Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3848
I. Cherrez-Ojeda, M. Felix, E. Vanegas, V. Mata, C. Vera Paz, M. J. Farfán, B. Guevara, S. Ruiz, J. Salazar, D. Chávez Reyes, M. Maisonet, F. Espinoza, M. Rodas, A. Díaz Armas, E. Sánchez
Rationale: To date, the COVID-19 pandemic has affected over 189 countries representing a global health problem of enormous proportions not only as a health crisis, but one with devastating social and economic implications for years to come. Adding to the already complex scenario are the different responses to the pandemic between countries according to their own strengths and weaknesses. The aim of our study was to provide a brief overview on how confirmed and suspected cases of COVID-19 were managed and worked up in an outpatient setting. Methods: We conducted an observational telephone-based study among 153 outpatients with a confirmed or suspected diagnosis of COVID-19 from the city of Guayaquil-Ecuador from April to May 2020. To be included in the study, participants were required to have a confirmed diagnosis of COVID-19 through a positive polymerase chain reaction (PCR) test. Alternatively, in cases where testing for was not accessible we considered a suspected case in those who presented with typical symptoms of COVID-19, and had either a compatible computed tomography (CT) scan, or a positive IgM in a rapid serological test. Results: The final sample comprised 153 patients, with a mean age of 44.3 years, and a gender distribution of 54.9% male and 45.1% female. The most reported comorbidity was hypertension (30.1%), followed by allergies (15.7%), and type 2 diabetes (7.2%). From all the patients, only 47.1% had a confirmed diagnosis through a positive PCR test for COVID-19. Fatigue was identified as the most common symptom in 82.3% of patients, followed by subjective fever (79.1%), and cough (76.6%). Regarding the workup of these cases, we found that CT scans were performed in 69.9% of cases, followed by PCR testing (47.1%), and chest x-ray (21.6%). Regarding treatment, acetaminophen was the most frequently prescribed medication (83%), followed by azithromycin (66.1%), n-acetylcysteine (56.2%), nitazoxanide (34.7%), hydroxychloroquine (25.5%), and corticosteroids (11.2%).Conclusions: During peak months of the pandemic in our country we found that roughly half of suspected outpatient cases with COVID-19 surveyed in our study had undergone confirmatory PCR testing. This finding may be the result of oversaturation of the healthcare system and a decreased capacity to perform confirmatory tests in our country. Furthermore, there was a considerable outpatient use of experimental treatments that may have led to potential drug interactions and side effects that were not accounted or supervised directly by a healthcare professional. class='MsoNormal' style='text-align:justify;lineheight: 150%'> .
理由:迄今为止，COVID-19大流行已影响到189多个国家，不仅是一场健康危机，而且是一场在未来几年具有破坏性社会和经济影响的巨大全球卫生问题。各国根据自己的长处和短处采取不同的应对措施，使本已复杂的情况更加复杂。我们研究的目的是简要概述如何在门诊环境中管理和处理COVID-19确诊和疑似病例。方法:对厄瓜多尔瓜亚基尔市2020年4月至5月确诊或疑似诊断为COVID-19的153例门诊患者进行电话观察性研究。要纳入研究，参与者必须通过聚合酶链反应(PCR)检测阳性确诊COVID-19。或者，在无法进行检测的情况下，我们将出现COVID-19典型症状的患者视为疑似病例，这些患者要么具有兼容的计算机断层扫描(CT)扫描，要么在快速血清学检测中呈IgM阳性。结果:最终样本包括153例患者，平均年龄44.3岁，性别分布为男性54.9%，女性45.1%。报告最多的合并症是高血压(30.1%)，其次是过敏(15.7%)和2型糖尿病(7.2%)。在所有患者中，只有47.1%的人通过新冠病毒PCR检测阳性确诊。82.3%的患者认为疲劳是最常见的症状，其次是主观发热(79.1%)和咳嗽(76.6%)。对于这些病例的随访，我们发现69.9%的病例进行了CT扫描，其次是PCR检测(47.1%)和胸部x线检查(21.6%)。在治疗方面，对乙酰氨基酚是最常见的处方药物(83%)，其次是阿奇霉素(66.1%)、n-乙酰半胱氨酸(56.2%)、硝唑肼(34.7%)、羟氯喹(25.5%)和皮质类固醇(11.2%)。结论:在我国大流行的高峰月份，我们发现在我们的研究中调查的疑似COVID-19门诊病例中大约有一半进行了验证性PCR检测。这一发现可能是由于我国医疗保健系统的过度饱和和进行确证性检测的能力下降。此外，有相当多的门诊病人使用实验性治疗，这可能导致潜在的药物相互作用和副作用，而这些都没有被医疗保健专业人员直接考虑或监督。class=' msonnormal ' style=' font - family:宋体;．
{"title":"Outpatient Management and Workup of Confirmed and Suspected COVID-19 Cases: A Brief Perspective from a Developing Country at the Height of the Pandemic","authors":"I. Cherrez-Ojeda, M. Felix, E. Vanegas, V. Mata, C. Vera Paz, M. J. Farfán, B. Guevara, S. Ruiz, J. Salazar, D. Chávez Reyes, M. Maisonet, F. Espinoza, M. Rodas, A. Díaz Armas, E. Sánchez","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3848","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3848","url":null,"abstract":"Rationale: To date, the COVID-19 pandemic has affected over 189 countries representing a global health problem of enormous proportions not only as a health crisis, but one with devastating social and economic implications for years to come. Adding to the already complex scenario are the different responses to the pandemic between countries according to their own strengths and weaknesses. The aim of our study was to provide a brief overview on how confirmed and suspected cases of COVID-19 were managed and worked up in an outpatient setting. Methods: We conducted an observational telephone-based study among 153 outpatients with a confirmed or suspected diagnosis of COVID-19 from the city of Guayaquil-Ecuador from April to May 2020. To be included in the study, participants were required to have a confirmed diagnosis of COVID-19 through a positive polymerase chain reaction (PCR) test. Alternatively, in cases where testing for was not accessible we considered a suspected case in those who presented with typical symptoms of COVID-19, and had either a compatible computed tomography (CT) scan, or a positive IgM in a rapid serological test. Results: The final sample comprised 153 patients, with a mean age of 44.3 years, and a gender distribution of 54.9% male and 45.1% female. The most reported comorbidity was hypertension (30.1%), followed by allergies (15.7%), and type 2 diabetes (7.2%). From all the patients, only 47.1% had a confirmed diagnosis through a positive PCR test for COVID-19. Fatigue was identified as the most common symptom in 82.3% of patients, followed by subjective fever (79.1%), and cough (76.6%). Regarding the workup of these cases, we found that CT scans were performed in 69.9% of cases, followed by PCR testing (47.1%), and chest x-ray (21.6%). Regarding treatment, acetaminophen was the most frequently prescribed medication (83%), followed by azithromycin (66.1%), n-acetylcysteine (56.2%), nitazoxanide (34.7%), hydroxychloroquine (25.5%), and corticosteroids (11.2%).Conclusions: During peak months of the pandemic in our country we found that roughly half of suspected outpatient cases with COVID-19 surveyed in our study had undergone confirmatory PCR testing. This finding may be the result of oversaturation of the healthcare system and a decreased capacity to perform confirmatory tests in our country. Furthermore, there was a considerable outpatient use of experimental treatments that may have led to potential drug interactions and side effects that were not accounted or supervised directly by a healthcare professional. class='MsoNormal' style='text-align:justify;lineheight: 150%'> .","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87535684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3856
