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1.
Diagnostics (Basel) ; 10(6)2020 May 30.
Article | MEDLINE | ID: covidwho-2109973

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic resulting in over 2.7 million infected individuals and over 190,000 deaths and growing. Assertions in the literature suggest that respiratory disorders due to COVID-19 commonly present with pneumonia-like symptoms which are radiologically confirmed as opacities. Radiology serves as an adjunct to the reverse transcription-polymerase chain reaction test for confirmation and evaluating disease progression. While computed tomography (CT) imaging is more specific than chest X-rays (CXR), its use is limited due to cross-contamination concerns. CXR imaging is commonly used in high-demand situations, placing a significant burden on radiology services. The use of artificial intelligence (AI) has been suggested to alleviate this burden. However, there is a dearth of sufficient training data for developing image-based AI tools. We propose increasing training data for recognizing COVID-19 pneumonia opacities using weakly labeled data augmentation. This follows from a hypothesis that the COVID-19 manifestation would be similar to that caused by other viral pathogens affecting the lungs. We expand the training data distribution for supervised learning through the use of weakly labeled CXR images, automatically pooled from publicly available pneumonia datasets, to classify them into those with bacterial or viral pneumonia opacities. Next, we use these selected images in a stage-wise, strategic approach to train convolutional neural network-based algorithms and compare against those trained with non-augmented data. Weakly labeled data augmentation expands the learned feature space in an attempt to encompass variability in unseen test distributions, enhance inter-class discrimination, and reduce the generalization error. Empirical evaluations demonstrate that simple weakly labeled data augmentation (Acc: 0.5555 and Acc: 0.6536) is better than baseline non-augmented training (Acc: 0.2885 and Acc: 0.5028) in identifying COVID-19 manifestations as viral pneumonia. Interestingly, adding COVID-19 CXRs to simple weakly labeled augmented training data significantly improves the performance (Acc: 0.7095 and Acc: 0.8889), suggesting that COVID-19, though viral in origin, creates a uniquely different presentation in CXRs compared with other viral pneumonia manifestations.

2.
J Assoc Med Microbiol Infect Dis Can ; 5(2): 98-103, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-2109663

ABSTRACT

As the pandemic of coronavirus disease 2019 (COVID-19) continues to evolve globally and within our Canadian borders, hospitals will begin to see an increasing number of confirmed or suspected cases at their doors. Although many patients can be managed at home, a reasonable proportion will experience progression of disease requiring hospitalization and potentially mechanical ventilation and intensive care. Herein, we report the presentation of the first case of COVID-19 admitted to hospital in Alberta. While The patient's course was mild, this case highlights a number of key points-namely the importance of widespread testing in the community to help inform emergency services (ambulance) workers and receiving front-line health care staff. Other important points include in-hospital monitoring and pharmacologic treatment.


Avec l'évolution de la pandémie de maladie à coronavirus 2019 (COVID-19) dans le monde et à l'intérieur des frontières du Canada, les hôpitaux verront un nombre croissant de patients au diagnostic confirmé ou présumé. De nombreux cas bénins peuvent être traités à la maison, mais dans une proportion raisonnable de cas, la maladie exigera une hospitalisation et peut-être une ventilation mécanique et une admission aux soins intensifs. Les auteurs rendent compte de la présentation du premier cas de COVID-19 hospitalisé en Alberta. Même si la maladie était bénigne, plusieurs éléments fondamentaux en sont ressortis, notamment l'importance de tests généralisés dans la population pour renseigner les services d'urgence (ambulance) et les travailleurs de la santé de première ligne. Le monitorage à l'hôpital et le traitement pharmacologique font partie des autres éléments importants.

