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    Impact of hematologic malignancy MESHD and type of cancer MESHD therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

    Authors: Julio García-Suárez*; Javier de la Cruz*; Ángel Cedillo; Pilar Llamas; Rafael Duarte; Víctor Jiménez-Yuste; José Ángel Hernández-Rivas; Rodrigo Gil-Manso; Mi Kwon; Pedro Sánchez-Godoy; Pilar Martínez-Barranco; Blanca Colás-Lahuerta; Pilar Herrera; Laurentino Benito-Parra; Adrián Alegre; Alberto Velasco; Arturo Matilla; María Concepción Aláez-Usón; Rafael Martos-Martínez; Carmen Martínez-Chamorro; Keina Susana-Quiroz; Juan Francisco Del Campo; Adolfo de la Fuente; Regina Herráez; Adriana Pascual; Elvira Gómez; Jaime Pérez-Oteyza; Elena Ruiz; Arancha Alonso; José González-Medina; Lucía Núñez Martín-Buitrago; Miguel Canales; Isabel González-Gascón; María Carmen Vicente-Ayuso; Susana Valenciano; María García Roa; Pablo Estival Monteliu; Javier López-Jiménez; Cristián Escolano Escobar; Javier Ortiz-Martín; José Luis Diez-Martin†; Joaquín Martínez-López†

    doi:10.21203/rs.3.rs-69133/v1 Date: 2020-08-31 Source: ResearchSquare

    Background Patients with cancer MESHD have been shown to have a higher risk of clinical severity and mortality compared to non-cancer MESHD patients with COVID-19. Patients with hematologic malignancies MESHD typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections MESHD than patients with solid tumours MESHD. Data on COVID-19 in patients with hematologic malignancies MESHD are limited. Here we characterise disease severity and mortality, and evaluate potential prognostic factors for mortality.Methods In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult TRANS patients with hematologic malignancies MESHD and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection MESHD within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centres between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age TRANS, sex, comorbidities, hematologic malignancy MESHD and recent active cancer MESHD therapy.Results Of 833 patients reported, 697 were included in the analyses. Median age TRANS was 72 years (IQR 60–79), 413 (60%) patients were male TRANS, and 479 (69%) and 218 (31%) had lymphoid MESHD and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age TRANS ≥60 years (hazard ratios 3·17–10·1 vs <50 years), >2 comorbidities (1·41 vs ≤2), acute myeloid leukemia HP acute myeloid leukemia MESHD (2·22 vs non-Hodgkin lymphoma HP lymphoma MESHD) and active antineoplastic treatment with monoclonal antibodies SERO (2·02) or conventional chemotherapy (1·50 vs no active therapy) were associated with increased mortality. Conversely, Ph-negative myeloproliferative neoplasms MESHD neoplasms HP (0·33) and active treatment with hypomethylating agents (0·47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20).Conclusions In this series of patients with hematologic malignancies MESHD and COVID-19, mortality was associated with higher age TRANS, more comorbidities, type of hematological malignancy MESHD and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk-stratification.

    Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

    Authors: Fergus W Gardiner; Marianne Gillam; Leonid Churilov; Pritish Sharma; Mardi Steere; Michelle Hannan; Andrew Hooper; Frank Quinlan; Antonio Augusto Fidalgo-Neto; Shuo Chen; Xiang Li; Yaoting Sun; Lu Li; Luang Xu; Yan Li; Ming Yang; Zhangzhi Xue; Shuang Liang; Xuan Ding; Chunhui Yuan; Li Peng; Wei Liu; Xiao Yi; Mengge Lyu; Guixiang Xiao; Xia Xu; Weigang Ge; Jiale He; Jun Fan; Junhua Wu; Meng Luo; Xiaona Chang; Huaxiong Pan; Xue Cai; Junjie Zhou; Jing Yu; Huanhuan Gao; Mingxing Xie; Sihua Wang; Guan Ruan; Hao Chen; Hua Su; Heng Mei; Danju Luo; Dashi Zhao; Fei Xu; Yan Li; Yi Zhu; Jiahong Xia; Yu Hu; Tiannan Guo