N. Kenyon, M. McCartney, E. Borras, A. Linderholm, T. Tham, K. Ramirez, R. W. Harper, C. Davis
Rationale: We have proposed to develop an at-home breath collection device to diagnose and monitor patients with COVID-19. There is currently no method to track an individual's health outside of a hospital and predict if they might require clinical intervention. The present COVID19 diagnostic tests only look for direct evidence of the virus. We hypothesize that our method looks for the human body's response to infection. This allows us to not only determine whether an individual is infected or not, but also determine the severity of their health condition through chemical analysis of their metabolism. T Methods: COVID-19 infected patients are given a device that allows them to safely, non-invasively, and painlessly collect their own breath samples, which we are screening for not only COVID- 19 infection, but for other common respiratory viral infections, such as other coronaviruses, rhinovirus and influenza. We will compare the breath biomarkers of influenza with COVID-19 with that of our identified pattern of influenza. We are assessing the sensitivity of our test to diagnose COVID-19 and the specificity to not only diagnose COVID-19 from typical influenzas and rhinoviruses, but also the specificity to diagnose COVID-19 in patients with co-infections of other pulmonary viruses. Nasopharyngeal swab will be the gold standard. Results: We have collected exhaled breath condensate samples from patients with COVI19 infection. The device is can be used safely by the patient and does not require the participation of research coordinators during the breath collection phase. Symptomatic patients are able to use the device without excessive shortness of breath or other effects. The mass spectroscopy screening of the breath samples will look at a panel of eicosanoid biomarkers related to pulmonary infection and markers of oxidative stress. Patterns are being compared to prior breath profiles found with influenza infection. Conclusion: Our breath collection device could provide an “alarm” for individuals who are potentially facing a stark decline in health and should preemptively move into a hospital or clinical setting for closer monitoring. Because this method screens for a myriad of respiratory viruses and of pulmonary health simultaneously, its impact would extend far beyond the current COVID-19 pandemic.
{"title":"Development of at-Home, Self-Administered Test for COVID19 and Respiratory Viruses","authors":"N. Kenyon, M. McCartney, E. Borras, A. Linderholm, T. Tham, K. Ramirez, R. W. Harper, C. Davis","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3856","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3856","url":null,"abstract":"Rationale: We have proposed to develop an at-home breath collection device to diagnose and monitor patients with COVID-19. There is currently no method to track an individual's health outside of a hospital and predict if they might require clinical intervention. The present COVID19 diagnostic tests only look for direct evidence of the virus. We hypothesize that our method looks for the human body's response to infection. This allows us to not only determine whether an individual is infected or not, but also determine the severity of their health condition through chemical analysis of their metabolism. T Methods: COVID-19 infected patients are given a device that allows them to safely, non-invasively, and painlessly collect their own breath samples, which we are screening for not only COVID- 19 infection, but for other common respiratory viral infections, such as other coronaviruses, rhinovirus and influenza. We will compare the breath biomarkers of influenza with COVID-19 with that of our identified pattern of influenza. We are assessing the sensitivity of our test to diagnose COVID-19 and the specificity to not only diagnose COVID-19 from typical influenzas and rhinoviruses, but also the specificity to diagnose COVID-19 in patients with co-infections of other pulmonary viruses. Nasopharyngeal swab will be the gold standard. Results: We have collected exhaled breath condensate samples from patients with COVI19 infection. The device is can be used safely by the patient and does not require the participation of research coordinators during the breath collection phase. Symptomatic patients are able to use the device without excessive shortness of breath or other effects. The mass spectroscopy screening of the breath samples will look at a panel of eicosanoid biomarkers related to pulmonary infection and markers of oxidative stress. Patterns are being compared to prior breath profiles found with influenza infection. Conclusion: Our breath collection device could provide an “alarm” for individuals who are potentially facing a stark decline in health and should preemptively move into a hospital or clinical setting for closer monitoring. Because this method screens for a myriad of respiratory viruses and of pulmonary health simultaneously, its impact would extend far beyond the current COVID-19 pandemic.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77986414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3832
M. Debray, J. Frija-Masson, R. Borie, C. Bancal, B. Crestani, A. Khalil
Rationale: The long term evolution of Covid-19 pneumonia has still little been evaluated. We herein describe CT features that persist 3 months after Covid-19 symptom onset and correlate them to the extent of disease at diagnosis. Methods: Monocentric retrospective study including consecutive patients with Covid-19 confirmed by RT-PCR who presented to Bichat Hospital, Paris, France, between March and May 2020, and had a follow-up chest-CT 3 months later as part of their usual care. Chest CT analysis at 3 months evaluated ground-glass opacities (GGO, graded according to their extent and density), reticulations, bronchial distortion, honeycombing, band-like atelectasis and air trapping. The grade of persistent GGO and the presence of any sign suggestive of fibrosis were correlated to the extent of disease at presentation.Results;Any residual opacity was observed in 99/142 patients (70%). GGO, band-like atelectasis and reticulations were the most frequent findings, in 87/142 (61%), 53/142 (37%) and 40/142 (28%) patients, respectively. Signs that may suggest a fibrosing evolution, including bronchial distortion and distorted reticulations, were observed in 17/142 patients (12%), whereas no case showed honeycombing. Air trapping was present in 12 out of 80 patients (15%) who had an expiratory CT. The grade of GGO and the presence of reticulations at 3 months were highly correlated to the extent of disease at presentation (p<0.0001 and p=0.020, Kruskall Wallis) but signs suggestive of fibrosis were not (p=0.15)Conclusion: Residual opacities are frequent 3 months after Covid-19 pneumonia onset, chest CT mostly showing GGO, band-like atelectasis and reticulations. Signs that may suggest a fibrosing evolution are observed in only 12% of patients.
