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Objectives: COVID-19 infected over 150 million people and caused over 1 million deaths in the US. This study evaluates several variables thought to be associated with mortality risk in the COVID-19 population. Method(s): The IQVIA longitudinal medical and pharmacy claims databases identified 17,682,111 patients with a COVID-19 diagnosis between 4/1/2020-4/30/2022 from a population of >277 million patients in the US. Patients were linked to Veritas Data Research fact-of-death records (90% complete compared to CDC reporting) and confirmed deaths were flagged. Confirmed mortality rates (CMR) were evaluated by age group, socioeconomic status (SES) using the Area Deprivation Index (v2.0, University of Wisconsin, 2015), co-morbidities and COVID-specific (approved and unapproved) treatments. Result(s): Of the 563,744 patients (3.2%) identified as dead (3.67% in men, 2.85% in women overall), CMR was lowest in patients aged 0-17 (0.08%), highest in age 65-75 (5.92%) and >75 (16.40%). Patients in the lowest 40% of SES had CMR of 4.43% while in the highest 20% was 1.56%. Respiratory failure, pneumonia and sepsis were the most common acute diagnoses accompanying COVID-19 deaths in all SES. In patients with comorbid dementia or Alzheimer's disease, CMR were 21.62% and 23.40% respectively. Additionally, congestive heart failure (15.79%), atrial fibrillation (15.50%), chronic kidney disease (15.30%) and COPD (12.19%) were associated with high CMR. Among patients receiving approved therapies, casirivimab/imdevimab and remdesivir had CMR of 1.41% and 12.63% respectively, while for those receiving unapproved therapies, ivermectin and hydroxychloroquine had CMR of 2.54% and 2.45%. Conclusion(s): Compared to the 1.1% case-mortality rate (Johns Hopkins 2023) among US COVID-19 patients, we found CMR exceeded 3% among those with a medical claim for COVID-19. Advanced age, dementia, and cardio-renal disease were associated with mortality. Patients with the lowest SES had approximately 3 times the confirmed mortality rate compared to those in the highest SES group.Copyright © 2023
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Introduction: Loop diuretics are the first-line treatment for volume overload in acute decompensation of congestive heart failure (AHF). Loop diuretic resistance is common due to pharmacologic tachyphylaxis. Therefore, thiazide and thiazide-like diuretics are often used as add-on therapy to combine two different pharmacologic mechanisms. This systemic review and meta-analysis aimed to synthesize the current evidence on the efficacy and safety of metolazone and other thiazide-like diuretics in AHF. Method(s): PRISMA guidelines were followed in conducting this systematic review. PubMed, Scopus, PubMed Central, and Embase databases were searched using relevant keywords for studies published before 5 Jan 2022. and title screening was performed, followed by full-text screening using the Covidence software. Data were extracted, and analysis was done using Cochrane Review Manager (RevMan v5.1). The results were reported in odds ratio and mean difference with 95% confidence intervals. Result(s): Out of 2999 studies identified by database search, eight studies met the inclusion criteria (2 RCTs and 6 cohort studies). Pooled analysis using a random-effects model showed no difference in mean difference among the metolazone group and control group for 24 hours total urine output (MD 69.32, 95% CI -638.29 to 776.94;n = 551;I2 = 84%), change in urine output in 24 hours (MD -284.09, 95% CI -583.99 to 15.81;n = 345;I2 = 0%), 48 hours total urine output (MD -465.62, 95% CI -1302.22 to 370.99;n = 242;I2 = 0%) and urine output at 72 hours (MD -13.24, 95% CI -90.88 to 64.40;n = 205;I2 = 0%). However, studies with furosemide only in the comparator arm, 24 hours of total urine outcome favored metolazone (MD 692.70, 95% CI 386.59 to 998.82;n = 334;I2 = 0%). There was no difference between the two groups in the rate of adverse events, loss of weight, mortality, or readmission rates. Conclusion(s): Metolazone therapy in diuretic resistant AHF may improves urine output and facilitates achieving a net negative balance. Thus, metolazone and thiazide-like diuretics can be used as add-on therapy in acute decompensation of heart failure, especially in diuretic resistance.Copyright © 2023 The Author(s)
