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1.
Archives of Disease in Childhood ; 107(Supplement 2):A17-A18, 2022.
Article in English | EMBASE | ID: covidwho-2064010

ABSTRACT

Aims The Omicron variant of SARS-CoV-2 variant has rapidly spread in the UK since December 2021.There was a significant increase in the number of children testing positive for SARS-CoV-2 in December 2021 in the population served by this DGHS. A clustering of cases of PIMS- TS was noted in the last week of December 2021 and the first week of January 2022. The focus of this descriptive study of PIMS-TS patients from a single centre is to report the clustering of cases in the Omicron dominant period and to describe the dilemma of managing children who present with fever and pain abdomen. Methods Children confirmed to have PIMS-TS and one child who presented mimicking PIMS -TS were identified, their investigations, treatment and outcomes were reviewed Results A cluster of 6 children diagnosed as PIMS -TS presented from the 29th of December 2021 to the 8th of January 2022.The mean age of patients was 9.3 years. There was ethnic variation with 3 Asian, 2 Afro Caribbean and one White child. Mean CRP was 226( range 85-400). All children presented with fever of more than 3 days.3 children presented with partial Kawasaki features, 2 children were treated for shock and 2 children presented with pain abdomen and fever. A 15 year old presented with fever, pain abdomen and tenderness in the right iliac fossa. He was managed initially as appendicitis. Blood markers for PIMS-TS were significantly raised along with raised CRP of 204. CT abdomen showed ileitis. His NPA RT- PCR was positive for SARS-CoV-2. He continued to have high fever, a diagnosis of PIMS-TS was made. There was significant improvement in both clinical condition and biochemical markers following IV Methylprednisolone. On the same day a 11 year old presented with fever, pain abdomen and increased irritability. He had global developmental delay and was PEG fed. He was initially managed as PIMS-TS then diagnosed to have appendicitis. CT abdomen showed a perforated appendix. He had a good outcome after surgery Conclusion The clustering of cases of PIMS- TS may be specific to this geographical area and multi-ethnic population following a period of high SARS-CoV-2 prevalence in the community with the Omicron variant. PIMS-TS can closely mimic appendicitis and distinguishing between both can be difficult. In the first child, CRP was unusually high (202) which helped in making a diagnosis avoiding unnecessary surgery. In the second child clinical acumen and involvement of multiple specialist teams helped in making the diagnosis of appendicitis. The global developmental delay and the child being nonverbal proved to be confounding factors. Cases of PIMS-TS can have bowel inflammation, it is also possible that COVID-19 can occur with other pathologies. Radiology findings need to be interpreted with the clinical picture. Clinical acumen, considering a range of differentials working closely with other specialities enables us to make a correct diagnosis for the unwell child who presents in the COVID-19 pandemic.

2.
American Journal of Transplantation ; 22(Supplement 3):874-875, 2022.
Article in English | EMBASE | ID: covidwho-2063454

ABSTRACT

Purpose: To characterize demographics, treatment patterns, and outcomes among 3,998 transplant patients hospitalized for COVID-19 over 16 months of the pandemic (May '20-Aug '21). Method(s): Adult patients in a transplant cohort (TC) and non-transplant cohort (NTC) hospitalized with COVID-19 (ICD-10: U07.1) were compared in the Premier Healthcare Database from May '20-Aug '21. Baseline measures in first two days, demographics, comorbidity, COVID-19 treatments and immunosuppressants were analyzed. Outcomes included mortality (discharge status expired or hospice) and hospital and ICU LOS. Result(s): 3,998 TC patients were hospitalized for COVID-19 in 587 US hospitals. Compared to NTC, TC were younger (61 vs 64 yrs;p<.0001), less likely to be white (59% vs 67%;p<.0001), obese (24% vs 33%;p<.0001) or have COPD (17% vs 24%;p<.0001). TC had higher rates hypertension (84% vs 69%;p<.0001), renal disease (80% vs 22%, p<.0001), diabetes (48% vs 29%;p<.0001) and chronic heart failure (23% vs 18%;p<.0001). During hospitalization, a lower proportion of TC needed any oxygen therapy compared to NTC (p<.05). Compared to NTC, fewer TC received remdesivir (RDV) (44% vs 48%;p<.0001), but more received corticosteroids (87% vs 78%;p<.0001), anticoagulants (44% vs 29%;p<.0001) and convalescent plasma (18% vs 16%;p=0.007). In TC, 44% received MMF, 73% calcineurin inhibitors and 5% mTOR. Use of MMF did not change over time (43% May-Jul 2020;43% Aug- Dec 2020;45% 2021). TC had higher ICU admission rates (31% vs 28%;p.001), but similar hospital LOS and ICU LOS compared to NTC. All-cause mortality in NTC (15% overall;16% May-Jul 2020;16% Aug-Dec 2020;14% 2021) was not significantly different than TC over time (16% overall;13% May-Jul 2020;16% Aug-Dec 2020;16% 2021). Conclusion(s): Very few large studies have assessed COVID-19 management in transplant patients over time. All-cause mortality was comparable in both cohorts despite TC immunosuppression. RDV use was lower in TC. Uncertainty around MMF use in COVID-19 patients did not impact reported use of MMF. Further analyses are needed to evaluate confounding factors (medication sequence, time since transplant, disease severity) and impact of external factors such as earlier testing and treatment for COVID-19, vaccination, and new variants. (Table Presented).

3.
American Journal of Transplantation ; 22(Supplement 3):426-427, 2022.
Article in English | EMBASE | ID: covidwho-2063400

ABSTRACT

Purpose: Due to heterogeneity observed in the kidney transplant population, it has been extremely challenging for traditional methods such as histopathology to predict graft outcomes. In this real-world evidence(RWE) study, we applied machine learning (ML) models to a multi-analyte urinary biomarker assay to predict whether a kidney allograft would experience a rejection episode. Method(s): A cohort of 550 (37.5% biopsy matched) urine samples from patients across 3 renal transplant centers were used to develop a predictive ML model (scaled 0-100) to prognosticate allograft failure. Samples were collected between 1-1539 days post-transplant from allograft recipients with ages ranging from 7-77 years. Of the 206 biopsy matched samples, acute kidney allograft rejection (AR) and no-rejection (NR) phenotypes were confirmed in 136 and 70 respectively. We also evaluated the developed ML model on two additional cohorts of 15 COVID+ transplant recipients and 30 non-transplant healthy population. The ML model incorporates clinico-demographics with 6 urinary biomarkers: Clusterin, total protein, CXCL10, Creatinine, cfDNA and methylated cfDNA. Monte Carlo confidence intervals for the model incorporated biomarker assay and sample variances. Result(s): The novel rejection score was able to discriminate AR from NR efficiently. Score below 32 classified stable allograft, score range of 32 - 55 identified progression of AR, and Score > 55 identified AR with high sensitivity: 92%, and specificity: 89%;AUC: 96% and accuracy: 91%(figure). The associated NPV and PPV of 87% and 93% respectively. In the COVID cohort with 86% clinician assessed rejection, the median score was 51(IQR:30-87). In the non-transplants the median score was 19(IQR:13-26). It was established that presence of COVID was not a confounder in the model. Conclusion(s): The accuracy of the novel rejection score emphasizes the promise of applying ML algorithms as an aid to decision-making in evaluating graft outcomes with high sensitivity and specificity. Moreover, this RWE retrospective analysis demonstrates the efficacy of the urine multi-analyte approach to accurately predict acute rejection in kidney transplant recipients. (Figure Presented).