{"title":"CT Features of Patients with Covid-19 Pneumonia at Three Months Following Infection","authors":"M. Debray, J. Frija-Masson, R. Borie, C. Bancal, B. Crestani, A. Khalil","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3832","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3832","url":null,"abstract":"Rationale: The long term evolution of Covid-19 pneumonia has still little been evaluated. We herein describe CT features that persist 3 months after Covid-19 symptom onset and correlate them to the extent of disease at diagnosis. Methods: Monocentric retrospective study including consecutive patients with Covid-19 confirmed by RT-PCR who presented to Bichat Hospital, Paris, France, between March and May 2020, and had a follow-up chest-CT 3 months later as part of their usual care. Chest CT analysis at 3 months evaluated ground-glass opacities (GGO, graded according to their extent and density), reticulations, bronchial distortion, honeycombing, band-like atelectasis and air trapping. The grade of persistent GGO and the presence of any sign suggestive of fibrosis were correlated to the extent of disease at presentation.Results;Any residual opacity was observed in 99/142 patients (70%). GGO, band-like atelectasis and reticulations were the most frequent findings, in 87/142 (61%), 53/142 (37%) and 40/142 (28%) patients, respectively. Signs that may suggest a fibrosing evolution, including bronchial distortion and distorted reticulations, were observed in 17/142 patients (12%), whereas no case showed honeycombing. Air trapping was present in 12 out of 80 patients (15%) who had an expiratory CT. The grade of GGO and the presence of reticulations at 3 months were highly correlated to the extent of disease at presentation (p<0.0001 and p=0.020, Kruskall Wallis) but signs suggestive of fibrosis were not (p=0.15)Conclusion: Residual opacities are frequent 3 months after Covid-19 pneumonia onset, chest CT mostly showing GGO, band-like atelectasis and reticulations. Signs that may suggest a fibrosing evolution are observed in only 12% of patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78319262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3851
Y. Vayner, S. Lessen, R. Shah, S. Congdon, M. Gong, A. Hope
Rationale: Recent reports suggest that many patients diagnosed with COVID-19 will experience protracted symptoms. As part of a COVID-19 Recovery Engagement program, we aimed to 1) elucidate the type and trajectory of protracted symptoms after COVID-19 diagnosis and 2) compare symptom prevalence and severity at 1, 3 and 6 months after COVID-19 diagnosis. Methods: This is a prospective observational study of adults diagnosed with COVID-19 at Montefiore Medical Center from March 2020 to December 2020. We identified patients with a positive SARS-CoV-2 result who were recently treated in outpatient, Emergency Department, or hospital settings within the medical center. Patients were contacted for consent via telephone at 1, 3, and 6 months after diagnosis and asked to complete 1) a modified revised Edmonton Symptom Assessment (mrESAS), which assessed 13 symptoms on a scale of 0-10 and 2) three additional questions that asked patients to compare their physical, emotional and cognitive health status to their pre-COVID health state. We used chart review to gather additional data for each of the patients, including demographics, past medical history, and course of COVID-19 illness.Results: We enrolled 141 patients (mean (standard deviation (SD) age 49.5(16.9)], with 29 in the 1-month cohort, 22 in 3-month cohort, and 90 in 6-month cohort;46/141 (32.6%) were hospitalized. In patients in the 1-month cohort, there was a high (≥ 25% of patients) prevalence of 7/13 symptoms: pain (31%), fatigue (31%), sleepiness (30.3%), nausea (30.3%), change in taste (31%), breathlessness (27.6%) and anxiety (37.9%). In general, prevalence of symptoms was lower in patients at 3- month and 6-months after discharge. We found a higher prevalence of nausea and change of taste symptoms in the 1-month group compared with the 3- and 6-month group (10% at 1-month reported nausea vs 1.8% in 3- and 6-month cohorts, p= 0.026;31% at 1-month reported change in taste vs. 10.7 in the 3- and 6-month groups, p=0.006 for change of taste). Furthermore, in the 6-month cohort, 24.4%, 25.6% and 30% reported being worse than pre-COVID in their physical, emotional and cognitive health status, respectively. Conclusion: Patients at 1-month post-COVID experience more nausea and taste change than patients called at later time points after diagnosis. Even at 6 months after COVID diagnosis, over one-fourth of all patients still consider themselves to have worse health status than before their illness. COVID-19 survivors have a significant risk of residual symptoms for months after diagnosis.