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IntroductionRecent results from the IRONMAN trial add to previous data and demonstrate that correction of iron deficiency in patients with heart failure, with high dose IV iron can improve quality of life, and reduce the risk of heart failure hospitalisation (by around 25% in meta-analysis). Yet there are theoretical risks that IV iron administration may increase the risk from bacterial infection. A meta-analysis in 2021 (across many clinical indications) suggested an excess risk of infections with IV iron but noted most trials did not pre-specify infection as an end point, with risk of reporting bias. To answer this important question hospitalisation for infection or death due to infection were pre-specified safety endpoints in IRONMAN.MethodsIRONMAN was a prospective, randomised open-label, blinded endpoint (PROBE) event-driven trial of IV ferric derisomaltose (FDI) and usual care versus usual care alone in patients with heart failure (LVEF ≤45% ) and iron deficiency (ferritin <100 µg/L and/or TSAT <20%, provided ferritin ≤400 µg/L). Patients were enrolled if they had a current or recent hospitalisation for heart failure or elevated natriuretic peptide plasma concentration. Every four months, IV iron was administered if either ferritin was <100 µg/L or TSAT was <25% (provided ferritin ≤400 µg/L). All hospitalisations and deaths were adjudicated blindly. Given that a large part of the trial was conducted during the COVID-19 pandemic, we also evaluated COVID-19 related SAEs.Results1137 patients (26.4% women) with median (IQR) age 73 (63 to 79) years were recruited by the Ironman Study Group between Aug 2016 and Oct 2021 across 70 UK sites. Median (IQR) follow-up was 2·7 (1·8 to 3·6) years. 97% of patients consented to record linkage to national databases of deaths and hospital discharge summaries, thereby ensuring investigators were aware of all potential events. There were a similar number of hospitalisations due to infection for those assigned to ferric derisomaltose (175) and usual care (213) (p = 0.16) and infection related death (34 and 28, respectively, p = 0.43). When considering first events of hospitalisation for infection or infection death there were 120 (21.1%) events for those randomised to IV FDI and 146 (25.7%) for the usual care arm (figure). There were fewer patients with COVID related SAEs in those randomised to IV FDI (12) as compared with usual care (30), HR (95% CI) 0.40 (0.20, 0.78). p=0.007. For deaths attributed to COVID-19, 4 were seen in the IV FDI arm and 8 in the usual care arm: HR 0.51 (0.15, 1.68) p=0.27.ConclusionsThere was no excess risk of infection related hospitalisation or death in patients receiving IV ferric derisomaltose. Fewer COVID-19 related SAEs were seen in patients receiving IV FDI. Given that iron plays an important role in the T and B cell response to vaccination, further analysis needs to be done in this area.Conflict of InterestHonorarium for education from Pharmocosmos
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Objectives: To describe demographic characteristics, comorbidities, and exacerbations in a cohort of patients with COPD in Chile. Method(s): Retrospective cohort study using INTEGRAMEDICA (a network of ambulatory medical centers) electronic medical records of patients with COPD aged >=40 years at index with data available one year before (baseline) and after (follow-up) index. Index date was fixed at 28-Feb-2019 to avoid including data from the COVID-19 pandemic. Moderate and severe exacerbations were defined as prescription of systemic corticosteroid/antibiotics and emergency visit/hospitalization, respectively. Result(s): In total, 19,000 patients were included. In the baseline period, 86% (n=16,400) had no moderate or severe exacerbations (NMSE), 13% (n=2,503) had only moderate exacerbations (OME) and <1% (n=96) had >=1 severe exacerbation (SEV). Mean age/proportion of females was: 64 years/60% (total cohort), 65 years/59% (NMSE), 61 years/67% (OME) and 73 years/62% (SEV). The four most frequent comorbidities were: hypertension (total: 17.6%;NMSE: 16.2%;OME: 26.0%;SEV: 24.0%), asthma (total: 8.9%;NMSE: 7.8%;OME: 15.3%;SEV: 17.7%), diabetes type 1/2 (total: 6.3%;NMSE: 5.9%;OME: 9.1%;SEV: 7.3%) and congestive heart failure (total: 3.2%;NMSE: 3.2%;OME: 2.9%;SEV: 4.2%). The proportion of patients with >=1 moderate/severe exacerbation during follow-up was 14% (total), 10% (NMSE), 38% (OME) and 35% (SEV). The severe exacerbation rate was 2.00 per 1,000 person-years in the overall population and increased based on exacerbation history (NMSE: 0.91;OME: 1.60;SEV: 197.92) Conclusion(s): Preliminary results indicate that severe exacerbations were more frequent in patients with a history of SEV compared with patients with a history of OME or NMSE. In addition, comorbidities were more frequent in patients with a history of exacerbation. To improve patient health outcomes, strategies with a multisectoral approach should be prioritized as COPD can coexist with, and be aggravated by, other chronic comorbidities. Funding(s):GSK [209968].Copyright © 2023