4.
Clinical Nutrition ESPEN. ; 2022.
Article in English | EMBASE | ID: covidwho-2061014

ABSTRACT

Background and aims: The micronutrient status of those receiving long-term enteral nutrition (EN) is poorly characterised. This systematic review was undertaken to determine prevalence of micronutrient deficiency in those receiving EN;the impact of the route of feeding;whether underlying disease or clinical factors were associated with micronutrient status;and the efficacy of interventions utilised to treat identified micronutrient deficiency. Method(s): Electronic databases (CINAHL, Embase, PubMed, Web of Science) were searched to June 2021 for publications of primary investigation of micronutrient status in adults or children (>5yrs) receiving EN for >2 months in their usual residence. Independent assessment of compliance with inclusion criteria (Covidence), data extraction of predefined data points, assessment of basis (Academy of Dietetics Quality Checklist) and certainty of evidence (GRADE) was assessed by at least two authors. (PROSPERO Registration: CRD42021261113). Result(s): Thirty-one studies (n = 744) met inclusion criteria. Deficiency was reported for copper, zinc, selenium, beta-carotene, and vitamins A, D and E: Only copper, zinc and selenium were associated with physical/haematological manifestations of deficiency. Jejunal feeding was associated with the development of copper deficiency and often required gastric or parenteral replacement to resolve the issue. Circumstances leading to deficiency included receiving feed products formulated with inadequate amounts of the implicated nutrient, low feed product volumes in the context of low macronutrient requirements, and nutritional decline prior to commencement of EN. Potential confounding factors such as inflammation were rarely accounted for. No studies investigated the contribution of underlying clinical condition on micronutrient status, and no other clinical or demographic features appeared to impact outcomes. Reported methods for treating identified deficiencies were usually successful in reversing deficiency symptoms. The certainty of evidence is very low, and the level of bias moderate to high. Conclusion(s): While the evidence is very uncertain about the effect of long-term enteral feeding on the development of micronutrient deficiencies, clinicians should be alert to the possibility of micronutrient deficiency developing in long-term EN fed patients. Those who may be at increased risk are those receiving nutrition into the jejunum, those who meet macronutrient requirements in low volumes of EN product, and those commencing EN in a nutritionally deplete state. Further research and surveillance of micronutrient status with contemporary EN products and practices is required. Copyright © 2022

5.
Chest ; 162(4):A1878, 2022.
Article in English | EMBASE | ID: covidwho-2060879

ABSTRACT

SESSION TITLE: COPD Medications and Treatment Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Conclusive data on whether inhaled corticosteroids (ICS) have a protective effect on COVID-19 hospitalization rates or outcomes are lacking. The main objective of our study was to assess the impact of pre-hospitalization ICS use on the clinical course of hospitalized COVID-19 patients with underlying obstructive lung diseases - asthma and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a retrospective chart review study of all COVID-19 patients hospitalized at our institution between March 1st - June 3th, 2020. Diagnosis of asthma and COPD was determined using ICD-10 codes. Demographics, information about pre-hospitalization ICS use and clinical data were recorded through chart review. Outcomes of interest were all-cause 28-day mortality and need for intubation. Chi-square or Fischer’s exact test was used to assess univariate associations. Linear and logistic regression models were constructed to adjust for potential confounders. RESULTS: Data was analyzed from 356 hospitalized COVID-19 patients with prior diagnosis of obstructive lung disease;219/356 (62%) had asthma, 137/356 (38%) had COPD. Hospitalized COVID-19 patients with asthma were younger (mean age 61 [range: 51-71] vs 74 [range:67-81] years, p<0.01), more likely to be female (69% vs 48%, p<0.01), Hispanic (43% vs 25%, p<0.01) and never smokers (52% vs 20%, p<0.01) compared to those with COPD. There was no difference in the use of pre-hospitalization ICS between the two groups (35.2% in Asthma vs 38% in COPD, p=0.59). Overall, COVID-19 patients with COPD were more likely to die compared to those with asthma (47% vs 25%, p<0.01). Pre-hospitalization ICS use was not significantly associated with all-cause 28-day mortality (asthma: OR 0.9 [95%CI 0.4-2.0], p=0.85;COPD: OR 0.7 [95%CI 0.3-1.5], p=0.3) or need for intubation (asthma: OR 1.0 [95%CI 0.5-2.0], p=0.94;COPD: OR 0.7 [95%CI 0.3-1.7],p=041) after adjusting for potential confounders. CONCLUSIONS: Mortality among hospitalized COVID-19 patients with COPD was higher compared to those with asthma. While the pre-hospitalization use of ICS was similar between the two groups, it did not protect hospitalized COVID-19 patients in either group from intubation or mortality. High mortality rates among COVID-19 patients with COPD is likely due to concomitant risk factors such as older age, and comorbidities such as diabetes and chronic kidney disease. Being a retrospective study, the quality of our data was limited and dependent on documentation accuracy. CLINICAL IMPLICATIONS: Pre-hospitalization ICS use did not improve outcomes in hospitalized COVID-19 patients with asthma or COPD. Further studies are required to investigate the role of ICS in preventing COVID-19 related hospitalizations, morbidity and mortality in randomized control settings. DISCLOSURES: No relevant relationships by Hammad Aleem No relevant relationships by Denisa Ferastraoaru No relevant relationships by Manuel Hache Marliere No relevant relationships by Gabriel Hernández Romero No relevant relationships by Christa McPhee No relevant relationships by Francine Palmares No relevant relationships by Divya Reddy No relevant relationships by Felix Reyes No relevant relationships by Deborah Schwartz