{"title":"Residual Symptom Burden in Adult COVID-19 Survivors at One, Three, and Six Months After COVID-19 Illness","authors":"Y. Vayner, S. Lessen, R. Shah, S. Congdon, M. Gong, A. Hope","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3851","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3851","url":null,"abstract":"Rationale: Recent reports suggest that many patients diagnosed with COVID-19 will experience protracted symptoms. As part of a COVID-19 Recovery Engagement program, we aimed to 1) elucidate the type and trajectory of protracted symptoms after COVID-19 diagnosis and 2) compare symptom prevalence and severity at 1, 3 and 6 months after COVID-19 diagnosis. Methods: This is a prospective observational study of adults diagnosed with COVID-19 at Montefiore Medical Center from March 2020 to December 2020. We identified patients with a positive SARS-CoV-2 result who were recently treated in outpatient, Emergency Department, or hospital settings within the medical center. Patients were contacted for consent via telephone at 1, 3, and 6 months after diagnosis and asked to complete 1) a modified revised Edmonton Symptom Assessment (mrESAS), which assessed 13 symptoms on a scale of 0-10 and 2) three additional questions that asked patients to compare their physical, emotional and cognitive health status to their pre-COVID health state. We used chart review to gather additional data for each of the patients, including demographics, past medical history, and course of COVID-19 illness.Results: We enrolled 141 patients (mean (standard deviation (SD) age 49.5(16.9)], with 29 in the 1-month cohort, 22 in 3-month cohort, and 90 in 6-month cohort;46/141 (32.6%) were hospitalized. In patients in the 1-month cohort, there was a high (≥ 25% of patients) prevalence of 7/13 symptoms: pain (31%), fatigue (31%), sleepiness (30.3%), nausea (30.3%), change in taste (31%), breathlessness (27.6%) and anxiety (37.9%). In general, prevalence of symptoms was lower in patients at 3- month and 6-months after discharge. We found a higher prevalence of nausea and change of taste symptoms in the 1-month group compared with the 3- and 6-month group (10% at 1-month reported nausea vs 1.8% in 3- and 6-month cohorts, p= 0.026;31% at 1-month reported change in taste vs. 10.7 in the 3- and 6-month groups, p=0.006 for change of taste). Furthermore, in the 6-month cohort, 24.4%, 25.6% and 30% reported being worse than pre-COVID in their physical, emotional and cognitive health status, respectively. Conclusion: Patients at 1-month post-COVID experience more nausea and taste change than patients called at later time points after diagnosis. Even at 6 months after COVID diagnosis, over one-fourth of all patients still consider themselves to have worse health status than before their illness. COVID-19 survivors have a significant risk of residual symptoms for months after diagnosis.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74507495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3831
A. Mechineni, A. Samuel, R. Manickam
Introduction: COVID 19 Pandemic posed devastating consequences for the healthcare community regarding morbidity, mortality, and resource utilization in 2020. Clinicians are studying all aspects of the disease, intending to provide the most efficient patient care. Monitoring in-patients with a proven COVID 19 disease diagnosis has been challenging and aided by tracking serum inflammatory markers. We aimed to study D Dimer as a potentially important serum marker and verify if it correlated to clinical patient outcomes. Our primary outcome is in-patient mortality, and the secondary outcome is respiratory failure requiring ventilator use and hospital length of stay. Methods: A single-center, retrospective observational study obtaining data from electronic medical records of all COVID-19 positive patients admitted to an urban tertiary care center in New Jersey between March 15th, 2020 to May 6th, 2020. A total of 1210 patients were identified with primary in-patient diagnosis of COVID-related acute illness during the study period. Among these patients, 928 patients were included in this study who had at least one recorded D dimer value during their hospitalization. In patients with multiple values, the highest value was taken for the study purpose. Two sample t-test and a Pearson correlation coefficient test were used to measure relationships between variables. R studio version 1.3.1073 was used for data analysis. Results: The mean age of patients was 60 years, and 571(61.5%) were male gender. The ethnicity distribution of patients was 24.3% Caucasian, 19% African American, and 49% Hispanic. Major symptoms on presentation were cough(68.9%), fever (58%), and shortness of breath(74.7%). Notable comorbidities among patients were Hypertension (57.3%), Diabetes Mellitus ( 38.9%), Obesity (39%), and Chronic kidney disease (9.91%). The mean D dimer values for patient groups discharged and died were 4.89 and 10.14 mcg/ml, respectively, with the t-test showing a significant difference between the groups(p value:0.0001, CI: -6.16:-4.34). D dimer values were also significantly different between the groups with ventilator use and without(p value:0.0001, CI:6.23-7.17). D dimer also predicted a higher length of stay with increasing value with a correlation coefficient of 0.14( p value:0.0001, CI: 0.08-0.20). Conclusion: Serum D dimer value is a critical laboratory value to trend and helps navigate an inpatient stay for COVID 19 patients. Clinical correlation with fibrinogen, LDH would give us more information regarding underlying hematological dysfunction. Increasing d dimer value in patients positively correlated with a higher risk of in-patient mortality, ventilator use, and increased length of stay in our study population.