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Objectives: Online health boards (OHBs) are web-based forums where patients post publicly about their conditions. We evaluated the extent to which OHB posts could be used to generate meaningful insights into the lived experience of patients. Specifically, we sought to (a) capture patient reactions to the Covid-19 pandemic, (b) determine pathways to diagnosis of ANCA-associated vasculitis (AAV) and (c) develop clinical outcome assessments (COAs) for congestive heart failure (CHF). Method(s): For each use case, a keyword-based search was used to retrieve relevant English language posts from multiple OHBs. A machine learning approach removed all posts except those where a patient was writing about themselves or someone in their care. Computer-assisted coding was applied to these posts and numerical analysis used to extract insights from the coding. Where possible, our findings were compared to those obtained using traditional methods. Result(s): Relevant posts were obtained from 53,134 users for the Covid study, 271 patients for the CHF work and 59 AAV patients. These proved sufficient to reveal meaningful insights across all three studies. For example, it was possible to rank lifestyle impacts of disease (e.g. limitations on exercise ranked highest, cited by 47% of CHF patients), reconstruct pathways to diagnosis (average time to AAV diagnosis was found to be seven years) and track patient concerns during the onset of the Covid-19 pandemic. Findings were broadly comparable with those reported elsewhere. Conclusion(s): Mining OHBs offers an alternative methodology for capturing the patient experience across a range of applications. Its strengths are the immediacy with which insights can be acquired, the size of cohorts that can be studied and the ability to retrospectively perform longitudinal studies. However, this approach is limited by the inability to probe beyond initial post content, the reliance on patients to proactively share their experience, and the inability to evidence their diagnosis.Copyright © 2023
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BackgroundIn COVID-19 severe disease course such as need of intensive care unit (ICU) as well as development of mortality is mainly due to cytokine storm.ObjectivesIn this study, we aimed to evaluate the high dose intravenous anakinra treatment response and outcome in patients with severe and critical COVID-19 compared to standard of care.MethodsThis retrospective observational study was carried out at a tertiary referral center. The study population consisted of two groups as follows;the patients receiving high dose intravenous anakinra (anakinra group) between 01.09.2021 and 01.02.2022 and the patients treated with standard of care (SoC, control group) as historical control group who were hospitalized between 01.07.2021 and 01.09.2021.ResultsAfter the propensity score 1:1 matching 79 patients in anakinra and 79 patients in SoC matched and included into the analysis. Mean±SD patient age was 67.4±16.7 and 67.1±16.3 years in anakinra and SoC group, respectively (p=0.9). Male gender was 38 (48.7 %) in anakinra and 36 (46.2 %) SoC (p=0.8). Overall, ICU admission was in 14.1 % (n=11) and 30.8 % (n=24) (p=0.013;OR: 6.2), intubation in 12.8 % (n=10) and 16.7 % (n=13) patients (p=0.5), 14.1 % (n=11) and 32.1 % (n=25) patients died in anakinra and control group, respectively (p=0.008;OR: 7.1)ConclusionIn our study mortality was lower in patients receiving anakinra compared to SoC. Intravenous high dose anakinra is safe and effective treatment in patients with severe and critical COVID-19.Table 1.Baseline clinical and laboratory features of patients receiving standard of care (SoC) and Anakinra before and after propensity score (PS) matchingBefore PS matchingAfter PS matchingVariablesAnakinra (n=148)SoC (n=114)p value (OR)Anakinra (n=78)SoC (n=78)p value (OR)Age (years) (mean±SD)66.8±1763.1±170.0967.4±16.767.1±16.30.9Gender, male (n, %)78 (52.7)45 (39.5)0.033 (4.5)38 (48.7)36 (46.2)0.8Duration of hospitalization (days) (median, IQR)11 (12)9 (7.3)0.027.5 (9)11 (8)0.01Comorbidities (n, %) Diabetes mellitus41/146 (28.1)39 (34.2)0.318 (23)31 (39.7)0.025 (5) Hypertension84/143 (58.7)64 (56)0.730 (61.5)50 (64)0.7 Coronary heart disease27/143 (19)24 (21)0.718 (23)20 (25.6)0.7 Heart failure18/143 (12.6)23 (20)0.114 (18)20 (25.6)0.24 Chronic renal failure31 (21)6 (5.3)<0.001 (13.06)15 (19)6 (7.7)0.035 (4.5) Chronic obstructive lung disease23/144 (16)19 (16.7)0.914 (18)15 (19)0.8 Dementia15/117 (12.8)2 (1.8)0.001 (10.4)3/61 (5)2 (2.6)0.5 Malignancy16/146 (11)8 (7)0.39 (11.5)6 (7.7)0.4 Immunosuppressive usage18/146 (12.3)2 (1.8)0.001 (10.08)5 (6.5)2 (2.6)0.2Disease severity (n, %) NIH score 3 (severe)57 (38.5)68 (59.6)0.001 (11.5)48 (61.5)44 (56.4)0.5 NIH score 4 (critical)91 (61.5)46 (40.4)30 (38.5)34 (43.6) mcHIS score (mean±SD)3.4±1.22.64±1.5<0.0012.9±13.1±1.30.2PS: Propensity score, SoC: Standard of care, OR: Odds ratio, SD: Standard deviation, IQR: Interquartile range, mcHIS: Modified Covid hyperinflammatory syndrome score, NIH: National Institute Health, ALT: Alanin aminotransferase, AST: Aspartate aminotransferaseTable 2.Outcomes of patients receiving SoC and Anakinra before and after PS matchingBefore PS matchingAfter PS matchingVariables (n, %)Anakinra (n=148)SoC (n=114)p value (OR)Anakinra (n=78)SoC (n=78)p value (OR)Pneumothorax3/134 (2.2)00.25*2/73 (2.7)00.5*Myocardial infarction3/132 (2.3)6 (5.3)0.32/72 (2.8)2/56 (3.6)1Pulmonary embolism4/134 (3)11 (9.6)0.034 (4.8)*3/73 (4.1)7 (9)0.3*Intensive care unit60 (40.5)25 (22)0.001 (10.2)11 (14.1)24 (30.8)0.013 (6.2)Intubation54 (36.5)13 (11.4)<0.001 (21.3)10 (12.8)13 (16.7)0.5Mortality56 (37.8)27 (23.7)0.015 (5.96)11 (14.1)25 (32.1)0.008 (7.1)PS: Propensity score, SoC: Standard of care, OR: Odds ratioREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The advent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in China at the end of 2019 has developed into a global outbreak, and COVID- 19 is an ongoing major public health issue. During the pandemic, transplant programs had to devise strategies to deal with the possibility of COVID-19-positive donors and recipients. We describe the case of a heart transplant recipient who tested positive with the SARS- CoV2 swab upon admission to our Unit of Cardiac Surgery when a suitable donor became available. Given his clinical status of end-stage heart failure and the absence of imaging and clinical signs suggestive of COVID-19, and his having been vaccinated with three doses, we decided to proceed with the transplant.
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Introduction: In gastroenterology, telemedicine has emerged as a means for improving patient access to medical care while limiting viral transmission during the pandemic. The purpose of this study was to assess patient order compliance in the virtual vs. in-person setting during the COVID-19 pandemic for the initial evaluation of constipation. Method(s): Using natural language processing, we identified outpatient gastroenterology visits (virtual and in-person) for constipation from March 2020 through December 2021. We assessed the number of orders placed for patients during these encounters and determined compliance based on order completion. A generalized linear mixed effects model with fixed effects for visit type and random intercepts for intra-patient correlation was used. A multivariable model was built controlling for age, socioeconomic status, BMI, dementia, stroke, and congestive heart failure. Result(s): Among 4,930 patients who presented for initial constipation evaluation since the start of the pandemic, 3,515 patients were evaluated in-person and 1,415 patients were evaluated virtually. Comparing order compliance in patients seen during the pandemic, patients seen virtually were 66% less likely to complete orders in comparison to patients seen in-person (p < .001). Patients seen in a pandemic virtual setting were 43% less likely to complete imaging orders (p < 0.001), 78% less likely to complete procedure orders (p < 0.001), and 90% less likely to complete lab orders (p < 0.001) (Table). Increased lab compliance was associated with the highest socioeconomic status ($75,000-$200,000) with patients eight times more likely to complete lab orders (p=0.049) and three times more likely to complete orders overall (p=0.021). Conclusion(s): Compared with in-person visits, patients seen virtually for their first presentation of constipation were less likely to complete labs, imaging and procedure evaluation ordered. In-person visits were more successful in leading to patient order completion during the pandemic. These findings suggest that virtual visits for constipation, despite convenience, may compromise care delivery;such visits may thus require additional care coordination to achieve compliance with medical recommendations. (Figure Presented).
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Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s): Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s): We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR: 3.45, 95% CI (2.98, 3.99)], hypertension [OR: 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR: 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR: 1.51, 95% CI (1.22, 1.86)], and diabetes [OR: 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s): This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.
