Influence of past infection with SARS-CoV-2 on the response to the BNT162b2 mRNA vaccine in health care workers: Kinetics and durability of the humoral immune response.

BACKGROUND: SARS-CoV-2 vaccines are an invaluable resource against COVID-19. Current vaccine shortage makes it necessary to prioritize distribution to the most appropriate segments of the population. METHODS: This is a prospective cohort study of 63 health care workers (HCWs) from a General Hospital. We compared antibody responses to two doses of BNT162b2 mRNA COVID-19 vaccine between HCWs with previous SARS-CoV-2 infection (experienced HCWs) and HCWs without previous infection (naïve HCWs). FINDINGS: Seven days after the first vaccine dose, HCWs with previous infection experienced a 126-fold increase in antibody levels (p<0·001). However, in the HCW naïve group, response was much lower and only five showed positive antibody levels (>50 AU). After the second dose, no significant increase in antibody levels was found in experienced HCWs, whereas in naïve HCWs, levels increased by 16-fold (p<0·001). Approximately two months post-vaccination, antibody levels were much lower in naïve HCWs compared to experienced HCWs (p<0·001). INTERPRETATION: The study shows that at least ten months post-COVID-19 infection, the immune system is still capable of producing a rapid and powerful secondary antibody response following one single vaccine dose. Additionally, we found no further improvement in antibody response to the second dose in COVID-19 experienced HCWs. Nonetheless, two months later, antibody levels were still higher for experienced HCWs. These data suggest that immune memory persists in recovered individuals; therefore, the second dose of the COVID-19 vaccine in this group could be postponed until immunization of the remaining population is complete.

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients.

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry.

BACKGROUND: Current guidelines make no specific recommendations for venous thromboembolism (VTE) treatment in patients with renal insufficiency, but some experts recommend some reduction in heparin dose. METHODS: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. In this analysis we retrospectively analyzed the effect of renal insufficiency on the incidence of fatal pulmonary embolism (PE) and fatal bleeding within 15 days of diagnosis. RESULTS: Up to March 2005, 10,526 patients with acute VTE were enrolled in RIETE, of whom 9234 (88%) had a creatinine clearance (CrCl) greater than 60 mL/min, 704 (6.7%) had a CrCl 30 to 60 mL/min, and 588 (5.6%) had a CrCl less than 30 mL/min. The incidence of fatal PE during the study period was 1.0%, 2.6%, and 6.6%, respectively. Fatal bleeding occurred in 0.2%, 0.3%, and 1.2% of the patients, respectively. On multivariate analysis, patients with a CrCl less than 30 mL/min were independently associated with an increased risk for fatal PE and fatal bleeding. In addition, initial diagnosis of PE, immobility for 4 days or more, cancer, and initial therapy with unfractionated heparin were independent predictors of fatal PE; whereas immobility for 4 days or more and cancer were independent predictors of fatal bleeding. CONCLUSIONS: Patients with VTE who have renal insufficiency had an increased incidence of both fatal PE and fatal bleeding, but the risk of fatal PE far exceeded that of fatal bleeding. Our data support the use of full-dose anticoagulant therapy, even in patients with a CrCl less than 30 mL/min.

Disfunción diastólica del ventrículo izquierdo en jóvenes con diabetes mellitus tipo 1. Factores asociados / Left ventricular diastolic dysfunction in young people with type 1 diabetes mellitus. Associated factors

Objetivo. El objetivo de nuestro estudio fue evaluar la función diastólica del ventrículo izquierdo por estudio ecocardiográfico en jóvenes (< 40 años) asintomáticos con diabetes mellitus tipo 1 sin síntomas cardiovasculares, y analizar los factores asociados a disfunción diastólica del ventrículo izquierdo (DDVI) en estos pacientes. Pacientes y métodos. Fueron estudiados 35 diabéticos tipo 1 (edad media de 27,8 ñ 7,5 años) sin síntomas cardiovasculares y 54 controles sanos (edad media de 26,1 ñ 4,1 años). Se realizó una anamnesis, exploración física, analítica general y estudio eco-Doppler. Resultados. El DDVI estuvo presente en 13 (37,1 por ciento) de los pacientes diabéticos y en ninguno de los pacientes control. En el grupo de diabéticos encontramos un índice entre la velocidad de llenado precoz y llenado tardío (auricular) significativamente menor que en el grupo control (1,1 ñ 0,3 frente a 1,5 ñ 0,2; p < 0,01) y un tiempo de relajación isovolumétrico mayor que en el grupo control (104 ñ 11 frente a 79 ñ 11; p < 0,01). Los diabéticos con DDVI tenían una mayor edad, en su mayoría eran varones, tenían un peor control glucémico, más alteración del metabolismo lipídico y mayores concentraciones de microalbuminuria que aquellos sin DDVI. Conclusión. La DDVI es frecuente en diabéticos jóvenes sin síntomas cardiovasculares. Estos estudios sugieren que la presencia en estos pacientes de una mayor edad, sexo masculino, pobre control glucémico, metabolismo lipídico alterado y microalbuminuria puede asociarse a una DDVI que, en ausencia de enfermedad cardiovascular, podría ser una alteración preclínica potencialmente relacionada con el subsiguiente desarrollo de miocardiopatía diabética (AU)