Optimal position of air purifiers in elevator cabins for the improvement of their ventilation effectiveness

Ventilation in confined spaces is essential to reduce the airborne transmission of viruses responsible for respiratory diseases such as COVID-19. Mechanical ventilation using purifiers is an interesting solution for elevator cabins to reduce the risk of infection and improve the air quality. In this work, the optimal position and blowing direction of these devices to maximize ventilation and minimize the residence time of the air inside two cabins (large and small) is studied. Special attention is devoted to idle periods when the cabin is not used by the passengers, in order to keep the cabin ambient safe and clean, avoiding that the trapped air in the cabin (after its use) could suppose a reservoir for contaminants. CFD numerical models of two typical cabin geometries, including the discretization of small slots and grilles for infiltration, have been developed. A full 3D URANS approach with a k-epsilon RNG turbulence model and a non-reactive scalar to compute the mean age of air (MAA) was employed. The CFD results have been also validated with experimental measurements from a home-made 1:4 small-scale mock-up. The optimal position of the purifier is on the larger sidewall of the cabins for a downward blowing direction (case 1 of the database). Flow rates in the range of 0.4–0.6 m3/min, depending on the size of the cabin, are sufficient to assure a correct ventilation. Upward blowing may be preferable only if interaction of the jet core with the ceiling or other flow deflecting elements are found. In general, the contribution of infiltrations (reaching values of up to 10%), and how these secondary flows interact with the main flow pattern driven by the purifier, is relevant and not considered previously in the literature. Though an optimal position can improve ventilation considerably, it has been proven that a good choice of the purification flow rate is more critical to ensure an adequate air renewal. © 2022 The Authors

SARS-CoV-2 structures detection in artificial saliva using ATR-FTIR associated with Linear Discriminant Analysis

Here, we used ATR-FTIR platform supported by artificial intelligence algorithms to identify unique infrared vibrational modes of a pseudotyped human immunodeficiency virus type-1 (HIV-1) coupled to Spike (S) protein of SARS-CoV-2 (HIV/NanoLuc-SARS-CoV-2 pseudotype virus). © Optica Publishing Group 2022 The Authors.

SARS-CoV-2 structures detection in artificial saliva using ATR-FTIR associated with Linear Discriminant Analysis

Here, we used ATR-FTIR platform supported by artificial intelligence algorithms to identify unique infrared vibrational modes of a pseudotyped human immunodeficiency virus type-1 (HIV-1) coupled to Spike (S) protein of SARS-CoV-2 (HIV/NanoLuc-SARS-CoV-2 pseudotype virus). © Optica Publishing Group 2022 The Authors.

Changes in physical activity and its impact on MAFLD during the COVID-19 pandemic

Introduction and Objectives Multiple factors, such as diet and physical activity, are involved in the pathogenesis of fatty liver associated with metabolic dysfunction (MAFLD). After confinement by COVID-19, interest has arisen to study its effect on the population. This study aimed to describe the impact of changes in physical activity during the COVID-19 pandemic on the progression of MAFLD. Materials and Methods Observational, analytical, retrospective, longitudinal and comparative study in patients with MAFLD from the Instituto de Investigations Médico Biologicals of the Universidad Veracruzana. The information was obtained from a database from which values of steatosis, fibrosis and degree of physical activity measured by IPAQ were obtained. Student's t-test for related samples was used for numerical variables. Results Thirty-four patients were studied, of which 15 were excluded due to incomplete records. Nineteen patients were included;the mean age was 60.42±8.1 years, female sex was predominant (57.9%). Initial somatometric data are described in Table 1. A significant increase in physical activity in minutes per week was observed (p=0.037), as well as the reduction of intrahepatic fat after the pandemic (Fig.1). Conclusions The results demonstrate that during the COVID-19 pandemic, our population increased physical activity, which resulted in an improvement in hepatic steatosis significantly. Funding The resources used in this study were from the hospital without any additional financing Declaration of interest The authors declare no potential conflicts of interest.