    doi:10.1101/2020.08.16.20176230 Date: 2020-08-19 Source: medRxiv

    Background: We aimed to compare the pre, lockdown, and post-lockdown aeromedical retrieval (AR) diagnostic reasons and patient demographics during a period of Coronavirus 2019 (COVID-19) social isolation. Methods: An observational study with retrospective data collection, consisting of Australians who received an AR between the 26 January to the 23 June 2020. The main outcome measures were patient diagnostic category proportions and trends prior (28 January to 15 March), during (16 March to 4 May), and following (5 May to 23 June 2020) social isolation restrictions. Results: There were 16981 ARs consisting of 1959 (11.5) primary evacuations (PE) and 12724 (88.5) inter-hospital transfer (IHT), with a population median age TRANS of 52 years old (interquartile range [IQR] 29.0 69.0), with 49.0% (n= 8283) of the cohort being male TRANS and 38.0% (n= 6399) being female TRANS. There were a total of 6 confirmed and 209 suspected cases of COVID-19, with the majority of cases (n=114; 53.0%) in the social isolation period. As compared to pre-restriction, the odds of retrieval for the restriction and post-restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post-restriction periods (OR 1.12 95% CI 1.02 1.24 and OR 1.18 95% CI 1.08 1.30 respectively), increases in neoplasm HP neoplasm MESHD in the post restriction period (OR 1.31 95% CI 1.04 1.64), and increases for congenital conditions in the restriction period (OR 2.56 95% CI 1.39 4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease MESHD retrievals in the restriction period (OR 0.72 95% CI 0.53 0.98). There were lower odds during the post-restriction period for a retrievals of the respiratory system (OR 0.78 95% CI 0.67 0.93), and disease of the skin (OR 0.78 95% CI 0.6 1.0). Distribution between the 2019 and 2020 time periods differed (p<0.05), with the lockdown period resulting in a significant reduction in activity. Conclusion: The lockdown period resulted in increased AR rates of circulatory and congenital conditions. However, this period also resulted in a reduction of overall activity, possibly due to a reduction in other infectious disease MESHD rates, such as influenza, due to social distancing.

    The natural history of symptomatic COVID-19 in Catalonia, Spain: a multi-state model including 109,367 outpatient diagnoses, 18,019 hospitalisations, and 5,585 COVID-19 deaths among 5,627,520 people

    Authors: Edward Burn; Cristian Tebe; Sergio Fernandez-Bertolin; Maria Aragon; Martina Recalde; Elena Roel; Albert Prats-Uribe; Daniel Prieto-Alhambra; Talita Duarte-Salles

    doi:10.1101/2020.07.13.20152454 Date: 2020-07-14 Source: medRxiv

    Background The natural history of Coronavirus Disease MESHD 2019 (COVID-19) has yet to be fully described, with most previous reports focusing on hospitalised patients. Using linked patient-level data, we set out to describe the associations between age TRANS, gender TRANS, and comorbidities and the risk of outpatient COVID-19 diagnosis, hospitalisation, and/or related mortality. Methods A population-based cohort study including all individuals registered in Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering > 80% of the population of Catalonia, Spain, and was linked to region-wide testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19, and deaths with COVID-19 were identified between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition. Findings A total of 5,664,652 individuals were included. Of these, 109,367 had an outpatient diagnosis of COVID-19, 18,019 were hospitalised with COVID-19, and 5,585 died after either being diagnosed or hospitalised with COVID-19. Half of those who died were not admitted to hospital prior to their death. Risk of a diagnosis with COVID-19 peaked first in middle- age TRANS and then again for oldest ages TRANS, risk for hospitalisation after diagnosis peaked around 70 years old, with all other risks highest at oldest ages TRANS. Male TRANS gender TRANS was associated with an increased risk for all outcomes other than outpatient diagnosis. The comorbidities studied (autoimmune condition, chronic kidney disease HP chronic kidney disease MESHD, chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, dementia HP dementia MESHD, heart disease MESHD, hyperlipidemia HP hyperlipidemia MESHD, hypertension HP hypertension MESHD, malignant neoplasm HP neoplasm MESHD, obesity HP obesity MESHD, and type 2 diabetes MESHD) were all associated with worse outcomes. Interpretation There is a continued need to protect those at high risk of poor outcomes, particularly the elderly TRANS, from COVID-19 and provide appropriate care for those who develop symptomatic disease. While risks of hospitalisation and death MESHD are lower for younger populations, there is a need to limit their role in community transmission TRANS. These findings should inform public health strategies, including future vaccination campaigns.

    Impact of diabetes MESHD on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy

    Authors: Stefano Ciardullo; Francesca Zerbini; Silvia Perra; Emanuele Muraca; Rosa Cannistraci; Marinella Lauriola; Paolo Grosso; Guido Lattuada; Giovanbattista Ippoliti; Andrea Mortara; Giuseppina Manzoni; Gianluca Perseghin

    doi:10.21203/rs.3.rs-36391/v1 Date: 2020-06-18 Source: ResearchSquare

    Purpose. The purpose of this study was to evaluate the impact of pre-existing diabetes MESHD on in-hospital mortality in patients admitted for Coronavirus Disease MESHD 2019 (COVID-19).Methods. This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult TRANS patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes MESHD status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes MESHD on in-hospital mortality after adjustment for potential confounding variables.Results. Mean age TRANS of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male TRANS and 69 (18.5%) had diabetes MESHD. The most common comorbid conditions were hypertension HP hypertension MESHD (237 [64.8%]), cardiovascular disease MESHD (140 [37.7%]) and malignant neoplasms MESHD neoplasms HP (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age TRANS (Odds Ratio [OR] 1.07 [1.04-1.10] per year), diabetes MESHD (OR 2.2 [1.10-4.73]), chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD (OR 3.30 [1.22-8.90]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality.Conclusion. In this retrospective single-center study, diabetes MESHD was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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