3.
Trials ; 23(1): 932, 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2108882

ABSTRACT

BACKGROUND: COVID-19 poses a global health challenge with more than 325 million cumulative cases and above 5 million cumulative deaths reported till January 17, 2022, by the World Health Organization. Several potential treatments to treat COVID-19 are under clinical trials including antivirals, steroids, immunomodulators, non-specific IVIG, monoclonal antibodies, and passive immunization through convalescent plasma. The need to produce anti-COVID-19 IVIG therapy must be continued, alongside the current treatment modalities, considering the virus is still mutating into variants of concern. In this context, as the present study will exploit pooled diversified convalescent plasma collected from recovered COVID-19 patients, the proposed hyperimmune Anti-COVID-19 intravenous immunoglobulin (C-IVIG) therapy would be able to counter new infectious COVID-19 variants by neutralizing the virus particles. After the successful outcome of the phase I/II clinical trial of C-IVIG, the current study aims to further evaluate the safety and efficacy of single low dose C-IVIG in severe COVID-19 patients for its phase II/III clinical trial. METHODS: This is a phase II/III, adaptive, multi-center, single-blinded, randomized controlled superiority trial of SARS-CoV-2 specific polyclonal IVIG (C-IVIG). Patients fulfilling the eligibility criteria will be block-randomized using a sealed envelope system to receive either 0.15 g/Kg C-IVIG with standard of care (SOC) or standard of care alone in 2:1 ratio. The patients will be followed-up for 28 days to assess the primary and secondary outcomes. DISCUSSION: This is a phase II/III clinical trial evaluating safety and efficacy of hyperimmune anti-COVID-19 intravenous immunoglobulin (C-IVIG) in severe COVID-19 patients. This study will provide clinical evidence to use C-IVIG as one of the first-line therapeutic options for severe COVID-19 patients. TRIAL REGISTRATION: Registered at clinicaltrial.gov with NCT number NCT04891172 on May 18, 2021.


Subject(s)
COVID-19 , Coronavirus Infections , Pneumonia, Viral , Humans , SARS-CoV-2 , COVID-19/drug therapy , Betacoronavirus , Pneumonia, Viral/drug therapy , Immunoglobulins, Intravenous/adverse effects , Coronavirus Infections/drug therapy , Pandemics , Treatment Outcome , Randomized Controlled Trials as Topic , Multicenter Studies as Topic , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic
4.
Crit Care ; 26(1): 338, 2022 11 04.
Article in English | MEDLINE | ID: covidwho-2108872

ABSTRACT

We conducted a proof of concept study where Anapnoguard endotracheal tubes and its control unit were used in 15 patients with COVID-19 acute respiratory distress syndrome. Anapnoguard system provides suction, venting, rinsing of subglottic space and controls cuff pressure detecting air leakage through the cuff. Alpha-amylase and pepsin levels, as oropharyngeal and gastric microaspiration markers, were assessed from 85 tracheal aspirates in the first 72 h after connection to the system. Oropharyngeal microaspiration occurred in 47 cases (55%). Episodes of gastric microaspiration were not detected. Patient positioning, either prone or supine, did not affect alpha-amylase and pepsin concentration in tracheal secretions. Ventilator-associated pneumonia (VAP) rate was 40%. The use of the AG system provided effective cuff pressure control and subglottic secretions drainage. Despite this, no reduction in the incidence of VAP has been demonstrated, compared to data reported in the current COVID-19 literature. The value of this new technology is worth of being evaluated for the prevention of ventilator-associated respiratory tract infections.


Subject(s)
COVID-19 , Pneumonia, Ventilator-Associated , Respiratory Distress Syndrome , Humans , Intensive Care Units , Pepsin A , Pronation , Equipment Design , Pneumonia, Ventilator-Associated/etiology , Intubation, Intratracheal/adverse effects , alpha-Amylases
5.
Clinical Imaging ; 2022.
Article in English | ScienceDirect | ID: covidwho-2104583

ABSTRACT

Coronavirus disease 2019 (COVID-19) is associated with pneumonia and has various pulmonary manifestations on computed tomography (CT). Although COVID-19 pneumonia is usually seen as bilateral predominantly peripheral ground-glass opacities with or without consolidation, it can present with atypical radiological findings and resemble the imaging findings of other lung diseases. Diagnosis of COVID-19 pneumonia is much more challenging for both clinicians and radiologists in the presence of pre-existing lung disease. The imaging features of COVID-19 and underlying lung disease can overlap and obscure the findings of each other. Knowledge of the radiological findings of both diseases and possible complications, correct diagnosis, and multidisciplinary consensus play key roles in the appropriate management of diseases. In this pictorial review, the chest CT findings are presented of patients with underlying lung diseases and overlapping COVID-19 pneumonia and the various reasons for radiological lung abnormalities in these patients are discussed.