LIFE CYCLE OF A COVID-19-INDUCED LUNG CYST

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: COVID-19 has affected over 200 million people worldwide. Clinicians continue to observe unusual manifestations of this disease. In an attempt to improve our understanding of COVID-19 pneumonia, we present the details of one patient who developed large bilateral pulmonary cysts. CASE PRESENTATION: A 40-year-old woman with no known medical problems presented with the chief complaint of fever, nausea, vomiting, generalized weakness followed by difficulty breathing that developed over a few days. Her vital signs on admission included temperature 98.4° F, heart rate 104 beats/minute, respiratory rate 48 breaths/minute, O2 saturation 88 percent on 15 liters of oxygen through a non-rebreather mask, and Body Mass Index 42 kg/m2. The patient tested positive for COVID-19. Computed tomography (CT) of the chest to rule out a pulmonary embolism showed bilateral extensive ground-glass opacities and reticular and nodular opacities. She was intubated for acute hypoxic respiratory failure. Twenty days into the hospital admission, she was noted to have a bulla in the right lower lobe. A repeat CT chest on day 45 revealed an increase in the number and size of cysts bilaterally. Patient was discharged to rehab and later readmitted for worsening respiratory status. This time she tested positive for human metapneumovirus. A CT chest showed increase in the size of the right sided lung cysts;the left sided lung cysts had resolved. DISCUSSION: The first COVID-19 related pulmonary cystic lesions were reported in May 2020(1). Since then, several reports have now established a relationship between an infection and cyst formation. The most common distribution is peripheral in the lower lobes. The pathogenesis remains uncertain, but several mechanisms have been proposed. Microthrombi in the pulmonary circulation could lead to ischemia and subsequent remodeling of interstitial matrix and bronchial obstruction with distal hyperinflation due to check valve mechanism. (1,2). Hamad et al. propose that pneumatoceles are formed by air leaked in to the interstitium which causes stripping and separation of a thin layer of lung parenchyma with further injury to the small blood vessels and bronchioles. The rate of barotrauma in non-COVID-19 related ARDS is 0.5%;the rate in COVID-19 ARDS is 15% (3). This suggests a close relation between COVID-19 pneumonia and subsequent development of pulmonary cysts. Our patient had no preexisting pulmonary disease and was noted to have pulmonary cysts after being on mechanical ventilation for almost 2 weeks. The patient later contracted the human metapneumovirus infection and CT showed that the right-sided lung cysts had become bigger in size. However, the left-sided cysts which had a maximum diameter of 4.8 cm had resolved. CONCLUSIONS: We need to follow patients with COVID 19 induced lung cysts clinically and radiologically to understand the clinical course and best management strategies. Reference #1: Kefu Liu et al. COVID 19 with cystic features on Computed tomography;Medicine (Baltimore) 2020May;99(18): e20175. PMCID: PMC7486878 Reference #2: Galindo J, Jimenez L, Lutz J et al. Spontaneous pneumothorax with or without pulmonary cysts, in patients with COVID 19 Pneumonia. Journal of infections in developing countries 2021;15(10);1404-1407 Reference #3: McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM, Thomas KM, Moore WH. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology. 2020;297(2): E252–E262. doi: 10.1148/radiol.2020202352 DISCLOSURES: No relevant relationships by Arunee Motes No relevant relationships by Kenneth Nugent No relevant relationships by Tushi Singh No relevant relationships by Myrian Vinan Vega

Incremento del riesgo cardiovascular en pacientes con COVID-19 a corto y largo plazo

Si bien la COVID-19 es una enfermedad dominantemente y los síntomas respiratorios tienden a ser la presentación clínica inicial, la evidencia acumulada ha sugerido que esta entidad clínica está estrechamente asociada con complicaciones cardiovasculares. Aunado a esto, aunque inicialmente se evidenció que las complicaciones cardiovasculares forman parte de la presentación aguda de la COVID-19, se dispone de datos limitados a largo plazo de las complicaciones posteriores a la misma. Hoy en día algunos estudios soportan que este tipo de complicaciones pueden persistir después de la resolución de la infección, evidenciándose la necesidad de un mayor entendimiento de las implicaciones a corto y largo plazo de la infección por SARS-CoV-2. El objetivo de esta revisión sintetizar la evidencia actual de las complicaciones cardiovasculares a corto y largo plazo de la COVID-19.Alternate :Although COVID-19 is a predominantly respiratory disease, and respiratory symptoms tend to be the initial clinical presentation, accumulated evidence suggests this clinical entity is closely related to cardiovascular complications. In addition, although cardiovascular complications have been an early observation of the acute presentation of COVID-19, limited data is available regarding the long-term complications in this respect. At present, some studies suggest that the risk for this type of complications may persist after the resolution of the infection, highlighting the need for a greater understanding of the implication of the SARS-CoV-2 infection in the short and long term. The objective of this review is to synthesize current evidence on the short-term and long-term cardiovascular complications of COVID-19.

