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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Markers Of Coagulation And Hemostatic Activation Identify COVID-19 Patients At High Risk For Thrombotic Events MESHD, ICU Admission and Intubation

    Authors: Darwish Alabyad; Srikant Rangaraju; Michael Liu; Rajeel Imran; Christine Kempton; Milad Sharifpour; Sara Auld; Manila Gaddh; Roman Sniecinski; Cheryl L Maier; Jeannette Guarner; Alexander Duncan; Fadi Nahab

    doi:10.1101/2020.10.04.20206540 Date: 2020-10-06 Source: medRxiv

    Background: Coronavirus disease 2019 (COVID-19) has been associated with a coagulopathy giving rise to venous and arterial thrombotic MESHD events. The objective of our study was to determine whether markers of coagulation MESHD and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic MESHD events and other complications. Methods: COVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent standardized admission testing of MOCHA profile parameters ( plasma SERO d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) with abnormal MOCHA defined as [≥] 2 markers above the reference. Prespecified thrombotic MESHD endpoints included deep vein thrombosis MESHD, pulmonary embolism HP pulmonary embolism MESHD, myocardial infarction HP myocardial infarction MESHD, ischemic stroke HP ischemic stroke MESHD, and access line thrombosis MESHD; other complications included ICU admission, intubation and mortality. We excluded patients on anticoagulation therapy prior to admission and those who were pregnant. Results: Of 276 patients (mean age TRANS 59 {+/-} 6.4 years, 47% female TRANS, 62% African American race) who met study criteria, 45 (16%) had a thrombotic MESHD event. Each coagulation marker on admission was independently associated with a vascular endpoint (p<0.05). Admission MOCHA with [≥] 2 abnormalities (n=203, 74%) was associated with in-hospital vascular endpoints (OR 3.3, 95% CI 1.2-8.8), as were admission D-dimer [≥] 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6), and admission D-dimer [≥] 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only admission MOCHA with [≥] 2 abnormalities was associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4), while admission D-dimer [≥] 2000 ng/mL and admission D-dimer [≥] 3000 ng/mL were not associated. MOCHA and D-dimer cutoffs were not associated with mortality. Admission MOCHA with <2 abnormalities (26% of the cohort) had a sensitivity SERO of 88% and negative predictive value SERO of 93% for a vascular endpoint. Conclusions: Admission MOCHA with [≥] 2 abnormalities identified COVID-19 patients at increased risk of ICU admission and intubation during hospitalization more effectively than isolated admission D-dimer measurement. Admission MOCHA with <2 abnormalities identified a subgroup of patients at low risk for vascular events. Our results suggest that an admission MOCHA profile can be useful to risk-stratify COVID-19 patients.

    The Impact of the COVID-19 Pandemic on the Emergency Department Visits: A Retrospective Analysis in Shanghai, China

    Authors: Wei Long; Jiudong Hu; Lijuan Li; Sheng Zuo; Qian Yang; Zenghua Ren

    doi:10.21203/rs.3.rs-49525/v1 Date: 2020-07-27 Source: ResearchSquare

    BackgroundThe novel coronavirus diseases MESHD (COVID-19) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic on characteristics and trends of emergency department (ED) visits in Shanghai, China.MethodsThis was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.ResultsDuring the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke MESHD ischemic stroke HP ( AIS MESHD) and acute coronary syndrome MESHD(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS MESHD has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly ( AIS MESHD: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).ConclusionThe outbreak of COVID-19 pandemic was correlated with a significant decline in the number of ED visits including AIS MESHD and ACS patients when compared to the pre-COVID-19 period. ODT of AIS MESHD and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke HP stroke MESHD and myocardial infarction HP myocardial infarction MESHD attack.

    The impact of the COVID-19 pandemic on the emergency department visits: a retrospective analysis in Shanghai, China

    Authors: Wei Long; Jiudong Hu; Lijuan Li; Sheng Zuo; Qian Yang; Zenghua Ren

    doi:10.21203/rs.3.rs-49525/v2 Date: 2020-07-27 Source: ResearchSquare

    Background The novel coronavirus diseases (COVID-19) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic on characteristics and trends of emergency department (ED) visits in Shanghai, China.Methods This was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.Results During the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke MESHD ischemic stroke HP ( AIS MESHD) and acute coronary syndrome MESHD(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS MESHD has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly ( AIS MESHD: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).Conclusion The outbreak of COVID-19 pandemic was correlated with a significant decline in the number of ED visits including AIS MESHD and ACS patients when compared to the pre-COVID-19 period. ODT of AIS MESHD and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke HP stroke MESHD and myocardial infarction HP myocardial infarction MESHD attack.

    Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

    Authors: Viktoria Schwarz; Felix Mahfoud; Lucas Lauder; Wolfgang Reith; Stefanie Behnke; Sigrun Smola; Jürgen Rissland; Thorsten Pfuhl; Bruno Scheller; Michael Böhm; Sebastian Ewen

    doi:10.21203/rs.3.rs-30359/v1 Date: 2020-05-19 Source: ResearchSquare

    Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome MESHD ( ACS MESHD) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS MESHD and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease MESHD (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS MESHD decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina MESHD, Δ -25% (p=0.42) for myocardial infarction HP myocardial infarction MESHD with ST-elevation and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack HP ischemic MESHD attack: Δ -32% (p=0.18), ischemic stroke HP ischemic stroke MESHD: Δ -23% (p=0.48), intracerebral haemorrhage MESHD: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients ( prevalence SERO 1,54%, thereof one patient with myocardial and two with cerebral ischemia HP cerebral ischemia MESHD) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events MESHD in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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