6.
Med Clin (Engl Ed) ; 158(7): 301-307, 2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-2105563

ABSTRACT

Introduction and objectives: Tocilizumab is an interleukin-6 receptor-blocking agent proposed for the treatment of severe COVID-19; however, limited data are available on their efficacy. The aim of this study was to assess the effect of tocilizumab on the outcomes of patients with COVID-19 pneumonia by using propensity-score-matching (PSM) analysis. Methods: A retrospective observational analysis of hospitalized COVID-19 adult patients admitted to the Vall d'Hebron Hospital was performed between March and April 2020. We used the logistic regression to analyze the effect of tocilizumab on mortality, as main outcome, and PSM analysis to further validate their effect. Secondary outcomes were length-of-stay (LOS) and intensive-care-unit (ICU) stay. Same outcomes were also assessed for early tocilizumab administration, within 72 h after admission. Patients were selected by matching their individual propensity for receiving therapy with tocilizumab, conditional on their demographic and clinical variables. Results: A total of 544 COVID-19 patients were included, 197 (36.2%) were treated with tocilizumab of whom 147 were treated within the first 72 h after admission; and 347 were included in the control group. After PSM analyses, the results showed no association between tocilizumab use and overall mortality (OR = 1.03, 95%CI: 0.63-1.68). However, shorter ICU-stay in the tocilizumab group was found compared to the control group (Coefficient -4.27 95%CI: -6.63 to -1.92). Similar results were found in the early tocilizumab cohort. Conclusions: The administration of tocilizumab in patients with moderate to severe COVID-19 did not reduce the risk of mortality in our cohort of patients, regardless of the time of administration.


Introducción y objetivos: El tocilizumab es un agente bloqueador del receptor de la interleucina 6 propuesto para el tratamiento de la COVID-19 grave; sin embargo, se dispone de datos limitados sobre su eficacia. El objetivo de este estudio fue evaluar el efecto de tocilizumab en los resultados de los pacientes con neumonía por COVID-19 mediante un análisis de emparejamiento por propensity-score-matching (PSM, «puntuación de propensión¼). Métodos: Se realizó un análisis observacional retrospectivo de los pacientes adultos con COVID-19 ingresados en el Hospital Vall d'Hebron entre marzo y abril de 2020. Se utilizó la regresión logística para analizar el efecto de tocilizumab en la mortalidad, como resultado principal, y el análisis PSM para validar aún más su efecto. Los resultados secundarios fueron la duración de la estancia y la estancia en la unidad de cuidados intensivos (UCI). También se evaluaron los mismos resultados para la administración temprana de tocilizumab, dentro de las 72 h posteriores al ingreso. Los pacientes se seleccionaron mediante el emparejamiento de su propensión individual a recibir tratamiento con tocilizumab, condicionado a sus variables demográficas y clínicas. Resultados: Se incluyeron 544 pacientes de COVID-19, 197 (36,2%) fueron tratados con tocilizumab, de los cuales 147 fueron tratados dentro de las primeras 72 h tras el ingreso; y 347 fueron incluidos en el grupo control. Tras los análisis PSM, los resultados no mostraron ninguna asociación entre el uso de tocilizumab y la mortalidad global (OR = 1,03; IC del 95%: 0,63-1,68). Sin embargo, se encontró una menor estancia en la UCI en el grupo de tocilizumab en comparación con el grupo de control (coeficiente −4,27; IC del 95%: −6,63 − −1,92). Se encontraron resultados similares en la cohorte de tocilizumab temprano. Conclusiones: La administración de tocilizumab en pacientes con COVID-19 moderada a grave no redujo el riesgo de mortalidad en nuestra cohorte de pacientes, independientemente del momento de la administración.