RACIAL DISPARITIES IN ADULT CANCER PATIENTS WITH ACUTE KIDNEY INJURY (AKI) AND CORONAVIRUS 2019 (COVID-19) INFECTION

Introduction COVID-19 infection is associated with a higher incidence of medical complications including AKI. It is not well known if racial differences are associated with worse outcomes. Methods All patient data from March 2020 through February 2021 were aggregated and analyzed as part of the D3CODE protocol at MD Anderson. Cohort: (1) positive COVID-19 test (2) baseline eGFR >60 ml/min/ 1.73m2 within 30 days prior to COVID infection. AKI defined by increased creatinine ≥0.3 within 30 days after infection. Kaplan-Meier analysis was used for survival estimates. Multivariable Cox Proportional Hazard model regression analysis was used for hazard ratios. Results 635 patients with Covid-19 infection were identified. 124 (19.5%) developed AKI. AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) myocardial infarction (15.3% vs 8.8%, p=0.046), require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Hispanic or Latino ethnicity (HR 56.6 CI 2.12-1510.57 p=0.016) vs White (HR 0.35 CI 0.02-6.02 p=0.47) was an independent risk factor associated with worse outcomes Conclusions Being Hispanic is associated with worse clinical outcomes in cancer patients with COVID-19 infection and AKI. Further studies are needed to address these disparities.

Hydroperiod analysis of three coastal ponds of Doñana Biological Reserve (2018-2020)

This study analyses the changes produced in the hydroperiod of the Santa Olalla, Taraje and Zahillo ponds, located on the coastal aquifer of the Doñana littoral aeolian mantle, to detect their degree of alteration. The water level was recorded from 2018 January 1st to 2020 June 26th. The 2019 was an exceptionally dry year, with a record of less than 200 mm/year of accumulated precipitation. It is worth noting the different degree of dependence of these ponds to rainfall. Although the Santa Olalla pond is resilient against dry periods, thanks to groundwater discharge, Zahillo pond is highly dependent on rainfall and has remained dry most of the study period. The lockdown caused by Covid-19 pandemic during the spring of 2020, has not implied any significant change in the withdrawal of groundwater close to the study area. Therefore, no positive hydrological changes have been detected in the ponds during such period. Copyright © 2021 Sociedad Geológica de España

Covid-19 health policy and social determinants based on technology and communication systems: a systematic review

This research is a systematic review article on public policies and social determinants during the Covid-19 pandemic, this study has a qualitative approach, basic-descriptive type, with N=180 articles reviewed, of which N=160 excluded, remaining 20 articles selected. The reviewed studies correspond to 35% to the theme of social determinants, followed by 35% to the theme of the Covid19 pandemic and 30% to the theme of Health Policy, reflecting that at the global level the policies aimed at managing health have not advanced at the same pace as the challenges of the speed and diversity of society imposes, due to the weak and insufficient approach to inequities, determining factors of health. © 2022, Associacao Iberica de Sistemas e Tecnologias de Informacao. All rights reserved.

