size are urgently needed to confirm this finding.

9.
Open Forum Infectious Diseases ; 7(SUPPL 1):S250, 2020.
Article in English | EMBASE | ID: covidwho-1185726

ABSTRACT

Background: COVID-19 is a major global pandemic. Since the first case reported in Wuhan, China, COVID-19 has spread across the globe with more than 7.6 million individuals affected worldwide. Several studies have tried to investigate the risk factors for mortality but there has bot been a definitive study in patients with ESRD. Herein, we aimed to investigate whether ESRD is associated with mortality as compared to age, gender and comorbidities matched cohorts. Methods: A retrospective case control study was performed on patients 18-yearold with confirmed SARS-CoV-2 admitted to our hospital during the study period (03/15/2020 to 05/15/2020). Demographic, characteristics and clinical outcome were retrieved and reviewed. We found 39 ESRD patients, we matched them for 5 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), and body mass index (BMI). Age was stratified into 3 groups (< 30, 30 to 60, >60), history of DM and HTN were defined by reviewing the admission medications, and BMI was divided into 2 categories (< 30 and 30 kg/m2). The primary endpoint was percentage of inpatient mortality. Results: We had 39 ESRD patients with COVID-19 out of the 400 patients admitted during the study period with known clinical outcome. Nineteen patients (49%) were between 30 to 60 years old while the rest (51%) were older than 60 years old. As for gender, 25 (64%) were males and 14 (36%) females. Additional comorbidities were present in 38 patients with hypertension (92%) being the most common, followed by DM (64%) and BMI >30 kg/m2 (49%). With the 5 variables, we were able to match with 177 controls. Nineteen individuals expired out of the 39 ESRD patients (49%), as compared to 46 patients from the 177 matched cohort (26%) (z-score 2.80, p=0.0051;odds ratio [OR], 2.71;95% confidence interval [CI], 1.28-5.41). Conclusion: Our results suggest that ESRD patients is an independent risk factor for increased mortality in patients with COVID 19 disease. Larger prospective studies will need to confirm this finding and try to find ways to mitigate this very high mortality in this vulnerable population.

10.
Open Forum Infectious Diseases ; 7(SUPPL 1):S163, 2020.
Article in English | EMBASE | ID: covidwho-1185695

ABSTRACT

Background: One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus;diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with isolated DKA or combined DKA/HHS to our institution. Methods: A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 03/20/20 and 04/20/20. Inclusion criteria were: 1) Blood Glucose >250mg/dL;2) Serum bicarbonate < 18 mmol/L;3) Anion Gap >10;4) serum pH < 7.3;4) ketonemia or ketonuria;and 5) positive SARS-CoV-2 RT-PCR. Hyperosmolality, on the other hand, was defined as an effective/calculated plasma osmolality >304 mOsm/kg. Results: A total of 87 patients with COVID-19 were admitted to the ICU during the study period, 12 of them had either isolated DKA or DKA/HHS. Baseline demographics, lab values and outcome are summarized in Table 1. Six of the patients had isolated DKA and six had combined DKA and HHS. The median age for the patient was 49.5 years old (range from 19 to 62 years old). The male to female ratio was 5:1. Of the 12 patients, 10 patients (83%) had a history of DM, nine were type 2 and only one type 1;two patients were newly diagnosed DM, presenting as DKA, presumptively precipitated by COVID-19. Five patients (42%) had a BMI >30 kg/m2. As for ethnicity;seven were Hispanic (59%), four African American (33%), and one Caucasian (8%). Patients with combined DKA/HHS, higher BMI, higher HbA1c, severe acidosis tended to have higher mortality. The striking feature was that isolated DKA or combined DKA/HHS was the initial presentation for COVID-19 for most of the cases. Conclusion: Our observational retrospective case series reinforces the need to watch for new onset DM and monitor blood sugar closely in those with known diabetes mellitus during SARS-CoV-2 infection, in order to avoid such serious complications as DKA and HHS. (Table Presented).

