scholarly journals Six-month sequelae of post-vaccination SARS-CoV-2 infection: a retrospective cohort study of 10,024 breakthrough infections

2021 ◽  
Author(s):  
Maxime Taquet ◽  
Quentin Dercon ◽  
Paul J Harrison
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Vaccine Dose ◽  
Service Planning ◽  
Research Centre ◽  
Event Analysis ◽  
Icd 10 ◽  
The Usa

Background. Vaccination has proven effective against infection with SARS-CoV-2, as well as death and hospitalisation following COVID-19 illness. However, little is known about the effect of vaccination on other acute and post-acute outcomes of COVID-19. Methods. Data were obtained from the TriNetX electronic health records network (over 81 million patients mostly in the USA). Using a retrospective cohort study and time-to-event analysis, we compared the incidences of COVID-19 outcomes between individuals who received a COVID-19 vaccine (approved for use in the USA) at least 2 weeks before SARS-CoV-2 infection and propensity score-matched individuals unvaccinated for COVID-19 but who had received an influenza vaccine. Outcomes were ICD-10 codes representing documented COVID-19 sequelae in the 6 months after a confirmed SARS-CoV-2 infection (recorded between January 1 and August 31, 2021). Associations with the number of vaccine doses (1 vs. 2) and age (< 60 vs. ≥ 60 years-old) were assessed. Findings. Among 10,024 vaccinated individuals with SARS-CoV-2 infection, 9479 were matched to unvaccinated controls. Receiving at least one COVID-19 vaccine dose was associated with a significantly lower risk of respiratory failure, ICU admission, intubation/ventilation, hypoxaemia, oxygen requirement, hypercoagulopathy/venous thromboembolism, seizures, psychotic disorder, and hair loss (each as composite endpoints with death to account for competing risks; HR 0.70-0.83, Bonferroni-corrected p<.05), but not other outcomes, including long-COVID features, renal disease, mood, anxiety, and sleep disorders. Receiving 2 vaccine doses was associated with lower risks for most outcomes. Associations between prior vaccination and outcomes of SARS-CoV-2 infection were marked in those < 60 years-old, whereas no robust associations were observed in those ≥ 60 years-old. Interpretation. COVID-19 vaccination is associated with lower risk of several, but not all, COVID-19 sequelae in those with breakthrough SARS-CoV-2 infection. These benefits of vaccination were clear in younger people but not in the over-60s. The findings may inform service planning, contribute to forecasting public health impacts of vaccination programmes, and highlight the need to identify additional interventions for COVID-19 sequelae. Funding. National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.

Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Jaehun Jung ◽  
Gi Hwan Bae
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Antiplatelet Agents ◽  
Risk Of Death ◽  
Hemorrhagic Events ◽  
All Cause Mortality ◽  
Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

scholarly journals Illnesses Associated With Increased Length of Stay for Individuals Experiencing Homelessness: A Retrospective Cohort Study of Emergency Department Visits and Hospitalizations.

2020 ◽  
Author(s):  
Sumantra Monty Ghosh ◽  
Khokan Sikdar ◽  
Adetola Koleade ◽  
Peter Farris ◽  
Jordan Ross ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Emergency Department Visits ◽  
Targeted Interventions ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Inpatient Settings ◽  
Artery Disease

Abstract Background: Individuals experiencing homelessness (IEH) tend to have increased length of stay (LOS) in acute care settings, which negatively impacts health care costs and resource utilization. It is unclear however, what specific factors account for this increased LOS. This study attempts to define which diagnoses most impact LOS for IEH and if there are differences based on their demographics. Methods: A retrospective cohort study was conducted looking at ICD-10 diagnosis codes and LOS for patients identified as IEH seen in Emergency Departments (ED) and also for those admitted to. Data were stratified based on diagnosis, gender and age. Statistical analysis was conducted to determine which ICD-10 diagnoses were significantly associated with increased ED and inpatient LOS for IEH compared to housed individuals.Results: Homelessness admissions were associated with increased LOS regardless of gender or age group. The absolute mean difference of LOS between IEH and housed individuals was 1.62 hours [95% CI 1.49 – 1.75] in the ED and 3.02 days [95% CI 2.42-3.62] for inpatients. Males age 18-24 years spent on average 7.12 more days in hospital, and females aged 25-34 spent 7.32 more days in hospital compared to their housed counterparts. Thirty-one diagnoses were associated with increased LOS in EDs for IEH compared to their housed counterparts; maternity concerns and coronary artery disease were associated with significantly increased inpatient LOS. Conclusion: Homelessness significantly increases the LOS of individuals within both ED and inpatient settings. We have identified numerous diagnoses that are associated with increased LOS in IE; these inform the prioritization and development of targeted interventions to improve the health of IEH.

scholarly journals Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038295
Author(s):  
Anna Zanetti ◽  
Carlo Alberto Scirè ◽  
Lisa Argnani ◽  
Greta Carrara ◽  
Antonella Zambon
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Quality Of Care ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Quality Standards ◽  
Standards Of Care ◽  
Adherence Score

ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.

scholarly journals A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012–14): a retrospective cohort study

2015 ◽  
Vol 15 (6) ◽  
pp. 671-682 ◽  
Author(s):  
Alexander L Greninger ◽  
Samia N Naccache ◽  
Kevin Messacar ◽  
Anna Clayton ◽  
Guixia Yu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Acute Flaccid Myelitis ◽  
The Usa ◽  
Enterovirus D68

scholarly journals Effect of an increased dosage of statins on spinal degenerative joint disease: a retrospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e017442 ◽  
Author(s):  
Yuan-Yang Cheng ◽  
Chung-Lan Kao ◽  
Shih-Yi Lin ◽  
Shin-Tsu Chang ◽  
Tz-Shiang Wei ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Research Database ◽  
Joint Diseases ◽  
Degenerative Joint Diseases

ObjectivesIt has been proven that statin can protect synovial joints from developing osteoarthritis through its anti-inflammatory effects. However, studies on the effect of statins on spinal degenerative joint diseases are few and limited to in vitro studies. Therefore, we investigated the relationship between the statin dosage and the development of spinal degenerative joint diseases.DesignA retrospective cohort study.SettingPatients registered in Taiwan National Health Insurance Research Database.ParticipantsPatients aged 40–65 years old from 2001 to 2010 were included. Those who received statin treatment before 2001, were diagnosed with spinal degenerative joint diseases or received any spinal surgery before 2004 or had any spinal trauma before 2011 were excluded. A total of 7238 statin users and 164 454 non-users were identified and followed up for the next 7 years to trace the development of spinal degenerative joint disease.Outcome measuresThe incident rate of spinal degenerative joint diseases and HRs among the groups treated with different statin dosages.ResultsA higher dosage of statins was associated with a significantly lower risk of developing spinal degenerative joint disease in patients with hypercholesterolaemia. Compared with the group receiving less than 5400 mg of a statin, the HR of the 11 900–28 000 mg group was 0.83 (95% CI 0.70 to 0.99), and that of the group receiving more than 28 000 mg was 0.81 (95% CI 0.68 to 0.97). Results of subgroup analysis showed a significantly lower risk in men, those aged 50–59 years and those with a monthly income less than US$600.ConclusionsOur study’s findings clearly indicated that a higher dosage of statins can reduce the incidence of spinal degenerative joint disease in patients with hypercholesterolaemia, and it can be beneficial for people with a higher risk of spine degeneration.

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