Variation of Drinking Water Consumption Due to the Health Emergency of SARS-CoV-2 Through Dynamic Modeling in Macas City, Amazon from Ecuador

The consumption of drinking water in the populations in the last 20 years has varied for different reasons, thus, it is necessary to determine its behavior for sustainable use of the resource. The objective of this work was to present the variation in drinking water consumption during the Sars-Cov-2 health emergency through dynamic modeling in the city of Macas in the Amazon region of Ecuador. The integrated moving average autoregressive model was used for the study (ARIMA), predicting the behavior of drinking water consumption for the year 2021 in the different neighborhoods of the city and relating this result with socioeconomic variables. The prediction for the year 2021 presented a decrease of 0.21% in the volume consumed compared to 2020, in April 2021 an increase of 85.21% was observed compared to the consumption of 2019, which can be attributed to the effects of the pandemic. The highest water consumption occurred in the cluster of neighborhoods with the highest population density, medium-high socioeconomic status, and high availability of basic services. The study aims to provide a valid alternative for decision-making in the framework of a health crisis, as well as possible conflicts in vulnerable areas in the face of the pandemic that affects the entire world. © 2021, Springer Nature Switzerland AG.

Psychological factors associated with the intention of getting vaccinated against covid-19 in mexico

Introduction: Intention of getting vaccinated are governed by positive beliefs and attitudes towards the vaccine and vaccination, as well as others’ opinion about the immunization. Objective: Identify the psychological factors associated with the intention to vaccinated against COVID-19 in Mexico, through the evaluation of a theory of planned behavior-based model. Material and methods: A sample of 729 adults from different states of the Mexican Republic participated, who were between 18 and 77 years old (mean = 33.57, SD = 14.28). The participants answered an evaluation battery disseminated by social networks. A path analysis was carried out on which absolute and comparative adjustment indices are reported. Results: It was identified that 87.2% of the participants reported intentions of getting vaccinated and the best perceived vaccine was the Pfizer-BioNTech. The model showed a good statistical fit and explains 62% of the variance for the intentions to vaccinated against COVID-19. Conclusion: Evidence is shown of the importance of beliefs and attitudes about vaccines, vaccination behavior and the opinion of the social group in the intention of getting vaccinated against COVID-19 in Mexican population. © 2021, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

Food insecurity, food waste, food behaviours and cooking confidence of UK citizens at the start of the COVID-19 lockdown. (Special Issue: The future of food: responsible production, acquisition, consumption, and disposition.)

Purpose: The current pilot study explored food insecurity, food waste, food related behaviours and cooking confidence of UK consumers following the COVID-19 lockdown. Design/methodology/approach: Data were collected from 473 UK-based consumers (63% female) in March 2020. A cross-sectional online survey measured variables including food insecurity prevalence, self-reported food waste, food management behaviours, confidence and frequency of use of a range of cooking methods, type of food eaten (ultra-processed, semi-finished, unprocessed) and packaging type foods are purchased in. Findings: 39% of participants have experienced some food insecurity in the last 12 months. Being younger, having a greater BMI and living in a smaller household were associated with food insecurity. Green leaves, carrots, potatoes and sliced bread are the most wasted of purchased foods. Polenta, green leaves and white rice are the most wasted cooked foods. Food secure participants reported wasting a smaller percentage of purchased and cooked foods compared to food insecure participants. Overall, participants were most confident about boiling, microwaving and stir-frying and least confident with using a pressure cooker or sous vide. Food secure participants were more confident with boiling, stir-frying, grilling and roasting than insecure food participants. Practical implications This has implications for post lockdown policy, including food policies and guidance for public-facing communications. Originality/value: We identified novel differences in self-report food waste behaviours and cooking confidence between the food secure and insecure consumers and observed demographics associated with food insecurity.