7.
J Theor Biol ; 555: 111293, 2022 Dec 21.
Article in English | MEDLINE | ID: covidwho-2105496

ABSTRACT

We develop a lattice-based, hybrid discrete-continuum modeling framework for SARS-CoV-2 exposure and infection in the human lung alveolar region, or parenchyma, the massive surface area for gas exchange. COVID-19 pneumonia is alveolar infection by the SARS-CoV-2 virus significant enough to compromise gas exchange. The modeling framework orchestrates the onset and progression of alveolar infection, spatially and temporally, beginning with a pre-immunity baseline, upon which we superimpose multiple mechanisms of immune protection conveyed by interferons and antibodies. The modeling framework is tunable to individual profiles, focusing here on degrees of innate immunity, and to the evolving infection-replication properties of SARS-CoV-2 variant strains. The model employs partial differential equations for virion, interferon, and antibody concentrations governed by diffusion in the thin fluid coating of alveolar cells, species and lattice interactions corresponding to sources and sinks for each species, and multiple immune protections signaled by interferons. The spatial domain is a two-dimensional, rectangular lattice of alveolar type I (non-infectable) and type II (infectable) cells with a stochastic, species-concentration-governed, switching dynamics of type II lattice sites from healthy to infected. Once infected, type II cells evolve through three phases: an eclipse phase during which RNA copies (virions) are assembled; a shedding phase during which virions and interferons are released; and then cell death. Model simulations yield the dynamic spread of, and immune protection against, alveolar infection and viral load from initial sites of exposure. We focus in this paper on model illustrations of the diversity of outcomes possible from alveolar infection, first absent of immune protection, and then with varying degrees of four known mechanisms of interferon-induced innate immune protection. We defer model illustrations of antibody protection to future studies. Results presented reinforce previous recognition that interferons produced solely by infected cells are insufficient to maintain a high efficacy level of immune protection, compelling additional mechanisms to clear alveolar infection, such as interferon production by immune cells and adaptive immunity (e.g., T cells). This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Interferons , Antiviral Agents , Lung , Immunity, Innate , RNA
8.
Int J Infect Dis ; 2022 Nov 09.
Article in English | MEDLINE | ID: covidwho-2105085

ABSTRACT

PURPOSE: This study aimed to investigate the differences between elderly patients hospitalized with coronavirus disease 2019 (COVID-19) or influenza A H1N1 virus infections. METHODS: We contrasted two absolute groups of patients (age ≥ 60) infected with either COVID-19 (n = 222) or influenza A H1N1 virus infections (n = 96). Propensity score matching was used to reduce the imbalance between the two matched groups. The clinical features, imaging presentations, therapies, and prognosis data were compared between the two groups. RESULTS: The influenza patients showed higher proportions of cough, expectoration, fatigue and shortness of breath. Higher counts of lymphocytes, hemoglobin and creatine kinase and lower counts of WBCs, neutrophils, blood urea nitrogen and C-reactive protein were found in the COVID-19 patients. Regarding the imaging characteristics, bilateral pneumonia was the most abnormal pattern in the two groups of patients. The incidence of ARDS or death was lower among the COVID-19 patients. CONCLUSIONS: The clinical manifestations of COVID-19 patients are more concealed than those of influenza patients. Fewer symptoms of sputum production, fatigue, and shortness of breath combined with lower counts of WBCs, neutrophils and CRP are possible predictive factors of COVID-19 among elderly patients.

9.
EBioMedicine ; 85: 104295, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2104816

ABSTRACT

BACKGROUND: A comparison of pneumonias due to SARS-CoV-2 and influenza, in terms of clinical course and predictors of outcomes, might inform prognosis and resource management. We aimed to compare clinical course and outcome predictors in SARS-CoV-2 and influenza pneumonia using multi-state modelling and supervised machine learning on clinical data among hospitalised patients. METHODS: This multicenter retrospective cohort study of patients hospitalised with SARS-CoV-2 (March-December 2020) or influenza (Jan 2015-March 2020) pneumonia had the composite of hospital mortality and hospice discharge as the primary outcome. Multi-state models compared differences in oxygenation/ventilatory utilisation between pneumonias longitudinally throughout hospitalisation. Differences in predictors of outcome were modelled using supervised machine learning classifiers. FINDINGS: Among 2,529 hospitalisations with SARS-CoV-2 and 2,256 with influenza pneumonia, the primary outcome occurred in 21% and 9%, respectively. Multi-state models differentiated oxygen requirement progression between viruses, with SARS-CoV-2 manifesting rapidly-escalating early hypoxemia. Highly contributory classifier variables for the primary outcome differed substantially between viruses. INTERPRETATION: SARS-CoV-2 and influenza pneumonia differ in presentation, hospital course, and outcome predictors. These pathogen-specific differential responses in viral pneumonias suggest distinct management approaches should be investigated. FUNDING: This project was supported by NIH/NCATS UL1 TR002345, NIH/NCATS KL2 TR002346 (PGL), the Doris Duke Charitable Foundation grant 2015215 (PGL), NIH/NHLBI R35 HL140026 (CSC), and a Big Ideas Award from the BJC HealthCare and Washington University School of Medicine Healthcare Innovation Lab and NIH/NIGMS R35 GM142992 (PS).


