Real-world clinical outcomes of treatment with casirivimab-imdevimab among patients with mild-to-moderate coronavirus disease 2019 during the Delta variant pandemic

BackgroundMutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may reduce the efficacy of neutralizing monoclonal antibody therapy against coronavirus disease 2019 (COVID-19). We here evaluated the efficacy of casirivimab-imdevimab in patients with mild-to-moderate COVID-19 during the Delta variant surge in Fukushima Prefecture, Japan. MethodsWe enrolled 949 patients with mild-to-moderate COVID-19 who were admitted to hospital between July 24, 2021 and September 30, 2021. Clinical deterioration after admission was compared between casirivimab-imdevimab users (n = 314) and non-users (n = 635). ResultsThe casirivimab-imdevimab users were older (P < 0.0001), had higher body temperature ([≥] 38{degrees}C) (P < 0.0001) and greater rates of history of cigarette smoking (P = 0.0068), hypertension (P = 0.0004), obesity (P < 0.0001), and dyslipidemia (P < 0.0001) than the non-users. Multivariate logistic regression analysis demonstrated that receiving casirivimab-imdevimab was an independent factor for preventing deterioration (odds ratio 0.448; 95% confidence interval 0.263-0.763; P = 0.0023). Furthermore, in 222 patients who were selected from each group after matching on the propensity score, deterioration was significantly lower among those receiving casirivimab-imdevimab compared to those not receiving casirivimab-imdevimab (7.66% vs 14.0%; p = 0.021). ConclusionThis real-world study demonstrates that casirivimab-imdevimab contributes to the prevention of deterioration in COVID-19 patients after hospitalization during a Delta variant surge. SummaryThis real-world retrospective study demonstrates the contribution of treatment with casirivimab-imdevimab to the prevention of deterioration in patients with mild-to-moderate coronavirus disease 2019 (COVID-19) even during the Delta variant pandemic.

Development and external validation of the DOAT and DOATS scores: simple decision support tools to identify disease progression among nonelderly patients with mild/moderate COVID-19

BACKGROUNDDue to the dissemination of vaccination against severe acute respiratory syndrome coronavirus 2 in the elderly, the virus-susceptible subjects have shifted to unvaccinated non-elderlies. The risk factors of COVID-19 deterioration in non-elderly patients without respiratory failure have not yet been determined. This study was aimed to create simple predicting method to identify such patients who have high risk for exacerbation. METHODSWe analyzed the data of 1,675 patients aged under 65 years who were admitted to hospitals with mild-to-moderate COVID-19. For validation, 324 similar patients were enrolled. Disease progression was defined as administration of medication, oxygen inhalation and mechanical ventilator starting one day or longer after admission. RESULTSThe patients who exacerbated tended to be older, male, had histories of smoking, and had high body temperatures, lower oxygen saturation, and comorbidities such as diabetes/obesity and hypertension. Stepwise logistic regression analyses revealed that comorbidities of diabetes/obesity, age [≥] 40 years, body temperature [≥] 38{degrees}C, and oxygen saturation < 96% (DOATS) were independent risk factors of worsening COVID-19. As a result two predictive scores were created: DOATS score, which includes all the above risk factors; and DOAT score, which includes all factors except for oxygen saturation. In the original cohort, the areas under the receiver operating characteristic curve of the DOATS and DOAT scores were 0.789 and 0.771, respectively. In the validation, the areas were 0.702 and 0.722, respectively. CONCLUSIONWe established two simple prediction scores that can quickly evaluate the risk of progression of COVID-19 in non-elderly, mild/moderate patients. SummaryThe risk stratification models using independent risks, namely comorbidity of diabetes or obesity, age [≥] 40 years, high body temperature [≥] 38{square}, and oxygen saturation < 96%, DOATS and DOAT scores, predicted worsening COVID-19 in patients with mild-to-moderate cases.

Cardiopulmonary response during supine and sitting bicycle exercise / 体力科学

The difference in cardiopulmonary response between supine exercise and sitting exercise was assessed by the following protocols.<BR>1) Cardiopulmonary exercise testing utilizing the ramp protocol with a bicycle ergometer (20 W/min) was performed by nine healthy Japanese men (mean age, 19.9 yr) in a sitting and a supine position. Oxygen uptake, heart rate and blood pressure were measured during the test. Blood was sampled in order to measure noradrenaline (NA) and angiotensin II (ANG II) in the resting control state and immediately after exercise.<BR>2) Single-level exercise testing at 100 W was performed on another day. The cardiac index (CI) was computed from the cardiac output, which was measured using the dye-dilution method in the resting control state and during exercise.<BR>The results were as follows:<BR>1) Heart rate and blood pressure during exercise had a tendency to be lower in the supine position compared to the sitting position, although not significantly.<BR>2) Anaerobic threshold (AT) was lower in the supine position than in the sitting position exercise, (18.3±2.6 ml/kg/min and 21.7±1.9 ml/kg/min, respectively) .<BR>3) NA and ANG II in the supine position were slightly lower than in the sitting position.<BR>4) At rest, the CI in the sitting position was significantly less than in the supine position; however, the CI during the 100 W exercises was the same in both the supine and sitting positions.<BR>It is concluded that blood flow to active muscle during 100W exercise is lower in the supine than in the sitting position. This is thought to be due to changes in blood redistribution and lowered blood flow to active muscle in the supine position, creating a lower AT.