6.
Chest ; 162(4):A1117, 2022.
Article in English | EMBASE | ID: covidwho-2060772

ABSTRACT

SESSION TITLE: SESSION TYPE: PRESENTED ON: PURPOSE: Critical Care Medicine (CCM) patients admitted to the Intensive Care Unit (ICU) but receiving ongoing care in the Emergency Department (ED) while awaiting an Intensive Care Unit (ICU) bed has been a growing area of concern. This has occurred more frequently during the COVID-19 global pandemic and resultant surge conditions at many hospitals. METHODS: This project presents a retrospective chart review and analysis, inclusive of 455 patients admitted to the medical ICU but receiving initial care while in the ED at Cleveland Clinic Akron General between October 1st 2020 and January 1st 2022. Linear regression analysis was performed to compare the association of boarding time (in total minutes after CCM assumed care,) ICU length of stay, and total ventilator days. Logistical regression analysis was used to investigate the association between boarding time and in-hospital mortality. Patients were further stratified into a subset of those with a diagnosis of Acute Respiratory Failure (ARF) in the setting of COVID-19 positivity. RESULTS: The total number of patients admitted under the ICU service was 454 (n=454). The total number of patients in a subset with ARF in the setting of COVID-19 positivity was 275 (n=275). Median age was 62.8 +/- 16.9 years. Mean ED boarding time was 462 +/- 1108 minutes. There was a statistically significant association between boarding time and ICU length of stay and boarding time and ventilator days. Linear regression analysis showed the variance between the ED boarding time and length of stay to be 0.024% (p-value 0.0116) and with ventilator days to be 0.023% (p-value 0.0401). Logistical regression analysis investigating an association between boarding time and in-hospital mortality did not reveal any significant relationship between these two variables. For the sub-group of ARF and COVID-19 positivity, there were no statistically significant associations. CONCLUSIONS: The overall impact of boarding time on ICU length of stay and in-hospital mortality was rather small, yet statistically significant: for every one additional minute of boarding time, ICU length of stay increased by 0.024% and ventilator days increased by 0.023%. Forthcoming analysis will stratify patients based on acuity and risk-adjustment metrics, in order to further eliminate confounding factors which may influence boarding time. CLINICAL IMPLICATIONS: The question of ED-CCM boarding is worthy of further examination in the setting of new and increased demands and strain on the national Critical Care Medicine infrastructure, as a result of the COVID-19 pandemic. This project aims to characterize the problem further and explore associated outcomes. This may provide the basis for further investigations, or targeted interventions, around the issue of EM-CCM boarding. DISCLOSURES: No relevant relationships by Amit Diwakar No relevant relationships by Zachary Jerusalem No relevant relationships by Palak Rath No relevant relationships by Sterling Shriber

7.
Chest ; 162(4):A987, 2022.
Article in English | EMBASE | ID: covidwho-2060745

ABSTRACT

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: COVID-related acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. PaO2/Fio2 (PFR) is a prognostic and severity marker for ARDS. Other markers have been posited for ARDS. PEEP Index (PIx) [PEEP/PFR] or [(PEEP*Fio2)/PaO2] could serve as a new discriminatory marker to assess rescue therapies such as proning or ECMO referral. METHODS: Retrospective cohort study of all intubated COVID-19 patients with ARDS hospitalized at our institution between February 5th – May 11th, 2020. ARDS were calculated within first 24 hours of worst PaO2/FIO2 and their associated PEEP with bilateral infiltrates on Chest X-ray manually confirmed within 24hours of intubation fulfilling 2012 Berlin criteria. Outcomes of interest were all-cause in-hospital mortality, need for pronation and paralysis use. Binomial logistic regression with ROC curve were performed for univariate association for outcomes of interest. Cox proportional hazard regression modeling was performed and adjusted for potential confounders. PFR was transformed into a denominator of itself to reflect a direct proportional relationship. RESULTS: Data was analyzed from 113 hospitalized COVID-19 patients with identified ARDS. Mean age was 56.4 (STD 14.4);24% (27/113) were female. Median BMI was 30.3 [IQR 48.5,65.5]. Mean Tidal Volume (Vt) was 430 (STD 54). 64% (72/113) were compliant with low Vt (=<6mL/kg based on IBW). Median PFR 125 [IQR 99,192]. Mortality was 66% (74/113). 44% (50/113) were proned. 62% (70/113) required paralysis. PEEP Index outperformed PFR for discrimination for proning use: AUC 0.73 [95%CI 0.63,0.82], p< 0.005;vs AUC 0.674 [95%CI 0.58,0.77], p= 0.02. PEEP Index performed mildy better than PFR for discrimination of requiring paralytic use in ARDS with AUC 0.68 [95% 0.57,0.78], p< 0.05;vs AUC 0.62 [95%CI 0.51,0.73], p<0.05. APACHE2 score showed poor discrimination for both proning and paralytic use (AUC= 0.46 [95%CI 0.35,0.56];p=0.43 and respectively, AUC=0.45 [95%CI 0.34,0.56];p=0.36). After adjusting for confounders, PEEP Index nor PFR didn’t for predict for mortality (p>0.05);however, our sample was not powered. CONCLUSIONS: PEEP Index (PIx) is a novel tool that can serve as a better discriminatory function to evaluate patients with ARDS in the ICU who will require proning in comparison to traditional used PFR. CLINICAL IMPLICATIONS: PEEP Index (PIx) can serve as an easy alternative calculation to Oxygenation Index (OI) [(FiO2 x PAW) / PaO2] to identify patients that would benefit from early proning and other rescue therapies. Further studies are required to compare and validate PIx and OI prospectively as well as benefit cut-off points between proning and ECMO. DISCLOSURES: No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere no disclosure on file for Adarsh Katamreddy;No relevant relationships by Hyomin Lim No relevant relationships by Marzio Napolitano No relevant relationships by Leonidas Palaiodimos No relevant relationships by Anika Sasidharan Nair No relevant relationships by Jee Young You

