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Journal of General Internal Medicine ; 37:S287-S288, 2022.
Article in English | EMBASE | ID: covidwho-1995669


BACKGROUND: The SAR-CoV-2 pandemic continues to negatively impact the healthcare system globally with over 800,000 deaths in the United States and millions more worldwide. The cases are rising despite availability of vaccines. For most immunocompetent patients these vaccines will generate a humoral response and also a memory T-cell response. Few if any studies have reported data that measure anti-spike IgG titers and also correlate those titers with clinical outcomes in the instance of breakthrough infection. METHODS: We conducted a pilot prospective observational clinical study enrolling 30 immunocompetent patients who were admitted with a positive SARS-CoV-2 PCR. Leftover blood from admission was used to obtain antispike and anti-nucleocapsid antibody levels. Baseline characteristics were collected and patients were divided into two categories based on anti-spike antibody level and vaccination status. Clinical outcomes including mortality, major adverse cardiac events (MACE), overall length of stay (LOS), ICU LOS, maximum oxygen support needs, and mechanical ventilation needs were analyzed on day 28 in both categories. RESULTS: On analyzing the patients enrolled, the median age was 59 years, 56.67% were female and 73.3% were Caucasian. 6 patients (20%) were asymptomatic, and 63.3% patients had hypertension. Among all patients, the median duration of symptoms was 7 days, and the median LOS was 7 days as well.Anti-spike antibody was detected in 22 patients (73.33%), and the median value was 956. Anti-nucleocapsid antibody was positive only in 9 patients (30%). Three patients (10%) were admitted to ICU, and all 3 were mechanically ventilated. Four patients (13.33%) had a MACE event in those 28 days, and 5 patients (16.67%) died. Comparing vaccinated vs unvaccinated: 3/5 deceased patients were unvaccinated, and 2/3 mechanically ventilated were unvaccinated as well but these were not statistically significant. 0.6% patients were asymptomatic in unvaccinated group versus 33% in the vaccinated group. Among the 7 patients with high oxygen needs (fio2 100%), 5 had undetectable anti-spike antibodies, and one had low value (89.6). 2 out of 3 mechanically ventilated and 3 out of 5 deceased patients had undetectable anti-spike antibodies. CONCLUSIONS: Our pilot study did not show significance in outcomes between vaccinated and unvaccinated patients, but this relation has been verified in multiple larger studies. We also noted patients with undetectable/ low anti- spike antibody levels had increased fio2 needs, ICU admission, and mortality.However, it was not feasible to compare both these findings between groups due to less number of patients. This demands a larger study to better describe these relations.

Gastroenterology ; 160(6):S-291-S-292, 2021.
Article in English | EMBASE | ID: covidwho-1594295


Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical outcomes of mechanical ventilation, intensive care unit (ICU) admission, and mortality. COVID-19 attributed pancreatitis was defined as an episode fulfilling criteria for acute pancreatitis defined earlier, a temporally associated diagnosis of COVID-19 and an exclusion of the most common etiologies of acute pancreatitis (gallstones, alcohol use, class IA/IB/II medication (by Badalov classification) use, endoscopic retrograde pancreatography, or metabolic etiologies (hypercalcemia, hypertriglyceridemia (>1000mg/ dl)). Results Prevalence of hyperlipasemia was 26.6% and of acute pancreatitis 0.33% in 301 patients with COVID-19. Patients with hyperlipasemia were older (p=0.044) and more likely to have chronic kidney disease (p=0.002) (Table 1). A total of 158 (52.5%) of patients reported at least one gastrointestinal symptom (abdominal pain, nausea, vomiting or diarrhea), and the presence of any gastrointestinal symptoms was not associated with the presence of hyperlipasemia (p=0.790). Neither presence of hyperlipasemia or its severity stratified into mild (60-120 U/L), moderate (120-180 U/L), and severe (>180 U/L) categories were associated with increased rates of mechanical ventilation, ICU admission or increased mortality (Table 2). Acute pancreatitis occurred in two patients of which one case was biliary in origin. Prevalence of COVID-19 acute pancreatitis in the reported cohort was 0.33%. Of the other patients with hyperlipasemia, 18 underwent computed tomography of the abdomen and an intra-abdominal process was identified in only two patients, with colitis identified in one patient, and ileus in another. Discussion and Conclusions Acute pancreatitis in COVID-19 patients is rare while hyperlipasemia is common. Hyperlipasemia in patients with COVID-19 is likely attributed to several non-pancreatic etiologies. Both hyperlipasemia in this population, and COVID-19 attributed acute pancreatitis do not appear to have significant impact on patients’ clinical outcomes.(Table presented) (Table presented)

Journal of General Internal Medicine ; 36(SUPPL 1):S94-S94, 2021.
Article in English | Web of Science | ID: covidwho-1349069
J Intern Med ; 288(4): 469-476, 2020 10.
Article in English | MEDLINE | ID: covidwho-810836


INTRODUCTION: Higher comorbidity and older age have been reported as correlates of poor outcomes in COVID-19 patients worldwide; however, US data are scarce. We evaluated mortality predictors of COVID-19 in a large cohort of hospitalized patients in the United States. DESIGN: Retrospective, multicenter cohort of inpatients diagnosed with COVID-19 by RT-PCR from 1 March to 17 April 2020 was performed, and outcome data evaluated from 1 March to 17 April 2020. Measures included demographics, comorbidities, clinical presentation, laboratory values and imaging on admission. Primary outcome was mortality. Secondary outcomes included length of stay, time to death and development of acute kidney injury in the first 48-h. RESULTS: The 1305 patients were hospitalized during the evaluation period. Mean age was 61.0 ± 16.3, 53.8% were male and 66.1% African American. Mean BMI was 33.2 ± 8.8 kg m-2 . Median Charlson Comorbidity Index (CCI) was 2 (1-4), and 72.6% of patients had at least one comorbidity, with hypertension (56.2%) and diabetes mellitus (30.1%) being the most prevalent. ACE-I/ARB use and NSAIDs use were widely prevalent (43.3% and 35.7%, respectively). Mortality occurred in 200 (15.3%) of patients with median time of 10 (6-14) days. Age > 60 (aOR: 1.93, 95% CI: 1.26-2.94) and CCI > 3 (aOR: 2.71, 95% CI: 1.85-3.97) were independently associated with mortality by multivariate analyses. NSAIDs and ACE-I/ARB use had no significant effects on renal failure in the first 48 h. CONCLUSION: Advanced age and an increasing number of comorbidities are independent predictors of in-hospital mortality for COVID-19 patients. NSAIDs and ACE-I/ARB use prior to admission is not associated with renal failure or increased mortality.

Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Disease Management , Hypertension/epidemiology , Pneumonia, Viral/epidemiology , Age Factors , COVID-19 , Comorbidity , Coronavirus Infections/therapy , Diabetes Mellitus/therapy , Female , Follow-Up Studies , Hospital Mortality/trends , Humans , Hypertension/therapy , Inpatients , Male , Michigan/epidemiology , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Prevalence , Prognosis , RNA, Viral/analysis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Survival Rate/trends