{"title":"Diagnostic Value of D Dimer Serum Marker in COVID 19 Patients","authors":"A. Mechineni, A. Samuel, R. Manickam","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3831","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3831","url":null,"abstract":"Introduction: COVID 19 Pandemic posed devastating consequences for the healthcare community regarding morbidity, mortality, and resource utilization in 2020. Clinicians are studying all aspects of the disease, intending to provide the most efficient patient care. Monitoring in-patients with a proven COVID 19 disease diagnosis has been challenging and aided by tracking serum inflammatory markers. We aimed to study D Dimer as a potentially important serum marker and verify if it correlated to clinical patient outcomes. Our primary outcome is in-patient mortality, and the secondary outcome is respiratory failure requiring ventilator use and hospital length of stay. Methods: A single-center, retrospective observational study obtaining data from electronic medical records of all COVID-19 positive patients admitted to an urban tertiary care center in New Jersey between March 15th, 2020 to May 6th, 2020. A total of 1210 patients were identified with primary in-patient diagnosis of COVID-related acute illness during the study period. Among these patients, 928 patients were included in this study who had at least one recorded D dimer value during their hospitalization. In patients with multiple values, the highest value was taken for the study purpose. Two sample t-test and a Pearson correlation coefficient test were used to measure relationships between variables. R studio version 1.3.1073 was used for data analysis. Results: The mean age of patients was 60 years, and 571(61.5%) were male gender. The ethnicity distribution of patients was 24.3% Caucasian, 19% African American, and 49% Hispanic. Major symptoms on presentation were cough(68.9%), fever (58%), and shortness of breath(74.7%). Notable comorbidities among patients were Hypertension (57.3%), Diabetes Mellitus ( 38.9%), Obesity (39%), and Chronic kidney disease (9.91%). The mean D dimer values for patient groups discharged and died were 4.89 and 10.14 mcg/ml, respectively, with the t-test showing a significant difference between the groups(p value:0.0001, CI: -6.16:-4.34). D dimer values were also significantly different between the groups with ventilator use and without(p value:0.0001, CI:6.23-7.17). D dimer also predicted a higher length of stay with increasing value with a correlation coefficient of 0.14( p value:0.0001, CI: 0.08-0.20). Conclusion: Serum D dimer value is a critical laboratory value to trend and helps navigate an inpatient stay for COVID 19 patients. Clinical correlation with fibrinogen, LDH would give us more information regarding underlying hematological dysfunction. Increasing d dimer value in patients positively correlated with a higher risk of in-patient mortality, ventilator use, and increased length of stay in our study population.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82781873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3846
N. Carrión, F. Sanz, F. Puchades, E. Verdejo, C. Ricart, J. Chordá, M. García, A. Lluch, A. González-Cruz, M. García del Toro, E. Fernández
BACKGROUND The role of lymphocytes in the response to SARS-CoV-2 infection is crucial and lymphopenia is a well-known poor prognostic factor in COVID-19. However, the influence of a hypoxemic environment on lymphocytes and their populations is not known.We aim to evaluate the influence of hypoxemia on lymphocyte populations in patients with SARS-CoV-2 pneumonia who present with lymphopenia. METHODSWe analyzed the clinical and analytical data of a prospective cohort of 338 patients with diagnosis of SARS-CoV-2 pneumonia. The microbiological diagnosis was made by RT-PCR. Hypoxemia was defined a PaO2/FiO2 value <300 and lymphopenia for the total lymphocyte count less than 1000 109/L. Statistical analysis was made using X2 and Student's t tests. RESULTSFrom an initial cohort of 338 patients with analyzed those with ABG resulting in 118 patients. 48.3% (57 cases) presented PaO2/FiO2<300 at admission. Lymphopenia was present in 75 cases (63.6%) and it was significantly associated with the presence of hypoxemia [PaO2/FiO2 280.5 (104.5) vs 328.3 (82.7);p=0.011] and high levels of ferritine [1108.4 (1530.5) vs 539 (488.9);p=0.020]. Patients with lymphopenia who presented hypoxemia showed low levels of CD4+ T lymphocytes compared to non-hypoxemic patients [339.7 (260.7) vs. 468.8 (319.5);p=0.019], however the CD8+ T lymphocyte values were not affected by the presence of hypoxemia [247.4 (339.8) vs. 239.7 (172.1);p=0.875].The presence of lymphopenia was associated with ICU admission (44% vs. 16.7%;p=0.003) and the need of mechanical ventilation (40% vs. 14.3%;p=0.004). Survival was similar between groups (29.3% vs. 16.3%;p=0.113). CONCLUSIONS In our series, the different lymphocyte subpopulations exhibit a different behavior in patients with acute hypoxemic respiratory failure: CD4+ T lymphocytes seem to be especially susceptible to hypoxemia in patients with SARSCoV- 2 pneumonia.
背景淋巴细胞在对SARS-CoV-2感染的反应中起着至关重要的作用，淋巴细胞减少是众所周知的COVID-19预后不良因素。然而，低氧环境对淋巴细胞及其种群的影响尚不清楚。我们的目的是评估低氧血症对出现淋巴细胞减少的SARS-CoV-2肺炎患者淋巴细胞群的影响。方法对338例诊断为SARS-CoV-2肺炎的前瞻性队列患者的临床和分析资料进行分析。采用RT-PCR进行微生物学诊断。低氧血症定义为PaO2/FiO2值<300，淋巴细胞总数小于1000 109/L定义为淋巴细胞减少。采用X2检验和Student’st检验进行统计学分析。结果对338例ABG患者的初始队列进行了分析，其中118例为ABG患者。入院时PaO2/FiO2<300为48.3%(57例)。75例(63.6%)患者淋巴细胞减少，且与低氧血症(PaO2/FiO2 280.5 (104.5) vs 328.3 (82.7)， p=0.011)和高铁氨酸水平(1108.4 (1530.5)vs 539 (488.9)， p=0.020)显著相关。出现低氧血症的淋巴细胞减少患者CD4+ T淋巴细胞水平低于非低氧血症患者[339.7(260.7)比468.8 (319.5);p=0.019]，但CD8+ T淋巴细胞值不受低氧血症的影响[247.4(339.8)比239.7 (172.1);p=0.875]。淋巴细胞减少的存在与ICU住院(44%比16.7%，p=0.003)和需要机械通气(40%比14.3%，p=0.004)相关。两组间生存率相似(29.3% vs. 16.3%;p=0.113)。在我们的研究中，不同的淋巴细胞亚群在急性低氧性呼吸衰竭患者中表现出不同的行为:CD4+ T淋巴细胞似乎对SARSCoV- 2肺炎患者的低氧血症特别敏感。
{"title":"Influence of Hypoxemia on Lymphocytes Subpopulations in SARS-CoV-2 Pneumonia","authors":"N. Carrión, F. Sanz, F. Puchades, E. Verdejo, C. Ricart, J. Chordá, M. García, A. Lluch, A. González-Cruz, M. García del Toro, E. Fernández","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3846","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3846","url":null,"abstract":"BACKGROUND The role of lymphocytes in the response to SARS-CoV-2 infection is crucial and lymphopenia is a well-known poor prognostic factor in COVID-19. However, the influence of a hypoxemic environment on lymphocytes and their populations is not known.We aim to evaluate the influence of hypoxemia on lymphocyte populations in patients with SARS-CoV-2 pneumonia who present with lymphopenia. METHODSWe analyzed the clinical and analytical data of a prospective cohort of 338 patients with diagnosis of SARS-CoV-2 pneumonia. The microbiological diagnosis was made by RT-PCR. Hypoxemia was defined a PaO2/FiO2 value <300 and lymphopenia for the total lymphocyte count less than 1000 109/L. Statistical analysis was made using X2 and Student's t tests. RESULTSFrom an initial cohort of 338 patients with analyzed those with ABG resulting in 118 patients. 48.3% (57 cases) presented PaO2/FiO2<300 at admission. Lymphopenia was present in 75 cases (63.6%) and it was significantly associated with the presence of hypoxemia [PaO2/FiO2 280.5 (104.5) vs 328.3 (82.7);p=0.011] and high levels of ferritine [1108.4 (1530.5) vs 539 (488.9);p=0.020]. Patients with lymphopenia who presented hypoxemia showed low levels of CD4+ T lymphocytes compared to non-hypoxemic patients [339.7 (260.7) vs. 468.8 (319.5);p=0.019], however the CD8+ T lymphocyte values were not affected by the presence of hypoxemia [247.4 (339.8) vs. 239.7 (172.1);p=0.875].The presence of lymphopenia was associated with ICU admission (44% vs. 16.7%;p=0.003) and the need of mechanical ventilation (40% vs. 14.3%;p=0.004). Survival was similar between groups (29.3% vs. 16.3%;p=0.113). CONCLUSIONS In our series, the different lymphocyte subpopulations exhibit a different behavior in patients with acute hypoxemic respiratory failure: CD4+ T lymphocytes seem to be especially susceptible to hypoxemia in patients with SARSCoV- 2 pneumonia.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73558862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3837