8.
Chest ; 162(4):A896, 2022.
Article in English | EMBASE | ID: covidwho-2060720

ABSTRACT

SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: We hypothesized that supplementation of NIH recommended remdesivir (REM) and dexamethasone (DEX) combination treatment with tocilizumab (TOCI) or baricitinib (BARI) initiated inside 48h of index hospitalization would enhance reduction of inflammatory markers and discharges to home in adults over 18 years old who received intensive care. METHODS: Electronic medical record data were extracted under IRB exemption. Treatment responsiveness was estimated using delta in C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) and D-dimer levels from assays respectfully respectively first within 24h and last between 25-72h of initiating REM/DEX with vs without TOCI or BARI. Confounder balanced multigroup contrasts were significant when p<.017. RESULTS: Between March 10, 2020 and January 31, 2022, 891 COVID-19 patients were admitted to the ICU with 459 receiving REM/DEX (n=326) or supplemented with BARI (n=85) or TOCI (n=41). Results are sequenced as REM/DEX, REM/DEX/BARI, REM/DEX/TOCI. Age was 67[57,77] (p<.0001) vs. 61[51,69] and 62[48,68] among statistically similar sex (male, 65%;female, 35%) and race (White, 76%;Black, 8%;Other, 16%) distributions and BMI (32[27,38] kg/m2). Hypertension (70%), obesity (59%), diabetes (38%), deficiency anemia (36%), coagulopathy (29%) chronic pulmonary disease (22%), and renal failure (17%) were similarly distributed. Initial CRP, ferritin, LDH and D-dimer levels -24h to +24h of REM/DEX first dose respectively were 12.1[7.1,18.2], 11.4[7.5,15.7], 14.0[11.2,21.0] mg/dL;811[441,1390], 1178[529,1956], 1110[653,1810] ng/mL (REM/DEX, p=.013);437[321,576], 516[403,695], 518[397,692] U/L (REM/DEX, p=.0001);and 1.02[0.67,2.28], 0.97[0.72,1.88], 1.47[0.86,2.19] ug/mL. Responsiveness quantified using last levels 25h-72h post REM/DEX first dose respectively included -3.4[-7.2,-0.6], -4.3[-7.7,-1.9], -7.2[-10.1,-3.6] mg/dL (REM/DEX/TOCI, p=.014);7[-125,202], -94[-329,69], -29[-181, 535] U/L;-3[-74,80], 85[-58,273], -33[-188,-3] U/L (p=.051);and 0.00[-0.50,1.05], 0.88[-0.45,10.52], -0.01[-0.38,0.50] ug/mL. ICU length of stay (LOS) was 6[3,13], 6[3,12], 8[5,15] days (p<.00001) with hospital LOS of 16[10,24], 20[12,33], 17[11,23] days (REM/DEX/BARI, p<.021). Hospital mortality was 51%, 71%, 43%, with REM/DEX/BARI exhibiting increase (p=.0019), but REM/DEX/TOCI numerically lowest (p>.017). Discharge to home was 24%, 18%, 43%, with REM/DEX/TOCI demonstrating increase (p=.0038). CONCLUSIONS: REM/DEX/TOCI combination therapy provided largest reduction of inflammatory markers and mortality while substantially increasing percentage of discharges to home. REM/DEX treatment responsiveness was adversely impacted by addition of baricitinib, while augmented by tocilizumab. CLINICAL IMPLICATIONS: Our findings highlight need to refine early longitudinal biomarker-tracking to identify patient-centric COVID-19 treatment responsiveness to COVID-19 directed treatments. DISCLOSURES: No relevant relationships by Qassem Abdelal No relevant relationships by Kevin Dawkins No relevant relationships by Karen Hamad No relevant relationships by Natalia Lattanzio No relevant relationships by Richard Walo Jr No relevant relationships by Wilhelmine Wiese-Rometsch No relevant relationships by Stephanie Williams

9.
Chest ; 162(4):A812, 2022.
Article in English | EMBASE | ID: covidwho-2060695

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Despite efforts for racial equality, racial disparities are evident in intensive care units. Numerous studies have demonstrated that Non-White patients have higher rates of sepsis, acute kidney injury, and overall mortality throughout different hospital settings. Mechanical ventilation is a common ICU intervention that has multiple associated complications. Prolonged mechanical ventilation (PMV) has been shown to have increased morbidity and resource utilization. In this study, we hypothesized that Non-White patients would experience PMV at higher rates than White patients. METHODS: The analysis cohort was filtered from de-identified administration registry containing inpatients admitted across a diverse five hospital health system between the years 2014 and 2021. Encounters coinciding with surges in COVID-19 were removed. The study group included discharged inpatients that were 18 years or older and experienced mechanical ventilation during their hospital stay. Prolonged mechanical ventilation (PMV) was defined as mechanical ventilation lasting 21 days or longer in accordance with the Centers for Medicare and Medicaid Services (CMS) definition. Univariate analysis was performed to compare characteristics and outcomes across racial identities. Multivariate logistic regression was completed regarding PMV allowing adjustment for confounding variables and assessment of the independent predictive value of racial identity. The analysis was deemed exempt from IRB review, and was performed using R in R-Studio, p-value ≤0.05 was considered significant. RESULTS: The compiled dataset resulted in 8917 mechanical ventilation cases. Of the 8917 cases, 338 patients experienced prolonged mechanical ventilation. The overall rate of PMV was 4%. There were 176/5987 (2.9%) White patients and 162/2930 (5.5%) Non-white patients that had prolonged mechanical ventilation (p<.001). Specifically for Black patients, logistic regression utilized all significant univariate variables confirmed the independent predictive value multivariate OR of 1.62. Additionally, Non-White patients with PMV had on average longer ICU length of stay and were less likely to be discharged to Hospice. CONCLUSIONS: There has been considerable research in identifying marginalized heath care of Non-white patients throughout the hospital. In the ICU, we looked to identify prolonged mechanical ventilation as it’s associated with numerous deleterious outcomes such as sepsis and delirium. A multihospital single system evaluation identified 338 cases of prolonged mechanical ventilation. Following data analysis, Non-White patients were nearly twice the risk of experiencing PMV as compared to White patients. Further investigation into the specific factors is still needed to reduce racial disparities in mechanical ventilation. CLINICAL IMPLICATIONS: Identification of racial disparities, rates of prolonged mechanical ventilation, and length of stay in the ICU. DISCLOSURES: No relevant relationships by David Barbat No relevant relationships by Camden Gardner