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Introduction/Aim: Patients with interstitial lung disease (ILD) are at higher risk of COVID-19 infection associated morbidity and mortality, and hence may benefit from early anti-viral therapy. The access criteria for early oral anti-viral therapies for COVID-19 varied in early 2022 due to limited supplies nationally. We created a live clinical database of ILD patients in a tertiary hospital setting, stratifying them by measurable risk factors and therefore accessibility by state or national criteria to anti-viral therapy. Method(s): A list of active ILD clinic patients was generated from the WEBPAS clinic database. Data on patient demographics, co-morbidities and immunosuppressive medications relevant to access to anti-viral medications via the PBS criteria and state-based criteria was gathered by medical records review. Demographic information included age, BMI, ethnicity, residential care living and rurality. Co-morbidity risk factors included congestive cardiac failure, neurological disease, diabetes mellitus, chronic kidney disease, liver cirrhosis, chronic lung disease and immunodeficiencies. Medications of relevance included glucocorticoids, steroid-sparing immunomodulators and chemotherapy. Combinations of the above risk factors equate to eligibility to treatment. Result(s): Between the data capture dates of 1 February 2021 and 31 January 2022, 526 patients were identified. Of these 457 fit the inclusion criteria. Median age was 71.4 years (range 20-92), ratio of F:M was 1.09. 11% of patients were on long term oxygen therapy. Commonest conditions were idiopathic pulmonary fibrosis (26.3%), connective-tissue disease ILD (18%) and sarcoidosis (13.4%). 92 (20%) of patients fit into 'moderate or severely immunocompromised' criteria. 346 (75%) of patients fit criteria for early anti-virals by the first iteration of PBS criteria. Using the second iteration of PBS criteria, 374 (82%) of the ILD patients fit criteria for early anti-viral treatment. Notably, some patients qualify for anti-virals on multiple eligibility PBS criteria. Conclusion(s): A large proportion of our ILD cohort is deemed 'high risk' for COVID-19 morbidity and would qualify for early anti-viral therapies (regardless of vaccination status).
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Introduction: While COVID-19 is predominantly a lung infection, it can cause systemic viremia in susceptible patients and lead to cardiac involvement and myocarditis (MC);an inflammation of the myocardium characterized by arrhythmias, cardiogenic shock, acute heart failure, and death. Although rare, there is evidence of a surge in MC-related admissions during the COVID-19 pandemic, implying a correlation. However, the risk factors associated with MC susceptibility in these patients remain unclear. This study aims to assess the comorbidities and demographic features associated with the development of MC in adult patients with COVID-19. Method(s): Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The database provides all-payers administrative claims data on the patient level. Using ICD-10-CM codes, a cohort of patients hospitalized with a primary diagnosis of COVID-19 was identified. The study included only patients admitted to the hospital between January and October 2020 to minimize bias associated with vaccine-related MC. Within this cohort, patients diagnosed with MC during and up to one month after admission were identified and their demographic features and comorbidities to were compared to those without MC. We calculated Risk Ratios with their respective 95% CI. A p-value <0.05 was deemed significant. Result(s): We found 627,465 admissions due to COVID-19 from January to October 2020, with 506 (0.08 %) diagnosis of MC. Patients with MC were more likely to be males (60%), younger (mean age 48, SD= 23 vs. 60, SD =17 - p<0.01), and they had more comorbidities (mean Elixhauser Comorbidity Index: 7.52, SD= 5 vs. 6.9, SD = 5 - p<0.001). The development of MC was significantly associated with a history of coagulopathies [0.55(0.46-0.66);p<0.0001], asthma [1.20 (1.06-1.23);p= 0.01], deep venous thrombosis [1.54(1.38-1.68);p<0.0001], renal disease[1.15 (1.02-1.27);p= 0.03], congestive heart failure [1.24 (1.12-1.34);p=0.006], ischemic heart disease [1.25 (1.14-1.35);p=0.0001], and arrhythmias [1.24 (1.14-1.32);p< 0.0001]. However, a history of diabetes [0.89 (0.67-0.99);p=0.02], hypertension [0.71 (0.62-0.80);<0.000.1], depression [0.71(0.52-0.88);p=0.0001], and hypothyroidism [0.42(0.08-0.69);p<0.0001] was associated with lower risk of MC-related hospitalization. Other preexistent conditions including, psychosis, rheumatoid arthritis, cerebrovascular disease, obesity, tobacco use, alcohol abuse, HIV, anemia, peripheral vascular disease, and non-metastatic solid tumor were not significantly correlated with MC. Discussion(s): MC is a rare yet serious complication of COVID-19. Therefore, a better knowledge of the pathophysiology of COVID-19 and the patient factors associated with development to MC is crucial for prognostication and providing risk-adjusted treatment. Conclusion(s): Patients with a history of cardiovascular disease, renal and pulmonary disease were more likely to develop MC as a result of COVID-19. However, hypertension and diabetes were associated with lower risk of MC, which warrants further investigation.Copyright © 2022