Subject(s)
COVID-19 , Influenza, Human , Pneumonia, Viral , Humans , SARS-CoV-2 , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Retrospective Studies , Hospitals
10.
Comput Biol Med ; 150: 106165, 2022 Oct 05.
Article in English | MEDLINE | ID: covidwho-2104646

ABSTRACT

OBJECTIVE: To develop a two-step machine learning (ML) based model to diagnose and predict involvement of lungs in COVID-19 and non COVID-19 pneumonia patients using CT chest radiomic features. METHODS: Three hundred CT scans (3-classes: 100 COVID-19, 100 pneumonia, and 100 healthy subjects) were enrolled in this study. Diagnostic task included 3-class classification. Severity prediction score for COVID-19 and pneumonia was considered as mild (0-25%), moderate (26-50%), and severe (>50%). Whole lungs were segmented utilizing deep learning-based segmentation. Altogether, 107 features including shape, first-order histogram, second and high order texture features were extracted. Pearson correlation coefficient (PCC≥90%) followed by different features selection algorithms were employed. ML-based supervised algorithms (Naïve Bays, Support Vector Machine, Bagging, Random Forest, K-nearest neighbors, Decision Tree and Ensemble Meta voting) were utilized. The optimal model was selected based on precision, recall and area-under-curve (AUC) by randomizing the training/validation, followed by testing using the test set. RESULTS: Nine pertinent features (2 shape, 1 first-order, and 6 second-order) were obtained after features selection for both phases. In diagnostic task, the performance of 3-class classification using Random Forest was 0.909±0.026, 0.907±0.056, 0.902±0.044, 0.939±0.031, and 0.982±0.010 for precision, recall, F1-score, accuracy, and AUC, respectively. The severity prediction task using Random Forest achieved 0.868±0.123 precision, 0.865±0.121 recall, 0.853±0.139 F1-score, 0.934±0.024 accuracy, and 0.969±0.022 AUC. CONCLUSION: The two-phase ML-based model accurately classified COVID-19 and pneumonia patients using CT radiomics, and adequately predicted severity of lungs involvement. This 2-steps model showed great potential in assessing COVID-19 CT images towards improved management of patients.

12.
Chest ; 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2104538

ABSTRACT

BACKGROUND: Home hospital (HH) is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite HH programs operating successfully for years, and scientific evidence of similar or better outcomes compared to bricks and mortar care, HH outcomes in the US for respiratory disease have not been evaluated. RESEARCH QUESTION: Do outcomes differ between patients admitted to HH with acute respiratory illness vs other acute general medical conditions? STUDY DESIGN AND METHODS: Retrospective evaluation of prospectively collected data of patients admitted to HH (2017-21). We compared patients requiring admission with respiratory disease (asthma exacerbation (26%), acute exacerbation for COPD [AECOPD] (33%), and non-COVID-19 pneumonia [PNA] (41%)) to all other HH patients. During HH, patients received 2 nurse and 1 physician visit daily, intravenous medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. MAIN OUTCOMES: acute and post-acute utilization and safety. RESULTS: We analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age 68 (SD, 17), 62% female, and 48% White. Respiratory patients were more often active smokers (21% vs 9%; p<0.001). FEV1/FVC ≤70 in 80% of cases; 28% had severe or very severe obstructive pattern (n=118). During HH, respiratory patients had less utilization: length of stay (mean days, 3.4 vs 4.6), laboratory orders (median, 0 vs 2), intravenous medication (43% vs 73%) and specialist consultation (2% vs 7%) (p all <0.001). 96% of patients completed the full admission at home with no mortality in the respiratory group. Within 30-days of discharge, both groups had similar readmission, ED presentation and mortality rates. INTERPRETATION: HH is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.