10.
Chest ; 162(4):A712-A713, 2022.
Article in English | EMBASE | ID: covidwho-2060673

ABSTRACT

SESSION TITLE: Pulmonary Involvement in Critical Care Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hemophagocytic Lymphohistiocytosis (HLH) is a condition in which the body's natural ability to end an immune or inflammatory response is defective1. COVID-19 also presents with severe inflammation, and like HLH, leads to significantly elevated ferritin2. We present a case that was initially thought to be COVID-19, but the patient was diagnosed with HLH in the setting of S. aureus endocarditis. CASE PRESENTATION: A 62-year-old male with a history of atrial fibrillation, mechanical mitral valve on warfarin, type II diabetes, chronic obstructive pulmonary disease, and recently diagnosed COVID-19 presented to the hospital with progressive dyspnea. In the emergency department, he was found to be hypoxemic and in atrial fibrillation with rapid ventricular response. He had a fever of 39.3°C and his initial laboratory workup revealed hemoglobin of 11.9 g/dL, leukocytes of 5,700, platelets of 83,000, AST 35 U/L, ALT 34 U/L, CRP of 31.89 mg/dL, and ferritin of 1994 ug/L. The patient was admitted and started on dexamethasone 6 mg daily. The following day, the patient's blood work revealed a significant worsening of AST and ALT to 7280 U/L and 3319 U/L, respectively. D-dimer increased to 11861 ng/mL (DDU) and ferritin to 36,470 ug/L. On the third day of admission, his clinical status declined acutely as he became significantly bradycardic, progressing to a cardiac arrest after which he required cardiopulmonary resuscitation, intubation, and was transferred to the intensive care unit. A CT scan obtained revealed hepatomegaly of 22 cm and blood cultures were positive for S. aureus requiring vancomycin treatment. The patient was kept on dexamethasone due to concerns for HLH. Ferritin continued to worsen, reaching 50,749 ug/L. His sCD25 came back positive. Unfortunately, the patient expired on his fifth day of hospitalization after discussing with his family their goals for his care and switching his care to comfort only. DISCUSSION: HLH is a challenging condition since diagnosis is difficult and mortality is high. There are a few methods used to diagnose HLH. Usually, 5 of 8 criteria must be met, which was achieved with this patient. However, often the patient only fulfills 4 of 8 since many criteria are difficult to obtain such as bone marrow biopsy, sCD25, and CXCL9. A useful tool is the H-calculator3. Our patient scored a 180 indicating a 50-75% likelihood of HLH. Assessing the likelihood of disease is important since sCD25 and CXCL9 take time and if the patient is clinically deteriorating treatment should not be delayed. CONCLUSIONS: HLH is catastrophic and rare. Physicians should always have it as a differential diagnosis in patients with severe inflammatory states and elevated ferritins to avoid anchoring bias. If suspicion is high based on clinical evaluation and scores, treatment should not be delayed. Reference #1: Filipovich A, McClain K, Grom A. Histiocytic disorders: recent insights into pathophysiology and practical guidelines. Biol Blood Marrow Transplant. 2010;16(1 Suppl):S82-S89. doi:10.1016/j.bbmt.2009.11.014 Reference #2: Cheng L, Li H, Li L, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618. doi:10.1002/jcla.23618 Reference #3: Fardet L, Galicier L, Lambotte O, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66(9):2613-2620. doi:10.1002/art.38690 DISCLOSURES: No relevant relationships by Areeka Memon No relevant relationships by Carissa Monterroso No relevant relationships by Carson Oprysko No relevant relationships by Eduardo Padrao No relevant relationships by Mouna Penmetsa

11.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-344499

ABSTRACT

Importance: Communication and adoption of modern study design and analytical techniques is of high importance for the improvement of clinical research from observational data. Objective(s): To compare (1) a modern method for causal inference including a target trial emulation framework and doubly robust estimation to (2) approaches common in the clinical literature such as Cox proportional hazards models. To do this, we estimate the effect of corticosteroids on mortality for moderate-to-severe coronavirus disease 2019 (COVID-19) patients. We use the World Health Organization's (WHO) meta-analysis of corticosteroid randomized controlled trials (RCTs) as a benchmark. Design(s): Retrospective cohort study using longitudinal electronic health record data for 28 days from time of hospitalization. Setting(s): Multi-center New York City hospital system. Participant(s): Adult patients hospitalized between March 1-May 15, 2020 with COVID-19 and not on corticosteroids for chronic use. Intervention(s): Corticosteroid exposure defined as >0.5mg/kg methylprednisolone equivalent in a 24-hour period. For target trial emulation, interventions are (1) corticosteroids for six days if and when patient meets criteria for severe hypoxia and (2) no corticosteroids. For approaches common in clinical literature, treatment definitions used for variables in Cox regression models vary by study design (no time frame, one-, and five-days from time of severe hypoxia). Main outcome: 28-day mortality from time of hospitalization. Result(s): 3,298 patients (median age 65 (IQR 53-77), 60% male). 423 receive corticosteroids at any point during hospitalization, 699 die within 28 days of hospitalization. Target trial emulation estimates corticosteroids to reduce 28-day mortality from 32.2% (95% CI 30.9-33.5) to 25.7% (24.5-26.9). This estimate is qualitatively identical to the WHO's RCT meta-analysis odds ratio of 0.66 (0.53-0.82)). Hazard ratios using methods comparable to current corticosteroid research range in size and direction from 0.50 (0.41-0.62) to 1.08 (0.80-1.47). Conclusion and Relevance: Clinical research based on observational data can unveil true causal relationships;however, the correctness of these effect estimates requires designing the study and analyzing the data based on principles which are different from the current standard in clinical research. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.

12.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S144-S145, 2022.
Article in English | EMBASE | ID: covidwho-2057611

ABSTRACT

Background: Multiple studies to date in both pediatric and adult literature have suggested a possible link between acute pancreatitis and recent COVID-19 infection. There have also been several case reports in the pediatric population describing children who presented with acute pancreatitis found to be SARS-CoV-2 PCR positive. Objective(s): The primary aim of our study was to observe acute pancreatitis admission trends in patients <=21-years-old at a local children's hospital between March 1, 2016 and February 28, 2021. The secondary aim was to observe the relationship between COVID-19 and pancreatitis since the onset of the COVID-19 pandemic. We hypothesized that there is an increase in acute pancreatitis admissions in patients <=21 years since the onset of the COVID-19 pandemic, which may be best explained as a post-viral sequela of a recent COVID-19 infection. Method(s): This study is a retrospective chart review that consisted of the following inclusion criteria: any individuals hospitalized <=21 years of age at time of admission with the diagnosis of acute pancreatitis and a peak lipase >200 u/L. Additional data was also obtained including date of admission, duration of admission, peak lipase, etiology of acute pancreatitis, and SARS-CoV-2 IgG and PCR status. Result(s): Over the course of 5 years, 91 patients met the inclusion criteria across 116 admissions for acute pancreatitis. The average number of admissions per year was 23 with highest during year 5 with 39. Females were affected highest with a rate of 1.6:1. The most common etiology of the 116 admissions for acute pancreatitis was idiopathic which accounted for 50 admissions, followed by gallstone pancreatitis which accounted for 23 admissions. Of the 39 patients admitted during the first year of the pandemic, only one was SARS-CoV-2 positive and 2 were SARS-CoV-2 IgG positive;23 had PCR testing obtained and only 9 had IgG testing obtained. Conclusion(s): From the data obtained, there is a statistically significant increase in total admissions for acute pancreatitis during the first year of the pandemic (39 admissions). With a large number of confounding variables, it cannot be concluded this is the result of a current or recent COVID-19 infection. The largest confounding variables include lack of testing for SARS-CoV-2 PCR or IgG and multiple readmissions for acute pancreatitis during the first year of the pandemic compared to any of the previous years. Future investigations should be made to standardize COVID PCR and SARS-CoV2 IgG testing for all patients admitted with acute pancreatitis if further data collection is to be obtained.