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Background and aim: Gastrointestinal (GI) bleeding is deemed "obscure" when upper and lower GI endoscopy reveal no bleeding site. While the term "overt" is used in cases where visible blood passage is observed or reported, cases without macroscopic bleeding stigmata are defined "occult". Although small bowel origin accounts for only about 5% of all GI bleedings, it makes up the majority of obscure GI bleedings. Diagnostic work-up and treatment of small bowel GI bleedings can be challenging, especially when overt bleeding symptoms are absent. Material(s) and Method(s): We report the case of a frail patient with multiple comorbidities and evidence of bleeding small bowel angiodysplastic lesions on videocapsule assisted enteroscopy (VCE). Device assisted enteroscopy (DAE), planned in order to treat the bleeding lesions, was delayed after the patient contracted SARSCoV- 2 infection. Eight weeks after, in the absence of clinical signs of bleeding, a device for real time luminal blood detection (HemoPillR acute, Ovesco) was applied to guide timing of enteroscopy. Result(s): The 71 year old male patient was on dual anti platelet therapy and had persistent clinical features of iron deficiency anemia (Hemoglobin 8,0g/dl). Upper and lower GI endoscopy were negative for potential bleeding sources. VCE showed three small lesions suspect for angiodysplasia within 1 to 13 minutes after pylorus passage. Upon recovery from SARS-CoV-2 infection and congestive heart failure with respiratory insufficiency, we administered HemoPillRacute orally, without previous bowel preparation. The measurement showed a peak HemoPillR-Index (HI max) at 1h 47min after capsule administration (Fig. 1) and was therefore indicative of a small bowel bleeding site, best approachable by antegrade oral route, in keeping with the prior VCE findings. On subsequent DAE, performed through spiral enteroscopy, the small bowel angiodysplastic lesions were successfully treated. [Figure presented] Conclusion(s): Our case report illustrates how a novel telemetric blood detection measurement was able to confirm luminal blood presence and successfully guide timing of therapeutic DAE in a patient with obscure-occult GI bleeding, without the need for repetition of VCE.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.
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Background & Objectives: This study aimed to compare PD patients with and without COVID-19 and to evaluate the associated factors about prognosis. Methods: The data of 37 hospitalized PD patients associated with COVID-19 pneumonia were evaluated. It was compared with the data of 40 PD patients who did not have COVID-19 in the same period. Clinical findings, prognosis, mortality and other related factors were compared in PD patients with and without COVID-19. Results: Hypertension was higher comorbid disease in PD patients with COVID-19 (p = 0.005). The duration of PD was longer in patients without COVID-19 disease (6.02 ± 2.80 vs 5.08 ± 4.59) (p = 0.028). In PD patients with COVID-19, the most common symptoms were myalgia-arthralgia (73.0%) and fatigue (48.6%). Intensive care was required in 17 (45.9%) patients, and invasive mechanical ventilation (IMV) was required in 9 (24.3%) patients. The in-hospital mortality rate was 29.7% (n = 11). Mortality and IMV requirement were higher in patients whose initial symptom was diarrhea (p = 0.004, p = 0.008, respectively). No correlation was detected between PD stage, treatment options and prognosis (p < 0.05). Conclusion: Mortality rate and IMV requirement are higher in PD patients with COVID-19 pneumonia, particularly in patients with initial symptoms of diarrhea. These patients should be followed more carefully in terms of probable poor prognosis. © 2023, ASEAN Neurological Association. All rights reserved.
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Introduction: A dialysis unit is compatible with a long-range airborne transmission environment resulting in a higher risk of Coronavirus disease 2019 (COVID-19) infection in hemodialysis patients. Reduction of hemodialysis frequency is a common practice to prevent COVID-19 from spreading in the dialysis unit. However, the predictors to determine which patient is likely to fail from reducing frequency of dialysis is still lacking. This study determined the predictors for a failure reduction in hemodialysis frequency at 4 weeks. Method(s): This retrospective observational study enrolled adult patients receiving long-term thrice-weekly hemodialysis at Thammasat University Hospital in 2021 who decreased dialysis frequency to twice-weekly during COVID-19 outbreak in Thailand. The outcomes were prevalence of failure reduction in dialysis frequency at 4 and 8 weeks and predictors of failure reduction at 4 weeks. Multivariable logistic regression analysis was performed to determine the predictors and create a predicting model for failure reduction of dialysis frequency. Result(s): Of 161 patients receiving hemodialysis in 2021, 83 patients with dialysis frequency reduction had a median age of 69.6 years and a median dialysis vintage of 4.5 years. 