13.
Gaceta Medica de Bilbao ; 119(2):88-103, 2022.
Article in English | EMBASE | ID: covidwho-2102322

ABSTRACT

Background: Covid-19 is a novel coronavirus disease with a broad clinical spectrum that has spread globally. Regional information is needed to inform the decision making for health care providers. Aim(s): Describe the presenting characteristics, clinical course, and outcomes of hospitalized patients in a tertiary Mexican hospital. Material(s) and Method(s): Retrospective cohort study of 619 consecutive patients admitted to a Third Level Medical Facility in Puebla, between April 3rd and October 17th, 2020 with a confirmed diagnosis of Covid-19 by RT-PCR. The data included demographics, socioeconomic data, level of education, clinical data of the entire admission, and the outcome at the moment of discharge. Result(s): All patients had pneumonia. Median age was 55 years, 91% had at least one comorbidity and the most frequent were: overweight/obesity (78.2%), hypertension (35.2%) and diabetes mellitus (20.5%). Fever, malaise, and cough were the most common presenting symptoms. D-dimer, fibrinogen, glucose calcium, blood gases and organ damage markers were the most frequent laboratory test values altered. Around 35.1% of patients required invasive ventilation. The overall mortality was 31% and the poorest outcome was seen in those mechanically ventilated outside ICU. Conclusion(s): Overweight, obesity, hypertension and diabetes mellitus were the most common comorbid conditions. Fever, malaise, and cough were the most common initial symptoms. Monocytopenia rather than lymphopenia was seen in this cohort. The highest mortality rate was seen in patients on mechanical ventilation outside UCI. Copyright © 2022 Academia de Ciencias Medicas de Bilbao. All rights reserved.

14.
Aging Clin Exp Res ; 34(10): 2585-2590, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2104161

ABSTRACT

Corticosteroids lower mortality in hospitalized patients with COVID-19 pneumonia requiring oxygen support. In this observational retrospective study (September 2020-June 2021), we explored the association between receiving home corticosteroids without oxygen supply and 30-day mortality in hospitalized patients with COVID-19 pneumonia. Among a total of 794 COVID-19 pneumonia patients, 763 were included into the study (males 68%; mean age 65 ±12 years), of whom 197 (26%) received home corticosteroids (mean daily prednisone equivalent-dose 40 mg ± 12 mg; range 10-50 mg; median 50 mg; IQR 25-50 mg; for 4 days). The overall 30-day mortality of the study population was 12%. The risk of death-adjusted for age, comorbidities, administration of remdesivir and respiratory failure severity-was lower (HR 0.405; p = 0.024) in patients receiving home corticosteroids. After stratifying the study population by age categories, home corticosteroids were associated with an adjusted decrease in mortality risk in patients > 77 years (HR 0.346; p = 0.040). Home corticosteroids may lower the 30-day mortality in elderly COVID-19 patients.


Subject(s)
COVID-19 , Male , Humans , Aged , COVID-19/drug therapy , SARS-CoV-2 , Outpatients , Retrospective Studies , Adrenal Cortex Hormones/therapeutic use , Oxygen , Steroids
15.
J Gen Intern Med ; 37(15): 3839-3847, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2104075

ABSTRACT

BACKGROUND: Deaths from pneumonia were decreasing globally prior to the COVID-19 pandemic, but it is unclear whether this was due to changes in patient populations, illness severity, diagnosis, hospitalization thresholds, or treatment. Using clinical data from the electronic health record among a national cohort of patients initially diagnosed with pneumonia, we examined temporal trends in severity of illness, hospitalization, and short- and long-term deaths. DESIGN: Retrospective cohort PARTICIPANTS: All patients >18 years presenting to emergency departments (EDs) at 118 VA Medical Centers between 1/1/2006 and 12/31/2016 with an initial clinical diagnosis of pneumonia and confirmed by chest imaging report. EXPOSURES: Year of encounter. MAIN MEASURES: Hospitalization and 30-day and 90-day mortality. Illness severity was defined as the probability of each outcome predicted by machine learning predictive models using age, sex, comorbidities, vital signs, and laboratory data from encounters during years 2006-2007, and similar models trained on encounters from years 2015 to 2016. We estimated the changes in hospitalizations and 30-day and 90-day mortality between the first and the last 2 years of the study period accounted for by illness severity using time covariate decompositions with model estimates. RESULTS: Among 196,899 encounters across the study period, hospitalization decreased from 71 to 63%, 30-day mortality 10 to 7%, 90-day mortality 16 to 12%, and 1-year mortality 29 to 24%. Comorbidity risk increased, but illness severity decreased. Decreases in illness severity accounted for 21-31% of the decrease in hospitalizations, and 45-47%, 32-24%, and 17-19% of the decrease in 30-day, 90-day, and 1-year mortality. Findings were similar among underrepresented patients and those with only hospital discharge diagnosis codes. CONCLUSIONS: Outcomes for community-onset pneumonia have improved across the VA healthcare system after accounting for illness severity, despite an increase in cases and comorbidity burden.