13.
ASAIO Journal ; 68(Supplement 3):26, 2022.
Article in English | EMBASE | ID: covidwho-2058110

ABSTRACT

Background: Mortality for patients receiving extracorporeal membrane oxygenation (ECMO) for COVID-19 has increased over time. We investigated the association between immunomodulators and mortality for patients receiving ECMO for COVID-19. Method(s): We analysed the Extracorporeal Life Support Organisation Registry from Jan 1, 2020 through Dec 31, 2021, comparing in-hospital mortality and the overall survival since ECMO initiation of patients who did and did not receive immunomodulators (selective interleukin blockers, corticosteroids, janus-kinase inhibitors, convalescent plasma, and intravenous immunoglobulins) before or during ECMO, by using logistic regression and Cox regression. We calculated the propensity scores, and applied the overlap-weightage method to account for confounding factors. We conducted sensitivity analyses including regression models using inverse propensity score weightage method, models adjusted by propensity score, and unadjusted models to ensure robustness of results. A subgroup analysis on patients receiving corticosteroids was conducted. Result(s): 7180 patients were included in the final analysis. Immunomodulators were associated with increased mortality (OR: 1.168, 95%CI: 1.059-1.289, p=0.0020) and shorter survival since ECMO (HR: 1.05, 95%- CI: 1.078, 95%CI: 1.007-1.154, p=0.031). Similarly, corticosteroids were associated with a significant increase in mortality (OR: 1.302, 95%-CI: 1.180-1.437, p<0.0001) and shorter survival (HR: 1.221, 95%-CI: 1.139- 1.308, p<0.0001). Sensitivity analyses did not significantly change the overall results. Conclusion(s): Immunomodulators and corticosteroids, in particular, were associated with a significant increase in mortality amongst patients receiving ECMO for COVID-19, even after adjusting for potential confounding variables. Further studies are required to evaluate the timing of immunomodulators and understand the possible mechanisms behind this association.

14.
Frontiers in Medicine ; 9, 2022.
Article in English | EMBASE | ID: covidwho-2043475

ABSTRACT

Background and Aims: Adherence to the Mediterranean diet (MD) has been associated with a decreased risk of developing a variety of chronic diseases that are comorbidities in COVID-19 patients. However, its association to the severity and symptoms of COVID-19 are still unknown. This study aimed to examine the association between adherence to the MD pattern and COVID-19 severity and symptoms in Iranian hospitalized patients. Methods: In this cross-sectional study, 250 COVID-19 patients aged 18 to 65 were examined. We employed a food frequency questionnaire (FFQ) to obtain data on dietary intake of participants in the year prior to their COVID-19 diagnosis. COVID-19 severity was determined using the National Institutes of Health's Coronavirus Disease 2019 report. Additionally, symptoms associated with COVID-19, inflammatory markers, and other variables were evaluated. The scoring method proposed by Trichopoulou et al. was used to assess adherence to the MD. Results: The participants' mean age was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients who adhered more closely to the MD had lower serum C-reactive protein levels (7.80 vs. 37.36 mg/l) and erythrocyte sedimentation rate (14.08 vs. 42.65 mm/h). Those with the highest MD score were 77% less likely to have severe COVID-19 after controlling for confounding variables. The MD score was also found to be inversely associated with COVID-19 symptoms, including dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat. Conclusion: Higher adherence to the MD was associated with a decreased likelihood of COVID-19 severity and symptoms, as well as a shorter duration of hospitalization and convalescence, and inflammatory biomarkers.

15.
Kidney International Reports ; 7(9):S483, 2022.
Article in English | EMBASE | ID: covidwho-2041713

ABSTRACT

Introduction: For more than 75,000 years, tuberculosis (TB) has plagued humans over the planet. It is the greatest cause of infectious disease-related death worldwide, surpassing out HIV, though COVID-19 may overtake it. Approximately 1,200,000 individuals died as a direct result of this disease, and an additional 250,000 people who were HIV-positive died as a result of it, according to WHO estimates for 2018. Only eight nations, India (28%) China (9%) Indonesia (8%), Pakistan 6%, Nigeria 4% and Bangladesh 4%, account for two thirds of the world's TB infections, according to the World Health Organization (WHO) (3 percent) Needless to highlight India remains the top contributor for the disease. While Diabetes mellitus (DM) is one of the most common chronic disorders in our society. and incidentally India had been time and again given the name of Diabetic Capital of World. Interestingly animal models have been used to examine how hyperglycaemia affects the immunological response to M. tuberculosis, but a definite answer has not yet been established. Its widely accepted that DM is a risk factor for TB. Various published evidence point out that, if a person has both tuberculosis and diabetes, the risk of death increases. TB treatment results are negatively correlated with diabetes. Diabetes patients have a mortality risk ratio that is higher than that of the general population, even after correcting for age and other relevant confounders. Keeping in view of these facts and the paucity of published evidence when it comes to tribal hinterlands of Jharkhand we decided to do a cross sectional observation analysis of the Data avaialbel in Nikshay portal. Nikshay portal is Methods: District of Pakur in Jharkahnd was chosen as it is one of the districts sharing border with West Bengal, Bihar and Bangladesh is nearby.We used data from the adult population obtained from Nikshay portal for one year 2021, and divided into two subgroups. We conducted univariate analysis to find association of DM presence with different sociodemographic variables using chi square and unpaired t-test/Mann Whitney test for non -parametric data. Multivariable logistic regression models were used to predict the association of DM presence with epidemiological factors. Data was analysed using JASP software and p value <0.05 was considered statistically significant. Results: Out of 1687 registered TB patients we found 29 who were having Diabetes as co morbidity, Majority of them were male, while 19 of them were referred from private facility, three of them died and two were lost to follow up. Other predictors were found which increased the chances of having DM along with TB were middle age, and sex. Conclusions: As has been reported by others as well the problem of co infection of TB with DM is a reality and growing. The two programs are now being run under different heads which need to change. As seen most of the diabetics were from Private facilities meaning we might be missing more. More active case findings needs to be done so that no case of DM with TB is missed. Screening for DM among TB patients should be compulsory and treatment of co-morbidity should be included in adult health programmes. No conflict of interest

