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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.

    Gender TRANS disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

    Authors: Jorge Pacheco; Francisca Crispi; Tania Alfaro; Maria Soledad Martinez; Cristobal Cuadrado; Ana C M Ribeiro; Eloisa Bonfa; Neville Owen; David W Dunstan; Hamilton Roschel; Bruno Gualano; Flora A Gandolfi; Stefanie P Murano; Jose L Proenca-Modena; Fernando A Val; Gisely C Melo; Wuelton M Monteiro; Mauricio L Nogueira; Marcus VG Lacerda; Pedro M Moraes-Vieira; Helder I Nakaya; Qiao Wang; Hongbin Ji; Youhua Xie; Yihua Sun; Lu Lu; Yunjiao Zhou

    doi:10.1101/2020.09.11.20192880 Date: 2020-09-11 Source: medRxiv

    Introduction: During the COVID-19 pandemic reduction on the utilisation of healthcare services are reported in different contexts. Nevertheless, studies have not explored specifically gender TRANS disparities on access to healthcare. Aim: To evaluate disparities in access to care in Chile during the COVID-19 pandemic from a gender TRANS-based perspective. Methods: We conducted a quasi-experimental design using a difference-in-difference approach. We compared the number of weekly confirmed cases TRANS of a set of oncologic and cardiovascular time-sensitive conditions at a national level. We defined weeks 12 to 26 as an intervention period and the actual year as a treatment group. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. To test heterogeneity by sex, we included an interaction term between difference-in-difference estimator and sex. Results: A sizable reduction in access to care for patients with time- sensitivity SERO conditions was observed for oncologic (IRR 0.56; 95% CI 0.50-0.63) and cardiovascular diseases MESHD (IRR 0.64; 95% CI 0.62-0.66). Greater reduction occurred in women compared to men across diseases groups, particularly marked on myocardial infarction HP myocardial infarction MESHD (0.89; 95% CI 0.85-0.93), stroke HP stroke MESHD (IRR 0.88 IC95% 0.82-0.93), and colorectal cancer MESHD (IRR 0.79; 95% CI 0.69-0.91). Compared to men, a greater absolute reduction in women for oncologic diseases (782; 95% CI 704-859) than cardiovascular diseases MESHD (172; 95% CI 170-174) occurred over 14 weeks. Conclusion: We confirmed a large drop in new diagnosis for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender TRANS perspective into the pandemic response and its aftermath.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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