A. Iqbal Muhammad, S. Ananth, M. Shah, T. Sedighi, I. Chahal, A. Barlow, F. Chua, W.-J. Song, R. Vancheeswaran
Rationale: SARS CoV-2 infection has been associated with long-term sequelae, including cough. The clinical course of chronic cough following SARS CoV-2 infection and therapies are not known. This study examined the prevalence and characteristics of chronic cough following SARS CoV-2 infection, aiming to assess its course, impact on patient well-being and predisposing factors. Methods: 113 patients were analysed as part of PREDICT UK follow up (NHS HRA: 20/HRA/2344) at 3 to 6 months (mean 152 days) after admission for a PCR positive SARS CoV2 infection. The baseline clinical and demographic characteristics were examined to assess contributing mechanisms that may predispose to chronic cough (defined as >8 weeks following SARS CoV2 infection). Results: 41.5% patients did not have a cough. In contrast, 24% of patients had an acute cough (<3 weeks), 10.6% had subacute cough (3 to 8 weeks), and 21.6% had chronic cough (>8 weeks). 1.7% of patients had a pre-existing cough, unchanged following COVID-19. The demographic and clinical characteristics of the study population are summarised in Table 1.50% of the cough group had a pre-existing lung disease (mainly airways disease), compared to 16% of patients without cough (P < 0.001). No differences in hypoxia, inflammation or infection markers (CRP) were noted between the 2 groups at admission. Diffusion Capacity for Carbon Monoxide (DLCO) was significantly reduced in those with cough compared with the non-cough group (32.2% vs 57.7%;P = 0.02). No significant differences in cough was noted between patients treated with different ventilator support strategies i.e. ITU and CPAP vs simple oxygen supplementation. Conclusions: This study notes a prevalence of chronic cough in 21.6% of patients post COVID-19. This was not associated with airway obstruction, reducing the likelihood of post infective bronchoconstriction. There was a significant reduction in DLCO consistent with post-infective interstitial lung disease (ILD). This study has looked at first-wave patients where dexamethasone was minimally used. Future studies reviewing cough with steroids therapy in patients requiring oxygen supplementation may note reduced levels of chronic cough. The use of cough as marker of post- COVID ILD warrants investigation. The current findings are in keeping with previous reports in SARS and MERS, where DLCO impairments were noted with time resolution of up to two years.
{"title":"Prevalence of Chronic Cough Following COVID-19 Infection: A Cross Sectional Study","authors":"A. Iqbal Muhammad, S. Ananth, M. Shah, T. Sedighi, I. Chahal, A. Barlow, F. Chua, W.-J. Song, R. Vancheeswaran","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3837","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3837","url":null,"abstract":"Rationale: SARS CoV-2 infection has been associated with long-term sequelae, including cough. The clinical course of chronic cough following SARS CoV-2 infection and therapies are not known. This study examined the prevalence and characteristics of chronic cough following SARS CoV-2 infection, aiming to assess its course, impact on patient well-being and predisposing factors. Methods: 113 patients were analysed as part of PREDICT UK follow up (NHS HRA: 20/HRA/2344) at 3 to 6 months (mean 152 days) after admission for a PCR positive SARS CoV2 infection. The baseline clinical and demographic characteristics were examined to assess contributing mechanisms that may predispose to chronic cough (defined as >8 weeks following SARS CoV2 infection). Results: 41.5% patients did not have a cough. In contrast, 24% of patients had an acute cough (<3 weeks), 10.6% had subacute cough (3 to 8 weeks), and 21.6% had chronic cough (>8 weeks). 1.7% of patients had a pre-existing cough, unchanged following COVID-19. The demographic and clinical characteristics of the study population are summarised in Table 1.50% of the cough group had a pre-existing lung disease (mainly airways disease), compared to 16% of patients without cough (P < 0.001). No differences in hypoxia, inflammation or infection markers (CRP) were noted between the 2 groups at admission. Diffusion Capacity for Carbon Monoxide (DLCO) was significantly reduced in those with cough compared with the non-cough group (32.2% vs 57.7%;P = 0.02). No significant differences in cough was noted between patients treated with different ventilator support strategies i.e. ITU and CPAP vs simple oxygen supplementation. Conclusions: This study notes a prevalence of chronic cough in 21.6% of patients post COVID-19. This was not associated with airway obstruction, reducing the likelihood of post infective bronchoconstriction. There was a significant reduction in DLCO consistent with post-infective interstitial lung disease (ILD). This study has looked at first-wave patients where dexamethasone was minimally used. Future studies reviewing cough with steroids therapy in patients requiring oxygen supplementation may note reduced levels of chronic cough. The use of cough as marker of post- COVID ILD warrants investigation. The current findings are in keeping with previous reports in SARS and MERS, where DLCO impairments were noted with time resolution of up to two years.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74294826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3850
M. Ahmed, M. Mohamed