16.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009663

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19), caused by betacoronavirus SARS-CoV-2, is associated with an increased risk of severe infection or death in cancer patients compared to the general population. The CANVAX trial recently demonstrated that short term immune responses to SARS-CoV-2 vaccines are modestly impaired in patients with cancer- particularly those who receive myelosuppressive chemotherapy. Because little is known regarding longitudinal antibody or T-cell responses in cancer patients who receive cytotoxic chemotherapy or non-myelosuppressive targeted systemic therapy, the aim of this longitudinal study is to assess immune B and T cell responses to SARS-CoV-2 over a 12-month period in solid tumor patients who receive chemotherapy or non-immunosuppressive therapy compared to healthy individuals without cancer. Methods: This is an ongoing prospective non-interventional clinical trial (NCT05238467). Approximately 100 patients will be enrolled into three different arms. Accrual began in May 2021 and 37 patients have been enrolled. Eligible patients must not have prior COVID-19 infection < 6 months from study enrollment and have a diagnosis of a solid tumor (breast, genitourinary, or gastrointestinal cancers), who either: received myelosuppressive chemotherapy within 60 days prior to initial or booster COVID vaccination, or who started on chemotherapy within 30 to 60 days after the initial or booster COVID vaccination (Arm A);or received non-immunosuppressive treatments (Arm B);or have no history of cancer or prior history of cancer but beyond 12 months from completion of curative cancer treatment (Arm C, control cohort). Whole blood will be collected in accordance with standard operating procedures. Blood samples analyzed for the presence of antibodies against the major antigenic components of SARS-CoV-2 including the spike glycoprotein (S), receptor binding domain (R) and nucleocapsid phosphoprotein (N). Antibody levels will be quantified utilizing quantitative ELISA. T-cell responses will also be quantified. The primary endpoint is seroprotection rate with an antibody titer protective (1:40) at any point: baseline, 2, 6, and 12 months. The secondary endpoint is to evaluate differences in longitudinal immunological responses to SARSCoV- 2 over a 12-month period. The difference of the seroprotection rate among 3 cohorts of participants will be examined using chi-square test. Moreover, the effect of treatment (chemotherapy, endocrine, TKIs) on seroprotection will be estimated using multivariable logistic regression controlling the effects of confounders, such as age, gender and cancer type. COVID antibody titers measured over time (baseline, 8 weeks, 6, 9, 12 months after the second vaccination) will be analyzed using mixedeffect models. .

17.
Annals of the Rheumatic Diseases ; 81:1639, 2022.
Article in English | EMBASE | ID: covidwho-2009111

ABSTRACT

Background: Glucocorticoid (GC) use is well established in the treatment of rheumatics diseases, particularly rheumatoid arthritis (RA). The use of low dose GC has been endorsed by EULAR recommendations for the management of rheumatic and musculoskeletal diseases even if in the context of SARS-CoV-2, but long-term use is generally discouraged. Objectives: To estimate the prevalence of glucocorticosteroids induced osteoporosis (GIOP) on bone mineral density (BMD) in African adult patients with infammatory rheumatic diseases. Methods: For this systematic review and meta-analysis, PubMed, Google Scholar, Scopus and African index medicus were systematically searched up to December 2020 without language restrictions. We included studies as follows: population-based or hospital-based study, study with sufficient information to estimate the prevalence of GIOP and osteoporotic fractures in African patients with rheumatic disease. Searches were limited to peer-reviewed full text articles. A standardized data extraction form was used to collect information from eligible studies. A random-effects meta-analysis was conducted to obtain the pooled prevalence of GIOP in these studies. The meta-analysis was strati-fed by geographical region. The study is registered with PROSPERO, number CRD42021256252. Results: Our search identifed 8571 studies, of which 8 studies were included in the systematic review from only four African countries and 7 studies in the meta-analysis. The pooled prevalence of osteoporotic fractures in our study was 47.7% (95% CI 32.9-62.8) with 52.2% (95% CI 36.5-67.6) in North Africa and 15.4% (95% 1.9-45.4%) in South Africa (SA). There was no evidence of publication bias, although heterogeneity was high (p=0.018). There was no data from sub-Saharan Africa apart from the two studies from SA. Conclusion: The overall prevalence of GIOP in African adult patients with infam-matory rheumatic diseases was high at 47.7% (95% CI 32.9-62.8). Meta-analysis calculation revealed patient geographic origin as possible confounding factors of the proportion outcomes and further studies are required.

18.
Annals of the Rheumatic Diseases ; 81:1672, 2022.
Article in English | EMBASE | ID: covidwho-2008900

ABSTRACT

Background: SARS-Cov-2 infection had a major impact on patients with infam-matory rheumatic diseases. Spondyloarthritis (SpA) patients were one of the most affected groups of these patients. Objectives: To assess the impact of Covid19 in spondyloarthritis patients under biological disease modifying anti-rheumatic drugs (bDMARDs). Methods: A retrospective observational study was conducted using registry data of patients with SpA under bDMARD therapy, followed at a tertiary level hospital, that have been diagnosed with COVID19 from March 2019 to December 2021. At least one evaluation previous (t0) and two evaluations after SARS-CoV-2 infection (t1, t2) were included in our analysis. Sociodemographic, clinical, disease activity, therapeutic response, function and general health status data were collected. Statistical analysis (signifcance at p < 0.05) was performed using paired T-test, Wilcoxon test and McNemar tests for paired samples. Linear and logistic regression models were performed to assess direction and strength of association Results: Thirty-two patients with SpA under bDMARD had COVID19, mostly women (20, 62.5%), with a disease course time averaged 18.65 (± 9.69) years, mainly with axial involvement (19, 59.4%) and positive for HLA-B27 antigen (11, 64.7%). The majority were under TNF inhibitors (30, 93.75%), with golimumab being the most common (9, 28.1%), and with a median bDMARD persistence of 2.63 (5.09) years. Seven (21.9%) were under a cDMARD, 3 (9.4%) under NSAID and 18 (56.3%) under corticosteroids. Three (9.4%) were already vaccinated against SARS-CoV-2, 2 (66.6%) with the mRNA-1273 vaccine, presenting a medium time since inoculation of 240 (± 234.01) days. Arterial hypertension was the most common comorbidity (5, 15.6%) and one patient (3.1%) had a previous diagnosis of type 2 diabetes. Most were never-smokers (17, 53.1%) and never-drinkers (29, 90.6%). The average age at infection was 40.97 (± 6.15) years and the most common symptom was cough (22, 68.8%), followed by headache (20, 62.5%) and myalgia (19, 59.4%). Event tree analysis didn't show association with SpA subtype, education level, work status, tobacco or alcohol consumption. Only one patient needed hospital admission but without needing of oxygen, therapy, ventilator or ECMO. Only one patient had an overlaid bacterial infection and no thromboembolic complications were observed. Two patients needed specific SARS CoV-2 infection treatment, one with hydroxychloroquine and another with azithromycin. Twelve (37.5%) patients suspended bDMARD at the time of infection, with only 2 (6.3%) maintaining suspension at the time of the first post-infection visit. When comparing clinical variables, higher disease activity was seen at t1 only for BASDAI mean values, without statistical signifcance. Higher all domains VAS scores were also observed at t1, but not at t2, also without statistical signifcance;moreover, physical function didn't change signifcantly. No differences were observed according to gender or SpA subtype, nor with the use of cDMARDs, NSAIDs or corticosteroids. The only statistically signifcant difference concerned MASES score between t0 and t1 (1 ± 4 vs. 2 ± 6, p=0.04), but not between t0 and t2. Higher baseline tender joint score (p < 0.01) and higher baseline LEI (p=0.03) negatively correlated with MASES score variation. Several baseline variables correlated positively with MASES at t1, including female gender (p < 0.01), corticosteroid use (p = 0.04), BASDAI (p < 0.01), ASDAS-ESR (p < 0.01), ASDAS-CRP (p < 0.01), DAS28 (p < 0.01), SPARCC (p = 0.04), physician VAS (p = 0.03) and total spine VAS (p = 0.01). Working status varied signifcantly after SARS-Cov-2 infection (at least part-time-29, 90.6% vs. 22, 68.8%, p= 0.016). Conclusion: SpA patients on bDMARD had a mild course of SARS-CoV-2 infection, with slight changes in enthesitis score in the short term, the latter particularly in those with higher disease activity in the pre-infection period. Long-term effects on work status could represent confounding factors related to the e onomic constraints of the pandemic.