Subject(s)
COVID-19 , Pneumonia , Veterans , Humans , United States/epidemiology , Retrospective Studies , Pandemics , COVID-19/therapy , Hospitalization , Patient Acuity , Hospitals
16.
Pediatr Pulmonol ; 2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2103691

ABSTRACT

Since the beginning of the COVID-19 pandemic, multisystem inflammatory syndrome in children (MIS-C) has been reported in increasing numbers, mostly focusing on cardiac dysfunction. Very few studies have evaluated lung involvement in terms of imaging findings, while data regarding pulmonary function in children with MIS-C are not available. The purpose of our study was to evaluate lung involvement in MIS-C by imaging and lung function by structured light plethysmography (SLP) at hospital admission and 6 months afterwards. Spirometry is the gold standard technique to evaluate lung function in children. However, SLP has the advantage of not requiring contact with the patient, offering an effective solution for the evaluation of lung function during the pandemic. To our knowledge this is the first study that aims to investigate pulmonary function by SLP in children with MIS-C.

17.
Metabolites ; 12(11)2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2099659

ABSTRACT

Pneumonia is a common cause of morbidity and mortality and is most often caused by bacterial pathogens. COVID-19 is characterized by lung infection with potential progressive organ failure. The systemic consequences of both disease on the systemic blood metabolome are not fully understood. The aim of this study was to compare the blood metabolome of both diseases and we hypothesize that plasma metabolomics may help to identify the systemic effects of these diseases. Therefore, we profiled the plasma metabolome of 43 cases of COVID-19 pneumonia, 23 cases of non-COVID-19 pneumonia, and 26 controls using a non-targeted approach. Metabolic alterations differentiating the three groups were detected, with specific metabolic changes distinguishing the two types of pneumonia groups. A comparison of venous and arterial blood plasma samples from the same subjects revealed the distinct metabolic effects of pulmonary pneumonia. In addition, a machine learning signature of four metabolites was predictive of the disease outcome of COVID-19 subjects with an area under the curve (AUC) of 86 ± 10 %. Overall, the results of this study uncover systemic metabolic changes that could be linked to the etiology of COVID-19 pneumonia and non-COVID-19 pneumonia.

18.
J Clin Med ; 11(21)2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2099604

ABSTRACT

BACKGROUND: Given the rapidly evolving pandemic of COVID-19 in 2020, authorities focused on the repurposing of available drugs to develop timely and cost-effective therapeutic strategies. Evidence suggested the potential utility of remdesivir in the framework of an early access program. REMDECO-19 is a multicenter national cohort study assessing the ability of remdesivir to improve the outcome of patients hospitalized with COVID-19. METHODS: We conducted a retrospective real-life study that included all patients from the early access program of remdesivir in France. The primary endpoint was the clinical course evolution of critically ill and hospitalized COVID-19 patients treated with remdesivir. Secondary endpoints were the SOFA score evolution within 29 days following the admission and mortality at 29 and 90 days. RESULTS: Eighty-five patients were enrolled in 22 sites from January to April 2020. The median WHO and SOFA scores were respectively reduced by two and six points between days 1 and 29. Improvement in the WHO-CPS and the SOFA score were observed in 83.5% and 79.3% of patients, respectively, from day 10. However, there was no effect of remdesivir on the 90-day survival based on the control cohort for hospitalized COVID-19 patients with invasive ventilation. CONCLUSIONS: SOFA score appeared to be an attractive approach to assess remdesivir efficacy and stratify its utilization or not in critically ill patients with COVID-19. This study brings a new clinical benchmark for therapeutic decision making and supports the use of remdesivir for some hospitalized COVID-19 patients.

