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1.
Gastroenterology ; 160(6):S-291-S-292, 2021.
Article in English | EMBASE | ID: covidwho-1594295

ABSTRACT

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)

2.
American Journal of Gastroenterology ; 116(SUPPL):S598, 2021.
Article in English | EMBASE | ID: covidwho-1534738

ABSTRACT

Introduction: The COVID-19 pandemic has taken the lives of over 3.8 million people worldwide. Recently, multiple publications have suggested that famotidine might be effective in reducing disease severity in the inpatient and outpatient settings. Therefore, we conducted a retrospective analysis of the effects of inpatient, as well as outpatient, use of famotidine and proton pump inhibitors (PPIs) on admitted COVID-19 patients. Methods: COVID-19 positive patients >18-years-old admitted to our tertiary care center between June and August 2020 were included. Those dismissed from the ED were excluded from the study. Univariate and multivariate regression analysis was conducted to determine the effect of famotidine and PPIs on the occurrence of mortality, ICU admission and acute kidney injury (AKI). Patient age, sex, body mass index, and comorbidities (hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD)) were included as covariates. Odds ratios for respective variables were calculated and recorded. Results: 489 patients were included in our study. 43 patients were on PPI therapy on admission. 26 patients were on famotidine on admission. 137 were treated with famotidine while inpatient. On univariate analysis, inpatient famotidine use, age, male sex and DMwere associated with increased mortality (Figure 1Aa). Both inpatient as well as outpatient famotidine use along with male sex were associated with increased ICU admission (Figure 1Ab). Inpatient famotidine use, age, male sex, HTN, DM, CKD and CHF were associated with increased AKI (Figure 1Ac). On multivariate analysis, patient age, male sex and inpatient famotidine were associated with increased mortality (Figure 1Ba). Both inpatient and outpatient famotidine use as well as male sex were associated with increased ICU admission (Figure 1Bb). Inpatient famotidine, male sex, CKD and CHF were associated with increased AKI (Figure 1Bc). PPI use was not associated with changed outcomes in our patient population. Conclusion: While recent publications suggested that famotidine use might be effective in reducing severity of COVID-19 infection, our experience has been to the contrary. It is unclear why the use of famotidine was significantly associated with worse outcomes in our patient population. These findings are consistent with a recent study by Yeramaneni et al. (PMID: 33058865). Further studies with randomized-controlled trials are needed to better evaluate the role of famotidine in COVID-19 patients..

3.
Journal of General Internal Medicine ; 36(SUPPL 1):S94-S94, 2021.
Article in English | Web of Science | ID: covidwho-1349069
4.
Chest ; 158(4):A298-A299, 2020.
Article in English | EMBASE | ID: covidwho-866520

ABSTRACT

SESSION TITLE: Respiratory Infections: What have We Learned About COVID-19 and New Trial Data for Management of Aspergilloma SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Early clinical observations of novel coronavirus-associated Acute Respiratory Distress Syndrome (C-ARDS) reported a higher than expected compliance discordant to the degree of hypoxemia. Our goal was to evaluate survival of patients with C-ARDS according to different lung mechanical parameters. METHODS: We conducted a prospective, observational study of C-ARDS patients admitted to the ICU at a tertiary care hospital in Michigan (March 1st to May 1st, 2020). Subjects were enrolled at the time of intubation and followed until death or discharge. The average lung compliance (AvC) measured in ml/cm H2O and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) were calculated daily over the first 7 days post-intubation. Median differences in AvC and P/F ratio between alive and deceased participants were calculated using Wilcoxon Rank Sum. Pearson correlation was used to describe the relationship between AvC and P/F ratio. Multivariate logistic regression was performed to explain co-variate effect after adjustment. Survival function was performed using the Kaplan-Meier estimator for different levels of AvC. RESULTS: 135 patients were included;mortality was 41.4% (n=56). Baseline demographics were similar between the survivor and deceased groups, except for hypertension and coronary artery disease (CAD) trending towards significance in the latter. Survivors had longer length of stay (34.7 days vs. 17.6 days;p = 0.001). There was no significant correlation between AvC and P/F ratio (Pearson's r 0.09;p=0.31). Surviving and deceased patients had different median P/F values (185 [IQR 242 to 135] vs 150 [IQR 196 to 109];p=0.01), but did not differ significantly in terms of median AvC (29 [IQR 35 to 26] vs 31 [IQR 37 to 24];p 0.69). There was no difference in survival curves between AvC levels of 35, 40 and 45. A multivariate logistic regression analysis was done to adjust for gender, BMI, hypertension, coronary artery disease and ventilator length of stay. Only age [OR =1.05, 95% CI: 1.02, 1.08, p 0.003] and PF value [OR = 0.98, 95% CI: 0.98, 0.99, p 0.001] were significant risk factors for mortality. CONCLUSIONS: Our results suggest that low P/F ratio and advanced age are the most significant independent predictors of mortality in C-ARDS. The severity of hypoxemia did not correlate significantly with lung elasticity, and lung compliance was not predictive of mortality. Our findings are consistent with other reports on lung mechanics in C-ARDS (Schenck et al). CLINICAL IMPLICATIONS: As with typical ARDS, degree of hypoxemia at the onset of respiratory failure may have prognostic implications in patients with C-ARDS. Pulmonary compliance by itself does not predict risk of mortality. DISCLOSURES: No relevant relationships by Abdulgadir Adam, source=Web Response No relevant relationships by Paul Bozyk, source=Web Response No relevant relationships by Enrique Calvo Ayala, source=Web Response No relevant relationships by Edward Castillo, source=Web Response No relevant relationships by christopher Dado, source=Web Response No relevant relationships by Bhavinkumar Dalal, source=Web Response Removed 04/27/2020 by Bhavinkumar Dalal, source=Web Response No relevant relationships by Bhavinkumar Dalal, source=Web Response Removed 04/27/2020 by Bhavinkumar Dalal, source=Web Response No relevant relationships by Bhavinkumar Dalal, source=Web Response Removed 04/27/2020 by Bhavinkumar Dalal, source=Web Response No relevant relationships by Bhavinkumar Dalal, source=Web Response Removed 04/27/2020 by Bhavinkumar Dalal, source=Web Response No relevant relationships by Sanjay Dogra, source=Web Response No relevant relationships by Giovi Grasso-Knight, source=Web Response No relevant relationships by Zaid Imam, source=Web Response No relevant relationships by Filip Ionescu, source=Web Response No relevan relationships by Daniel Keena, source=Web Response No relevant relationships by Nader Mina, source=Web Response No relevant relationships by Ehsun Naeem, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Girish Nair, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GlaxoSmithKline Please note: $20001 - $100000 Added 05/31/2020 by Vishal Patel, source=Web Response, value=Consulting fee

5.
J Intern Med ; 288(4): 469-476, 2020 10.
Article in English | MEDLINE | ID: covidwho-810836

ABSTRACT

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.


Subject(s)
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
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