19.
Annals of the Rheumatic Diseases ; 81:933, 2022.
Article in English | EMBASE | ID: covidwho-2008869

ABSTRACT

Background: Since early 2020, governments have initiated local and nationwide measures to contain the spread of the coronavirus disease 2019 (COVID-19). In the Netherlands, people were strongly recommended to work from home, and several work sectors were shut down. In addition, hospitals had to reduce regular care. These changes, together with the risk of contracting COVID-19 and becoming ill, could have affected people's employment perspectives and work productivity. It is unknown to what degree this affected persons with chronic disorders, such as spondyloarthritis (SpA). Objectives: To investigate whether work productivity in patients with SpA changed following the onset of the pandemic and the associated government-initiated containment measures in the Netherlands. Methods: Data from the Dutch eHealth monitoring system SpA-Net were used. Since 2016, patients in SpA-Net completed outcome measurements when they attended outpatient rheumatology visits. Employment and work productivity were assessed with the Work Productivity and Activity Impairment questionnaire (WPAI, work productivity loss range 0-100%), capturing both sick leave and reduced at-work productivity. Covariables of interest were age, gender, education (high vs. low) and disease activity (ASDAS, BASDAI, patient global). The proportions of patients employed and their work productivity losses were compared during a 1-year period before and after the onset of the pandemic (March 2020). Generalized Estimating Equations (GEE) analysis of all assessments over time explored if work productivity in employed patients had changed with the onset of the pandemic, adjusting for potential confounders. Similar analyses with disease activity as outcome were used to facilitate interpretation of work productivity results. Results: Of 238 patients, data were available during the 1-year period both before and after onset of the pandemic. Pre-pandemic, 128 (54%) patients were employed. These employed patients had a mean age of 49.0 (SD 10.2) years, 66 (54%) were male and the mean ASDAS was 2.1 (0.9). After the onset of the pandemic, 7 (5.5%) were no longer employed. In addition, 8 out of 110 (7.3%) originally unemployed patients had become employed by this time. Work productivity loss (0-100%) was worse after the onset of the pandemic (37.0) compared to the pre-pandemic year (27.0) (p<0.01). In multivariable GEEs with work productivity loss as outcome (and stratifed by education due to interaction), patients with low education had work productivity losses that were almost 10% (absolute) higher after onset of the pandemic compared to pre-pandemic (B = 9.57, 95%CI 5.63-13.51) (Table 1). This was independent of ASDAS and other confounders. In patients with high education, however, no such association between pandemic onset and work productivity was seen. Analyses adjusting for other measures of disease activity (BASDAI, patient global) showed similar results. In GEEs with disease activity as outcome, disease activity before and after pandemic onset did not differ (B =-0.05, 95%CI-0.15 to 0.06 for ASDAS, model not shown). Conclusion: Work productivity has worsened in patients with SpA since the onset of the pandemic, especially in patients with lower educational attainment, while disease activity remained stable. Care should be taken to support patients in their work role during the pandemic, and thereafter.

20.
Annals of the Rheumatic Diseases ; 81:932-933, 2022.
Article in English | EMBASE | ID: covidwho-2008866

ABSTRACT

Background: Individuals with autoimmune infammatory rheumatic diseases (AIRDs) have an increased baseline risk of severe COVID-19 infection. Intersection of inequity factors may result in more severe adverse effects through influencing opportunities for health. We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs. Objectives: The objective of this study is to assess how health equity is considered in studies of COVID-19 vaccination studies in individuals with AIRDs. Methods: All studies (N=19) from an ongoing Cochrane living systematic review on the effects of COVID-19 vaccination in people with AIRDs were included. We identifed inequity factors using the PROGRESS-Plus framework which stands for Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. Age, multimorbidity, and health literacy were also assessed as 'Plus' factors. We applied the framework to assess equity considerations in relation to differences in COVID-19 baseline risk, description of participant characteristics, controlling for confounding factors, subgroup analysis and applicability of study fndings. RESULTS: All nineteen studies are cohort studies that followed individuals with AIRDs after COVID-19 vaccination. Two articles (11%) described differences in baseline risk for COVID-19 across age. All nineteen studies described participant age and sex, with race/ethnicity and multimorbidity described in four (21%) and occupation in one (5%). Seven studies (37%) controlled for age and/or sex as confounding factors. Eleven studies (58%) conducted subgroup analysis across at least one PROGRESS-Plus factor, most commonly age. Eight studies (42%) discussed at least one PROGRESS-Plus factor in interpreting the applicability of results, most commonly age (32%), then race/ethnicity and multimorbidity (11%). Conclusion: It is unknown whether COVID-19 vaccine studies on individuals with AIRDs are applicable to populations experiencing inequities, as key inequity factors beyond age and sex have little to no reporting or analysis. Future COVID-19 vaccine studies should report social characteristics of participants consistently, facilitating informed decisions about the applicability of study results to the population of interest.

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