Rationale: COVID 19 virus infection is ongoing catastrophic worldwide pandemic with significant morbidity and mortality. Large numbers of persons that getting COVID19 virus infection at high risk of developing COVID 19 pneumonia;with increasing chance of worse and prolonged illness. Early diagnosis of COVID 19 pneumonia, patient care and isolation using simple less expensive image are wanted. Decreasing the numbers of medical and paramedical personnel exposure to COVID 19 patients is always recommended, High resolution CT Chest (HRCT chest) is the Gold standard method to diagnosis COVID 19 pneumonia;however it is expensive with increasing the exposure risk;chest ultrasonography may be alternative method, however still not confirmed. Methods: In consecutive patients referred to assess COVID 19 pneumonia in outpatient pulmonology clinic in Assiut Governorate;between May 2020 and October 2020. Chest ultrasonography was done for patients accepting to participate in the study. HRCT chest to confirm COVID 19 pneumonia were done within 24 hours of Chest ultrasonography exam, the chest ultrasonography operators were blind to HRCT chest results;chest ultrasonography were done by two chest consultants expert in chest ultrasonography at Chest Department of Assiut University Hospital . The chest ultrasonography was done using the convex probe of Aloka and Fukuda ultrasonography devices. The chest Ultrasonography considered positive for pneumonia if the examiners find presence of abnormal multiple vertical B-lines or presence of consolidations dots unilateral or bilateral with good cardiac function, HRCT chest result were recorded. Results: 197 patients are included in the study, with mean age 48 ±16.2 year , 52% male, 10% have DM, 9% have HTN, 5 % needed hospitalization, mean oxygen saturation were 95±5 percent, 152 patients confirmed COVID pneumonia with HRCT chest while 45 patients had normal HRCT chest , while chest ultrasonography positive finding for pneumonia in 128 patients while normal Chest ultrasonography 69patients ,Chest ultrasonography is having good association (R 0.690 p value <0.001)when correlated with HRCT to diagnose COVID 19 pneumonia. The sensitivity and specificity and accuracy of Chest ultrasonography in diagnosis of COVID19 pneumonia are 84.56% , 95.83% and 87.31% respectively when compared with HRCT chest.102 patients successfully followed within 15 days;all of them showing clinical and ultrasonographically improvement. Conclusion :Chest Ultrasonography is a promising cheap method for evaluation of COVID 19 pneumonia with high specificity , sensitivity and accuracy with less patients' exposure and virus spread when compared with HRCT chest .
{"title":"Accuracy of Chest Ultrasonography in Diagnosis of COVID 19 Pneumonia","authors":"M. Ahmed, M. Mohamed","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3850","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3850","url":null,"abstract":"Rationale: COVID 19 virus infection is ongoing catastrophic worldwide pandemic with significant morbidity and mortality. Large numbers of persons that getting COVID19 virus infection at high risk of developing COVID 19 pneumonia;with increasing chance of worse and prolonged illness. Early diagnosis of COVID 19 pneumonia, patient care and isolation using simple less expensive image are wanted. Decreasing the numbers of medical and paramedical personnel exposure to COVID 19 patients is always recommended, High resolution CT Chest (HRCT chest) is the Gold standard method to diagnosis COVID 19 pneumonia;however it is expensive with increasing the exposure risk;chest ultrasonography may be alternative method, however still not confirmed. Methods: In consecutive patients referred to assess COVID 19 pneumonia in outpatient pulmonology clinic in Assiut Governorate;between May 2020 and October 2020. Chest ultrasonography was done for patients accepting to participate in the study. HRCT chest to confirm COVID 19 pneumonia were done within 24 hours of Chest ultrasonography exam, the chest ultrasonography operators were blind to HRCT chest results;chest ultrasonography were done by two chest consultants expert in chest ultrasonography at Chest Department of Assiut University Hospital . The chest ultrasonography was done using the convex probe of Aloka and Fukuda ultrasonography devices. The chest Ultrasonography considered positive for pneumonia if the examiners find presence of abnormal multiple vertical B-lines or presence of consolidations dots unilateral or bilateral with good cardiac function, HRCT chest result were recorded. Results: 197 patients are included in the study, with mean age 48 ±16.2 year , 52% male, 10% have DM, 9% have HTN, 5 % needed hospitalization, mean oxygen saturation were 95±5 percent, 152 patients confirmed COVID pneumonia with HRCT chest while 45 patients had normal HRCT chest , while chest ultrasonography positive finding for pneumonia in 128 patients while normal Chest ultrasonography 69patients ,Chest ultrasonography is having good association (R 0.690 p value <0.001)when correlated with HRCT to diagnose COVID 19 pneumonia. The sensitivity and specificity and accuracy of Chest ultrasonography in diagnosis of COVID19 pneumonia are 84.56% , 95.83% and 87.31% respectively when compared with HRCT chest.102 patients successfully followed within 15 days;all of them showing clinical and ultrasonographically improvement. Conclusion :Chest Ultrasonography is a promising cheap method for evaluation of COVID 19 pneumonia with high specificity , sensitivity and accuracy with less patients' exposure and virus spread when compared with HRCT chest .","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80927565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3838
Z. Muzaffarr, J. Ambut, S. Gottlieb
RationaleThe novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the greatest challenges in modern medicine. As the pandemic has progressed throughout the globe it has revealed vulnerable populations;one of these being obese patients. Obesity has been associated with an increased risk of hospitalization along with other co-morbid conditions such as hypertension, diabetes, cardiovascular disease and chronic lung disease. We sought to investigate the mortality associated with COVID-19 positive obese patients in the inpatient setting. MethodsThis observational retrospective study included patients who were admitted to the hospital with confirmed SARS-CoV-2 RNA qualitative polymerase chain reaction assay from March 1, 2020 until May 20, 2020. The primary outcome of this study was the mortality of patients who were admitted to the hospital. Other outcomes included: hospital length of stay, need for intensive care, mechanical ventilation, continuous renal replacement therapy and secondary bacterial infection. Primary Statistical analysis of data was performed using Microsoft Excel and R 4.0.2. Quantitative variables were compared using a t-test and categorical variables with chi-squared testing. Time to event analysis was evaluated with a log-rank test. ResultsAmong the 178 patients hospitalized COVID-19 positive patients, the average BMI was 28.90 (SD 6.48). There were 40 in hospital deaths with an average BMI of those alive 28.80 (SD 6.16) and among those who expired of 29.26 (SD 7.56). Multivariate logistic regression of the full variable model of mortality demonstrated that age, intensive unit care, mechanical ventilation and days of hospitalization were statistically significant and correlated with mortality (p-values 0.007, 0.031, 0.020, and 0.0001). Kaplan Meier analysis comparing obese and non obese individuals to number of days of hospitalization until time of death with censoring demonstrated an absence of statistically significant difference (p-value 0.696). Backward stepwise reduction of the multivariate linear regression model demonstrated multivariate statistical significance for age (pvalue 1.58 E -09), gender (p-value 0.01), hypertension (p-value 0.003), and smoking status (p-value 0.005). Conclusion Advanced age, intensive care, mechanical ventilation and days of hospitalization increased the risk of mortality. We also confirmed that hypertensive and patients with a history of smoking also had an increased risk of mortality.