ACUTE ONSET ACUTE DISSEMINATED ENCEPHALOMYELITIS IN AN ADULT HEALTHY FEMALE: A RARE AUTOIMMUNE CONDITION

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute disseminated encephalomyelitis (ADEM), is an autoimmune demyelinating disease of the central nervous system, with acute onset of encephalopathy and rapidly progressive multifocal neurologic deficits. ADEM is an uncommon illness in adults, thus the precise incidence is unknown. CASE PRESENTATION: 38 year old female with no prior history besides prior COVID infection 6 months ago, presented with 2 day history of nausea, intractable vomiting, ataxia, confusion, and generalized weakness.Initial MRI brain reported numerous white matter lesions supratentorially and infratentorially. LP demonstrated oligoclonal bands, WBC 14, no xanthochromia. She was diagnosed with multiple sclerosis (MS) and received 5 day course of Solumedrol, with no improvement. Her mental status worsened, and she required mechanical ventilation. She later developed rigidity of the neck and lower extremities, with meningeal signs and dystonia. EEG was done for dystonia but no epileptiform activity was captured. The HIV, syphilis Ig G antibody, ANA Ab, HSV and enterovirus PCR were negative. A continuous EEG for 48 hours did not capture any seizure activity.A repeat MRI Brain demonstrted worsening white matter lesions with symmetrical distribution through thalamus, basal ganglia, internal capsule, and brainstem (Figure 1). Spinal MRI revealed no abnormal enhancement. Given the large monophasic infratentorial and supratentorial lesions ADEM was suspected. Patient received IVIG treatment and plasmapheresis, with mild clinical improvement to date. DISCUSSION: ADEM is theorized to be an immunologically mediated demyelinating disease triggered by a febrile illness or recent vaccination, eliciting an inflammatory response affecting the central nervous system. Possible mechanisms may include either molecular mimicry or direct inflammatory damage to myelinated neurons. Radiographically, the T2/FLAIR (MRI) lesions of ADEM are diffuse, asymmetric, often irregular, patchy areas of homogeneous signal hyperintensities often involving both gray and white matter with over half of the cases involving infratentorial structures. ADEM diagnosis remains a challenge and is particularly difficult to differentiate from MS. In contrast to MS, ADEM should be suspected whenever a patient presents with a prodromal viral illness, fever, neck stiffness, ataxia and encephalopathy. Unlike MS, ADEM does not follow a relapsing-remitting course. Treatment involves high dose corticosteroids, intravenous immunoglobulin (IVIG), and plasmapheresis. CONCLUSIONS: The diagnosis of ADEM entails careful clinical assessment and characteristic imaging findings, as no clear criteria exist. It should be highly suspected in patients with atypical MS. REFERENCE #1: Nicole Mahdi, Peter A. Abdelmalik, Mark Curtis, Barak Bar, "A Case of Acute Disseminated Encephalomyelitis in a Middle-Aged Adult", Case Reports in Neurological Medicine, vol. 2015. REFERENCE #2: De Seze J, Debouverie M, Zephir H, et al. Acute fulminant demyelinating disease: a descriptive study of 60 patients. Arch Neurol 2007;64:1426. REFERENCE #3: Ceronie B, Cockerell OC. Acute disseminated encephalomyelitis in an older adult following prostate resection. eNeurologicalSci. 2018;14:40-42 DISCLOSURES: No relevant relationships by Jeannie Lee, source=Web Response No relevant relationships by Barbara Mantilla, source=Web Response No relevant relationships by Arunee Motes, source=Web Response No relevant relationships by Victor Test, source=Web Response No relevant relationships by Myrian Vinan Vega, source=Web Response

Food insecurity, food waste, food behaviours and cooking confidence of UK citizens at the start of the COVID-19 lockdown

Purpose The current pilot study explored food insecurity, food waste, food related behaviours and cooking confidence of UK consumers following the COVID-19 lockdown. Design/methodology/approach Data were collected from 473 UK-based consumers (63% female) in March 2020. A cross-sectional online survey measured variables including food insecurity prevalence, self-reported food waste, food management behaviours, confidence and frequency of use of a range of cooking methods, type of food eaten (ultra-processed, semi-finished, unprocessed) and packaging type foods are purchased in. Findings 39% of participants have experienced some food insecurity in the last 12 months. Being younger, having a greater BMI and living in a smaller household were associated with food insecurity. Green leaves, carrots, potatoes and sliced bread are the most wasted of purchased foods. Polenta, green leaves and white rice are the most wasted cooked foods. Food secure participants reported wasting a smaller percentage of purchased and cooked foods compared to food insecure participants. Overall, participants were most confident about boiling, microwaving and stir-frying and least confident with using a pressure cooker or sous vide. Food secure participants were more confident with boiling, stir-frying, grilling and roasting than insecure food participants. Practical implications This has implications for post lockdown policy, including food policies and guidance for public-facing communications. Originality/value We identified novel differences in self-report food waste behaviours and cooking confidence between the food secure and insecure consumers and observed demographics associated with food insecurity.