19.
Front Med (Lausanne) ; 9: 957773, 2022.
Article in English | MEDLINE | ID: covidwho-2099175

ABSTRACT

Background: In COVID-19 patients requiring mechanical ventilation, the administration of high oxygen (O2) doses for prolonged time periods may be necessary. Although life-saving in most cases, O2 may exert deleterious effects if administered in excessive concentrations. We aimed to describe the prevalence of hyperoxemia and excessive O2 administration in mechanically ventilated patients with SARS-CoV-2 pneumonia and determine whether hyperoxemia is associated with mortality in the Intensive Care Unit (ICU) or the onset of ventilator-associated pneumonia (VAP). Materials and methods: Retrospective single-center study on adult patients with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation for ≥48 h. Patients undergoing extracorporeal respiratory support were excluded. We calculated the excess O2 administered based on the ideal arterial O2 tension (PaO2) target of 55-80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed through multivariate analyses. Results: One hundred thirty-four patients were included. For each day of mechanical ventilation, each patient received a median excess O2 of 1,121 [829-1,449] L. Hyperoxemia was found in 38 [27-55]% of arterial blood gases, hyperoxia + hyperoxemia in 11 [5-18]% of cases. The FiO2 was not reduced in 69 [62-76]% of cases of hyperoxemia. Adjustments were made more frequently with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (OR 1.300 95% CI [1.097-1.542]), time of exposure to hyperoxemia (OR 2.758 [1.406-5.411]), hyperoxia + hyperoxemia (OR 1.144 [1.008-1.298]), and daily excess O2 (OR 1.003 [1.001-1.005]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006-1.061]), time of exposure to hyperoxemia (OR 1.108 [1.018-1.206]), hyperoxia + hyperoxemia (OR 1.038 [1.003-1.075]), and daily excess O2 (OR 1.001 [1.000-1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents (before VAP), prolonged prone positioning and mean PaO2/FiO2 before VAP. Conclusion: Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 pneumonia. The exposure to hyperoxemia may be associated with ICU-mortality and greater risk for VAP.

20.
Ann Intensive Care ; 12(1): 102, 2022 Oct 29.
Article in English | MEDLINE | ID: covidwho-2098453

ABSTRACT

BACKGROUND: Dexamethasone is recommended for COVID-19 patients who require oxygen therapy. However, its effectiveness in reducing mortality and intubation, and its safety, remain debated. We aimed to investigate whether dexamethasone reduces day-28 mortality in unselected patients with critical COVID-19. METHODS: We performed an observational cohort study in consecutive COVID-19 patients admitted to any of 13 French intensive care units (ICUs) in 2020. The primary objective was to determine whether early dexamethasone therapy was associated with day-28 mortality and the secondary objectives were to assess whether early dexamethasone decreased intubation requirements and to collect adverse events. RESULTS: Of 1058 included patients, 611 (57.75%) received early dexamethasone (early dexamethasone group), 358 (33.83%) did not receive any steroids (no steroids group), and 89 (8.41%) received late dexamethasone or other steroids. Day-28 mortality was similar between the early dexamethasone and the no steroids groups (15.06% and 14.25%, respectively; P = 0.59). Factors associated with day-28 mortality were older age (adjusted hazard ratio [aHR], 1.06; 1.04-1.09; P < 0.001), worse SOFA score (aHR, 1.13; 1.06-1.20; P < 0.001), and immunocompromised status (aHR, 1.59; 1.01-2.50; P = 0.043). Early dexamethasone was associated with fewer intubations (48.55% vs. 61.49%, P < 0.001) and more ventilator-free days by day 28 (22 [2-28] vs. 17 [1-28] days, P = 0.003), compared to no steroids. Ventilator-associated pneumonia (VAP) was more common with early dexamethasone (HR, 1.29 [1.01-1.63], P = 0.04) than with no steroids, whereas no differences were noted for bloodstream infection, fungal infection, or gastrointestinal bleeding. CONCLUSIONS: Early dexamethasone in critically ill COVID-19 patients was not associated with lower day-28 mortality. However, early dexamethasone was associated with lower intubation needs and more ventilator-free days by day 28. In patients treated with invasive mechanical ventilation, early dexamethasone was associated with a higher risk of VAP.

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