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Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925289


Objective: To further characterize the relationship between markers of inflammation and outcome in patients undergoing mechanical thrombectomy for acute stroke. Background: Inflammation and infection after ischemic stroke are known to exacerbate tissue injury and worsen clinical outcome. Thrombectomy has become standard of care in stroke, but little data exist regarding how inflammation affects outcome after thrombectomy. Design/Methods: We performed retrospective chart review of stroke patients who underwent mechanical thrombectomy at 2 tertiary academic centers between December 2018 and November 2020. The relationship between discharge mortality, admission WBC count, admission neutrophil percentage, peak WBC count, and fever (peak temperature >38°C) were analyzed using the Wilcoxon rank sum test, Student's t-test, and Fisher's exact test. Multivariable analysis was performed to test for independent predictors of discharge mortality. Analyses were performed for the entire cohort, then repeated in a cohort excluding COVIDpositive patients. Results: Of 254 patients who had thrombectomy for acute stroke, 42 (16.5%) died prior to discharge. Mortality was associated with admission WBC count (10.7 [8.9-14] vs. 8.6 [7-12], p=0.0064), admission neutrophil percentage (78% ± 11 vs. 70% ± 14, p=0.0001), peak WBC count (17 [13-22] vs. 12 [8.9-15], p<0.0001), and fever (71% vs. 29%, p<0.0001). In multivariable analysis, admission WBC count (OR 14, CI 1.5-158, p=0.024), neutrophil percentage (OR 1.04, CI 1.0-1.1, p=0.039), peak WBC count (OR 343, CI 27-5702, p<0.0001) and fever (OR 8.6, CI 3.6-23, p<0.0001) were significantly predictive of discharge mortality after controlling for age, admission NIHSS and post-thrombectomy ASPECTS score. Fifteen patients tested positive for COVID-19. In analyses excluding these patients, peak WBC count and fever remained independent predictors of discharge mortality. Conclusions: Elevated markers of inflammation during hospitalization predict discharge mortality in patients who undergo mechanical thrombectomy for acute stroke. Further study is warranted to investigate causation and identify opportunities to improve quality of care in this patient population.

Rheumatology (United Kingdom) ; 60(SUPPL 1):i40-i41, 2021.
Article in English | EMBASE | ID: covidwho-1266165


Background/AimsIndividuals on immunosuppressive therapies were among thoseidentified by the UK Department of Health and Chief Medical Officeras clinically extremely vulnerable to COVID-19. Advice on shieldingfrom infection was disseminated by NHS England, primary care andNHS hospital trusts to those identified at highest risk. The BritishSociety for Rheumatology (BSR) developed further risk stratificationguidance specifically focused on autoimmune rheumatic disease. As the UK entered a period of nationwide lockdown on 23rd March 2020, the clinically highly vulnerable group were asked to shield frominfection by staying at home and avoiding any face-to-face contact foran initial period of 12 weeks. The implications of social isolation, disruption to planned medical care and economic consequencesbecame increasingly recognised. This work aimed to understand theexperience and wellbeing of this patient group during week 5 -6 of UKLockdown, as a guide to how we might best adapt services andaddress the needs of this group.MethodsShort semi-structured telephone interviews were conducted with 141patients during week five and six of UK lockdown, between 20th Apriland 1st May 2020. Participants were sampled systematically from thedepartmental biologic therapy database at Wexham Park Hospital, ageneral hospital providing services to a diverse population ofapproximately 450, 000 people in Berkshire and SouthBuckinghamshire.ResultsTelephone interview was conducted with 141 patients prescribedbiologic therapy. Written advice on risk and shielding was received byover 90%. Sixty four percent of respondents were female with amedian age of 56 years. Thirty-nine percent of those interviewed fellwithin highest BSR risk category for whom full shielding was highlyrecommended, yet at the time of interview 51.1% of respondentsreported they had committed to full shielding. Four percent ofrespondents self-identified as key workers and had continued theirusual commitments. Amongst those interviewed, 35% reportedsignificant adverse impact on their emotional and mental wellbeingwithin the first six weeks of UK lockdown. Isolation, uncertainty, limitedphysical exercise and cancellations to planned appointments werecommon themes. Twenty-eight percent of respondents felt theirdisease control had significantly deteriorated during the ongoingpandemic. Due to prevailing anxiety about the impact of immunosuppression on COVID-19 risk, 5% of patients had adjusted theirprescribed therapies without the direct supervision or clinical advice.ConclusionThis study gives initial insights into the behaviours and concerns ofpatients with autoimmune and inflammatory disease on biologictherapy during the first wave of COVID-19 in the UK. Wellbeing anddisease management have considerably suffered for many individuals.Further understanding patient experience may help guide restructuringof rheumatology services in next phase of the UK pandemic.