11.
Open Forum Infectious Diseases ; 7(SUPPL 1):S161-S162, 2020.
Article in English | EMBASE | ID: covidwho-1185692

ABSTRACT

Background: A few COVID-19 related retrospective studies have established that older age, elevated neutrophil-lymphocyte ratio (NLR), and decreased lymphocyte-CRP ratio (LCR) were associated with worse outcome. Herein, we aim to identify new prognostic markers associated with mortality. Methods: We conducted a retrospective hospital cohort study on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Study individuals were recruited if they had a complete CBC profile and inflammatory markers such as CRP, ferritin, D-dimer and LDH, as well as a well-defined clinical outcomes (discharged alive or expired). Demographic, clinical and laboratory data were reviewed and retrieved. Univariate and multivariate logistic regression methods were employed to identify prognostic markers associated with mortality. Results: Out of the 344 confirmed COVID-19 hospitalized patients during the study period, 31 who did not have a complete blood profile were excluded;303 patients were included in the study, 89 (29%) expired, and 214 (71%) were discharged alive. Demographic analysis was tabulated in Table 1. The univariate analysis showed a significant association of death with absolute neutrophil count (ANC, p=0.022), NLR (p=002), neutrophil-monocyte ratio (NMR, p=< 0.0001), LCR (p=0.007), lymphocyte-LDH ratio (LLR, p=< 0.0001), lymphocyte- D-dimer ratio (LDR, p=< 0.0001), lymphocyte-ferritin ratio (LFR, p=< 0.0001), and platelets (p=0.037) with mortality. With multivariable logistic regression analysis, the only values that had an odds of survival were high LDR (odds ratio [OR] 1.763;95% confidence interval [CI], 1.20-2.69), and a high LFR (OR 1.136, CI 1.01-1.34). We further build up a model which can predict >85% mortality in our cohorts with the utilization of D-dimer (>500 ng/ml), Ferritin (>200 ng/ml), LDR (< 1.6), LFR (< 4) and ANC (>2.5). This new model has a ROC of 0.68 (p< 0.0001). Conclusion: This retrospective cohort study of hospitalized patients with COVID-19 suggests LDR and LFR as potential independent prognostic indicators. A new model with combination of D-dimer, Ferritin, LDR, LFR and ANC, was able to predict >85% mortality in our cohort with ROC of 0.68, it will need to be validated in a prospective cohort study. (Table Presented).

12.
Circulation ; 142:2, 2020.
Article in English | Web of Science | ID: covidwho-1090808
13.
J Hosp Infect ; 106(2): 226-231, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-635357

ABSTRACT

BACKGROUND: In late 2019, a novel human coronavirus - severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) - emerged in Wuhan, China. This virus has caused a global pandemic involving more than 200 countries. SARS-CoV-2 is highly adapted to humans and readily transmits from person-to-person. AIM: To investigate the infectivity of SARS-CoV-2 under various environmental and pH conditions. The efficacies of various laboratory virus inactivation methods and home disinfectants against SARS-CoV-2 were investigated. METHODS: The residual virus in dried form or in solution was titrated on to Vero E6 cells on days 0, 1, 3, 5 and 7 after incubation at different temperatures. Viral viability was determined after treatment with various disinfectants and pH solutions at room temperature (20-25oC). FINDINGS: SARS-CoV-2 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature. SARS-CoV-2 could be detected under a wide range of pH conditions from pH 4 to pH 11 for several days, and for 1-2 days in stool at room temperature but lost 5 logs of infectivity. A variety of commonly used disinfectants and laboratory inactivation procedures were found to reduce viral viability effectively. CONCLUSION: This study demonstrated the stability of SARS-CoV-2 on environmental surfaces, and raises the possibility of faecal-oral transmission. Commonly used fixatives, nucleic acid extraction methods and heat inactivation were found to reduce viral infectivity significantly, which could ensure hospital and laboratory safety during the SARS-CoV-2 pandemic.


Subject(s)
Betacoronavirus/growth & development , Betacoronavirus/pathogenicity , Coronavirus Infections/physiopathology , Microbial Viability , Pneumonia, Viral/physiopathology , Severe Acute Respiratory Syndrome/pathology , Virulence , Virus Inactivation , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology
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