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MeSH Disease

Human Phenotype

Transmission

Seroprevalence

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    A Systematic Review Assessing the Under-Representation of Elderly TRANS Adults TRANS in COVID-19 Trials

    Authors: Virginie Prendki; Noam Tau; Tomer Avni; Marco Falcone; Angela Huttner; Laurent Kaiser; Mical Paul; Yaara Leibovici-Weissmann; Dafna Yahav

    doi:10.21203/rs.3.rs-39538/v1 Date: 2020-07-01 Source: ResearchSquare

    BackgroundCoronavirus disease MESHD (COVID-19) has caused a pandemic threatening millions of people worldwide. Yet studies specifically assessing the geriatric population are scarce. We aimed to examine the participation of elderly TRANS patients in therapeutic or prophylactic trials on COVID-19.MethodsIn this review, randomized controlled trials (RCTs; n=12) comparing therapeutic or prophylactic interventions registered on preprint repositories and/or published since December 2019 were analyzed. We aimed to describe the age TRANS of included patients, the presence of an upper age TRANS limit and of adjusted analyses on age TRANS, any exclusion criteria that could limit participation of elderly TRANS adults TRANS such as comorbidities, cognitive impairment HP, limitation of life expectancy; and the assessment of long-term outcomes such as the need of rehabilitation of institutionalization. Mean participant ages TRANS were reported and compared with observational studies.ResultsTwelve RCTs assessing drug therapy for COVID-19 were included. Mean age TRANS of patients included in RCTs was 56.3 years. An upper age TRANS limit was applied in three published trials (25%) and in 200/650 (31%) trials registered at clinicaltrials.gov. One trial reported a subgroup analysis in patients ≥65. Patients were excluded for liver-function abnormalities in eight trials, renal disease MESHD in six, cardiac disease MESHD or risk of torsade de pointes MESHD torsade de pointes HP in five, and four for cognitive or mental criteria, which are frequent comorbidities in the oldest patients. Only three trials allowed a family member TRANS to provide consent. Patients enrolled in RCTs were on average 20 years younger than those included in large (n≥1000) observational studies. Seven studies had as their primary outcome a clinical endpoint, but none reported cognitive, functional or quality of life outcomes or need for rehabilitation or long-term care facility placement.ConclusionsElderly patients are clearly underrepresented in RCTs, although they comprise the population hardest hit by the COVID-19 pandemic. Long-term outcomes such as the need of rehabilitation or institutionalization were not reported. Future investigations should target specifically this vulnerable population.

    Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection MESHD

    Authors: Donogh Maguire; Marylynne Woods; Conor Richards; Ross Dolan; Jesse Wilson Veitch; Wei MJ Sim; Olivia EH Kemmett; David C Milton; Sophie LW Randall; Ly D Bui; Nicola Goldmann; Allan Cameron; Barry Laird; Dinesh Talwar; Ian Godber; Alan Davidson; Donald C McMillan

    doi:10.21203/rs.3.rs-38340/v1 Date: 2020-06-29 Source: ResearchSquare

    BackgroundSevere COVID-19 infection MESHD results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure MESHD. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age TRANS, sex, BMI and documented evidence of COVID-19 infection MESHD at time of discharge or death MESHD certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure HP (75%) and multiorgan failure (12%) were the commonest causes of death MESHD recorded. Age TRANS>70 years (p<0.001), past medical history of cognitive impairment HP (p<0.001), previous delirium MESHD delirium HP (p<0.001), clinical frailty MESHD score>3 (p<0.001), hypertension MESHD hypertension HP (p<0.05), heart failure MESHD (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L ( male TRANS) / <0.37 L/L ( female TRANS)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On analysis, age TRANS >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure MESHD (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age TRANS >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure MESHD (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation MESHD as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection MESHD.

    Cognitive impairment HP is a common comorbidity in COVID-19 deceased patients. A hospital-based retrospective cohort study.

    Authors: Paloma Martin-Jimenez; Mariana I Munoz-Garcia; David Seoane; Lucas Roca-Rodriguez; Ana Garcia-Reyne; Antonio Lalueza; Guillermo Maestro; Dolores Folgueira; Victor A Blanco-Palmero; Alejandro Herrero-San Martin; Sara Llamas-Velasco; David A Perez-Martinez; Marta Gonzalez-Sanchez; Alberto Villarejo-Galende

    doi:10.1101/2020.06.08.20125872 Date: 2020-06-09 Source: medRxiv

    Introduction: Little is known about the relation of cognitive impairment HP (CI) to COVID-19 mortality. Here, we analyse the frequency of CI in deceased COVID-19 patients. Methods: We included 477 adult TRANS cases that died after admission from March 1 to March 31, 2020: 281 with confirmed COVID-19, 58 probable COVID-19, and 138 who died of other causes. Results: The number of comorbidities was high in the confirmed COVID-19, and CI was common (30%: 21.1% dementia MESHD dementia HP; 8.9% mild cognitive impairment HP). Subjects with CI were older, more lived in nursing homes and had shorter times from symptom onset TRANS to death MESHD than those without CI. COVID-19 patients with CI were rarely admitted to the ICU and fewer received non-invasive mechanical ventilation, but palliative care was provided more often. Conclusions: Dementia MESHD Dementia HP is a frequent comorbidity in COVID-19 deceased patients. The burden of COVID-19 in the dementia MESHD dementia HP community will be high.

The ZB MED preprint Viewer preVIEW includes all COVID-19 related preprints from medRxiv and bioRxiv, from ChemRxiv, from ResearchSquare, from arXiv and from Preprints.org and is updated on a daily basis (7am CET/CEST).

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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