27 (33%) and 68 (82%) patients failed to reduce dialysis frequency at 4 and 8 weeks. At 4 weeks, 22 (81.5%) patients failed to reduce dialysis frequency from hypervolemia-related causes. From multivariate logistic regression analysis showed that the predictors for failure reduction at 4 weeks were pre-existing diabetes, congestive heart failure, pre-dialysis weight gain, dry weight from body composition measurement, mean pre- and post-dialysis weight gain during one week before dialysis reduction (Table 1). The model including these predictors (Table 2) demonstrated an Area Under the Receiver Operating Characteristic (AUROC) of 0.78 (95% CI 0.69-0.88) for predicting a failure reduction. At 4 weeks, 0 (0%), 7 (28.0%), and 20 (54.1%) of patients with low risk (score of <0 point), intermediate risk (score of 0-1 point) and high risk (score of >1 point) failed to reduce dialysis frequency, respectively. Conclusion(s): During the COVID-19 pandemic, 33% and 88% of hemodialysis patients failed to reduce their dialysis frequency at 4 and 8 weeks. The predicting model for a failure dialysis reduction demonstrated a good performance. Conflict of interest Potential conflict of interest: - Speaker fee from Fresenius Medical Care and Boehringer Ingelheim (Thai) - Registration fee from Novo Nordisk and Sanofi Aventis ThailandCopyright © 2023
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Objectives: In this study, we aimed to investigate the prognostic value of the neutrophile-lymphocyte ratio and the effects of age, gender, and comorbidities on mortality. Method(s): In our study, 100 patients who had a ground-glass opacification on computed thorax tomography and who had a positive polymerase chain reaction test were included in our study. Demographic data, laboratory data and comorbidities of the patients were recorded. Result(s): Sixty-five (65%) of the patients participating in the study were male. The mean age of the patients was 66 (21.5). The mortality rate was found to be 27% (n=27) High neutrophile-lymphocyte ratio, low lymphocyte count, high urea, and creatin levels were significant in terms of mortality. In addition, advanced age, diabetes mellitus, and hypertension are other factors that have an impact on mortality. Conclusion(s): The neutrophile-lymphocyte ratio can solely be used as a prognostic marker because it is simple and economical.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Background Coronavirus disease 2019 (COVID-19) mortality remains high in those with cardiovascular disease (CVD). The temporal trend in higher COVID-19 mortality due to CVD has public health implications. We assessed the association between CVD and COVID-19 mortality throughout the COVID-19 pandemic. Methods We retrospectively studied all patients who received care for COVID-19 at Rush University System for Health during the pandemic (divided into 7 waves based on predominant virus variants and vaccine rollouts). CVD was defined as congestive heart failure (CHF), myocardial infarction (MI), cerebrovascular or peripheral vascular disease (ascertained by ICD codes). Using multivariable logistic regression, we assessed independent associations of COVID-19 mortality with age, sex, race, and 17 comorbidities in the Charlson comorbidity index, overall and stratified by pandemic waves. Results Of 43876 patients (mean age 40, 56% female, 14% with CVD), 1032 (2%) died from COVID-19 between March 2020 and August 2022. Adjusted for covariables, mortality was 3.2 times as likely in those with CVD as those without (OR=3.2, 95%CI 2.7-3.9;p<0.001). There was a trend toward increasing mortality associated with co-existing CVD as pandemic progressed to later waves (where Delta and Omicron were predominant), particularly in those with CHF or MI (Figure). Conclusion We found that COVID-19 mortality associated with co-existing CVD (particularly CHF and MI) increased temporally throughout the pandemic. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Introduction: The global prevalence of chronic kidney disease (CKD) is approximately between 9 and 12%. One of the main predictors of CKD is elderly age, and about 38% of patients are older than 65 years of age. People with CKD have impairment of the normal reaction of the innate and adaptive immune systems. Therefore, this cohort of patients is more predisposed to chronic comorbid conditions and viral infections. The COVID-19 pandemic shifted the morbidity and mortality of people with CKD. The research shows that patients with kidney disease were more likely to have worse outcomes from coronavirus infection compared to patients without CKD. The aim of this study is to investigate in-hospital mortality of CKD patients and its risk factors with coronavirus in Almaty, Kazakhstan. Method(s): The retrospective analysis includes patients, who had been admitted to a hospital with coronavirus infection, in the Almaty region of Kazakhstan, between June 2020 and June 2022. The database was extracted from the Unified National Electronic Healthcare System (UNEHS). Patients were included if they had been hospitalized with the main diagnosis of U07.1 (COVID-19, virus identified) and U07.2. (COVID-19, virus not identified). Patients' unique IDs were used to merge the database of CKD patients to define whether they had the disease or not. The statistical analysis was performed with STATA 16.0. Person's chi-square test was used for bivariate analysis, and Logistic regression was used for estimation of the