Headache during SARS-CoV-2 infection as an early symptom associated with mild inflammation and pulmonary disease: A retrospective cohort study

Objective: We aim to characterize this symptom and identify factors associated with headache in COVID-19. Background: Previous studies have demonstrated that headache is an important neurological manifestation during SARS-CoV-2 infection. However, little is known about the characteristics of COVID-19 patients that exhibit headache. Design/Methods: This retrospective study includes COVID-19 patients with headache hospitalized during March 2020. Controls comprise COVID-19 patients without headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by semi-structured telephonic interview after discharge. Results: Of a total of 379 COVID-19 patients, 48 (13%) developed headache. Among these, 30 (62%) were men and the median age was 57.9 (47-73) years. Headache was associated with younger age, less comorbidities and reduced mortality, as well as with low levels of C-Reactive Protein, mild acute respiratory distress syndrome (ARDS) and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D-dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, while urea levels, beta-lactamic treatment and hypertension were negatively associated with headache. COVID- 19-associated headache characteristics were available in 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%), of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and holocranial 8/19 (42%) or temporal 7/19 (37%) localization. Conclusions: Our results show that headache is associated with mild pulmonary disease and inflammation during SARS-CoV-2 infection. COVID-19-associated headache appears in most cases as an early symptom and as a novel headache with characteristics of headache attributed to systemic viral infection. Further research addressing the underlying mechanisms to confirm these findings is warranted.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection

Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data - demographics, labs, comorbidities and outcomes - were aggregated and analyzed in the Syntropy platform, Palantir Foundry ('Foundry'), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test;(2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient's infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. KaplanMeier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/- 13.2 vs 56.9 +/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Clinical characteristics and outcomes of cancer patients with chronic kidney disease and coronavirus disease 2019

Background: Coronavirus disease 2019 (COVID19) has been associated with higher risk of acute kidney injury (AKI) and mortality rate in cancer patients. The prevalence of CKD in cancer patients is close to 20-30% however there has been limited data about cancer patients with CKD and COVID-19 infection. The aim of this study is to evaluate the clinical characteristics and outcomes of this patient population at a tertiary cancer center. Methods: All patient data - demographics, labs, comorbidities and outcomes - were aggregated and analyzed in the Syntropy platform, Palantir Foundry ('Foundry'), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test;(2) baseline eGFR 15-59 ml/min/1.73m2 calculated by chronic kidney disease epidemiology collaboration equation. The baseline GFR and creatinine values used the most temporally proximal lab results within 30 days prior to the patient's infection. AKI was defined as an absolute change of creatinine ≥0.3 mg/dl above the baseline after the positive COVID-19 test. Results: Out of 790 patients with COVID19,19.6% had underlying CKD. Among these, 86.5% and 46.5% had history of hypertension and diabetes mellitus, respectively. 77.3% had a solid malignancy and 87.3% of them had metastatic disease. 67.7% were asymptomatic, 14.2% required ICU admission, 10.3% required invasive ventilation support, and 11.6% died within 90 days of the COVID-19 test. AKI developed within the first 30 days in 61.3% and 8.4% required renal replacement therapy. AKI was more prevalent in patients who were hospitalized (84.2% vs. 31.7%, p< 0.001), had concurrent pneumonia (63.3% vs. 36.8%, p< 0.002), required critical care (68.3% vs. 15.8% , p< 0.001), and were on ventilation support (16.8% vs. 0%, p=0.002). There was no significant statistical difference in rates of diabetes (52.6% vs. 36.7%, P of 0.076), tumor staging (metastasis;95.1% vs. non metastatic 82.6%, p< 0.2) , readmission rate (52.6% vs. 43.3%, p=0.336), and death rate at 30 days (9.5% vs. 3.3%, p=0.205) between the two groups. Conclusions: The overall mortality rate of cancer patients with CKD and positive COVID-19 test was relatively high and close to 1.7 times the rate of patients with no CKD at our tertiary cancer center. AKI is a common complication in CKD patients with concurrent pneumonia and requiring ventilation support, and was associated with increased morality at 90 days.