{"title":"Obesity and Outcomes in Patients with Covid-19: A Retrospective Review from a Community Hospital","authors":"Z. Muzaffarr, J. Ambut, S. Gottlieb","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3838","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3838","url":null,"abstract":"RationaleThe novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the greatest challenges in modern medicine. As the pandemic has progressed throughout the globe it has revealed vulnerable populations;one of these being obese patients. Obesity has been associated with an increased risk of hospitalization along with other co-morbid conditions such as hypertension, diabetes, cardiovascular disease and chronic lung disease. We sought to investigate the mortality associated with COVID-19 positive obese patients in the inpatient setting. MethodsThis observational retrospective study included patients who were admitted to the hospital with confirmed SARS-CoV-2 RNA qualitative polymerase chain reaction assay from March 1, 2020 until May 20, 2020. The primary outcome of this study was the mortality of patients who were admitted to the hospital. Other outcomes included: hospital length of stay, need for intensive care, mechanical ventilation, continuous renal replacement therapy and secondary bacterial infection. Primary Statistical analysis of data was performed using Microsoft Excel and R 4.0.2. Quantitative variables were compared using a t-test and categorical variables with chi-squared testing. Time to event analysis was evaluated with a log-rank test. ResultsAmong the 178 patients hospitalized COVID-19 positive patients, the average BMI was 28.90 (SD 6.48). There were 40 in hospital deaths with an average BMI of those alive 28.80 (SD 6.16) and among those who expired of 29.26 (SD 7.56). Multivariate logistic regression of the full variable model of mortality demonstrated that age, intensive unit care, mechanical ventilation and days of hospitalization were statistically significant and correlated with mortality (p-values 0.007, 0.031, 0.020, and 0.0001). Kaplan Meier analysis comparing obese and non obese individuals to number of days of hospitalization until time of death with censoring demonstrated an absence of statistically significant difference (p-value 0.696). Backward stepwise reduction of the multivariate linear regression model demonstrated multivariate statistical significance for age (pvalue 1.58 E -09), gender (p-value 0.01), hypertension (p-value 0.003), and smoking status (p-value 0.005). Conclusion Advanced age, intensive care, mechanical ventilation and days of hospitalization increased the risk of mortality. We also confirmed that hypertensive and patients with a history of smoking also had an increased risk of mortality.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90496551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3845
A. Wong, S. López-Romero, E. Figueroa-Hurtado, Y. N. Pou-Aguilar, K. Milne, C. Ryerson, J. Guenette, A. Cortés-Télles
Rationale: Clinical outcomes after coronavirus-2019 disease (COVID-19) have been well described, including persistent symptoms and abnormalities on pulmonary function tests and imaging. However, the presence and underlying mechanism of functional impairments after COVID-19 remain unclear. Methods: Patients with SARS-CoV-2 confirmed by real-time polymerase chain reaction were recruited from a hospital in Yucatan, Mexico. Patients who were able to complete surveys, pulmonary function tests, and 6-minute walk tests within 30-90 days after symptom onset were included. COVID-19 severity based on the location of treatment and need for supplemental oxygen was categorized as follows: mild (ambulatory, no hypoxemia), moderate (ambulatory, supplemental oxygen (O2) ≤ 5 l/min), or severe (hospitalised, O2 > 5 l/min without invasive mechanical ventilation). The association between COVID-19 severity and 6-minute walk distance (6MWD) was determined using multivariable linear regression, and underlying mechanisms for reduced 6MWD were then explored. Unadjusted and adjusted linear regression models were used to determine the association between potential predictor variables (Borg dyspnea, Borg fatigue, and end-exercise SpO2) and 6MWD. A final model with Borg dyspnea and end-exercise SpO2 as co-primary endpoints was performed to explore the independent relationship of these two predictors with 6MWD. All models were adjusted for age, sex, smoking, and body mass index (BMI). Results: There were 148 eligible patients with a mean age of 47±14 years and BMI of 32±7kg/m2, with 66% males and 19% current or past-smokers. There were 26% patients with mild, 10% with moderate, and 64% with severe COVID-19 illness. The mean follow-up time was 59 days. The mean 6MWD was 450±104m (83±19% predicted). Patients with severe COVID-19 had a lower 6MWD compared to patients with mild COVID-19 (- 52m [95%CI -88,-15], p=0.006). There was no difference in 6MWD between mild and moderate COVID-19. For every unit increase, Borg dyspnea (coefficient -21m [95%CI -31,-10]) and end-exercise SpO2 (coefficient 13m [95%CI 8,18]) were associated with 6MWD (both p<0.001);however, Borg fatigue was not. When Borg dyspnea and end-exercise SpO2 were included as co-primary predictors, both variables remained independently associated with reduced 6MWD with coefficients of -13m (95%CI -23,-2) and 10m (95%CI 5,16), respectively, after adjusting for covariates (Table 1). Conclusions: Patients with severe COVID-19 had significantly lower 6MWD compared to those with mild disease. Exertional dyspnea and hypoxemia were independent predictors of lower 6MWD, suggesting that dyspnea related to hypoxemia is not the sole driver of reduced functional capacity in COVID- 19 survivors.
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