relationship between in-hospital mortality and predictors. Result(s): The final cohort consisted of 58,970 patients, and 929 (2%) of them had CKD. The age of patients with kidney disease was statistically significantly higher than that of the comparison group (Table 1). As for the comorbid conditions, CKD patients had a higher ratio of acute myocardial infarction (AMI), diabetes, hypertension, congestive heart failure (CHF), and cerebrovascular disease (CVD) compared to the reference group. The mortality ratio was statistically significantly different in two groups. Table 1. Demographic characteristics and comorbidities of patients with and without CKD. [Formula presented] People of elderly age, male gender, having CKD, AMI, diabetes, hypertension, CHF, and CVD had higher odds of death according to unadjusted logistic regression (Table 2). After adjustment for the abovementioned predictors, age, male gender, CKD, diabetes, and CVD showed higher risks of mortality and remained statistically significant. Table 2. Association between socio-demographic and medical characteristics and in-hospital mortality of patients. [Formula presented] Conclusion(s): This research evaluated hospitalization outcomes of coronavirus patients with and without CKD in Almaty, Kazakhstan. The effect of socio-demographic factors and comorbidities on mortality was analyzed. Although CKD can be prevented and treated to a large extent, multimorbid conditions, especially viruses causing a pandemic, can alter the situation. Therefore, it is necessary to establish a comprehensive disease management strategy for unexpected infectious disease outbreaks. No conflict of interestCopyright © 2023
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Introduction: Congestive heart failure (CHF) is the most common cardiac admission diagnosis worldwide with high risk of morbidity and mortality. The data on the clinical impact of CHF on COVID-19 hospitalizations is limited. Here we present a study of the cardiovascular outcomes of baseline CHF on COVID-19 admissions at a national level. Method(s): The National Inpatient Sample database from 2020 was queried to identify patients with a primary diagnosis of COVID-19 and stratified based on the presence of congestive heart failure. Multivariate regressions analysis was done to compare inpatient outcomes among COVID patients with and without CHF. The primary outcome measure was in-hospital mortality. Secondary outcomes were in hospital cardiovascular outcomes. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STATA v.17. Result(s): 1,060,885 weighted COVID-19 hospitalizations were identified, of which 115,685(10.9%) were associated with CHF. On adjusted analysis, patients with COVID-CHF had significantly higher odds of MACCE (aOR 1.23, 95% CI 1.182-1.28, P<0.001), MCS ( aOR 3.22, 95% CI 2.26-3.26, P<0.001), cardiogenic shock ( aOR 2.72, 95% CI 2.26-3.26, P<0.001), AMI (aOR 2.72, 95% C. On the contrary, patients with COVID and baseline CHF had a lower incidence of inpatient AKI (aOR 0.64, 95% CI 0.49-0.84, P<0.001). The odds of in-hospital mortality, major bleeding and cardiac arrest between the two cohorts were similar. Additionally, presence of CHF in COVID hospitalization was associated with higher length of stay (8.81+/- 8.91 vs 7.28 +/-7.9) and adjusted total charge ($96,640 +/- 177,439 vs $76,214 +/-145,830) compared to COVID without CHF Conclusion(s): COVID 19 patients with CHF have increased odds of MACCE, MCS, cardiogenic shock, AMI, PCA and PCI. Out of hospital outcomes need further studies. [Formula presented]Copyright © 2023
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Background: Gas exchange abnormalities in COVID-19 survivors might involve impairment of the transfer through alveolar-capillary membrane and/or loss of capillary bed. Membrane diffusing capacity (Dm) and capillary volume (Vc) can be calculated from combined DLCO-DLNO. Aim(s): To investigate the values of Dm and Vc after COVID-19. Method(s): We retrospectively included all the patients (Pts) having performed DLCO-DLNO after COVID-19 in 4 French centres between 2020/04/20 and 2021/12/16. We excluded Pts with known history of COPD, severe asthma, interstitial lung disease, pulmonary hypertension, and congestive heart failure. We collected data from clinical records, pulmonary function test (PFT), and CT-scan when performed +/-1.5 months from PFT. Result(s): Data from 132 Pts have been analysed yet (over a total of about 500): 72 men (55%), mean age 57.7+/-13 years, mean BMI 30+/-5.7. 25 Pts (19%) were grade 1-4 on COVID-19 WHO scale (no oxygen), 45 (34%) were grade 5 (oxygen), 44 (33%) were grade 6 (NIV or high-flow oxygen), and 18 (14%) were grade 7-9 (mechanical ventilation). Median time between COVID-19 and PFT was 4.4 months [3.1-6.1]. 58 Pts (44%) had DLCO < lower limit of normal (LLN), with a significant correlation between initial COVID-19 severity and later DLCO. Mean Dm and Vc were 48.7% +/-15.1 and 80.2% +/-21. The most frequent pattern was Dm < LLN and normal Vc, in 78 Pts (59%). Only 1 (1%) had isolated Vc < LLN with normal Dm. Among the 37 (28%) with both Dm and Vc < LLN, 36 performed a CT-scan that showed fibrosing sequellae in 26 (72%). Conclusion(s): Dm was the most decreased variable, suggesting delayed healing after COVID-19. Decreased Vc was frequently associated with pulmonary fibrosis.