scholarly journals Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4170-4170
Author(s):  
Tom Adamkiewicz ◽  
Mohamed Mubasher ◽  
Folashade Omole ◽  
Melvin R. Echols ◽  
Jason Payne ◽  
...  
Keyword(s):  
African American ◽  
Respiratory Failure ◽  
Conflicts Of Interest ◽  
Care Facility ◽  
Memorial Hospital ◽  
Beta Thalassemia ◽  
Separate Analysis ◽  
Black African ◽  
Medicine Service ◽  
Increased Risk

Abstract A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA; 960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Heparin-Induced Thrombocytopenia: Analysis of Risk Factors In Medicine Inpatients.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3689-3689
Author(s):  
Shumei Kato ◽  
Koichi Takahashi ◽  
Kengo Ayabe ◽  
Reza Samad ◽  
Eri Fukaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
New York ◽  
Autoimmune Disease ◽  
Conflicts Of Interest ◽  
Heparin Induced Thrombocytopenia ◽  
Medicine Service ◽  
Increased Risk ◽  
Medical Inpatients ◽  
Inpatient Medicine

Abstract Abstract 3689 Background: Heparin-induced thrombocytopenia (HIT) is an unpredictable drug reaction to heparin characterized by thrombocytopenia and increased risk of life threatening venous and/or arterial thrombosis. Although HIT is uncommon, it is a serious side effect in patients receiving heparin. Data are lacking if there are additional risk factors that may be associated with the development of HIT. Accordingly, the aim of this study was to identify the risk factors that may be associated with the development of HIT in medical inpatients receiving heparin. Methods: This is a retrospective cohort study with 25,653 patients who were admitted to the medicine service and received heparin products (unfractionated heparin [UFH] or enoxaparin) in an urban teaching hospital in New York City from August 2005 to January 2010. Computerized discharge summaries, medical charts, radiology and laboratory reports were used in this retrospective study. Demographics such as age, gender and race were recorded. Details of medical history and hospital course of each patient was reviewed to obtain the known risk factors for HIT as well as possible confounding factors that may be related to the development of HIT. The diagnosis of HIT was confirmed if the platelet count dropped >50% from baseline and there was a positive laboratory HIT assay. Results: Fifty-five cases of in-hospital HIT (raw incidence, 0.21%, 95% CI [0.16, 0.28]) were observed (Table 1). After multivariate analysis, patients whose race was either Asian or Hispanic demonstrated an increased risk of developing HIT (relative risk [RR]= 2.61; 95% CI [1.10, 6.17]; p= 0.03 and RR= 2.21; 95% CI [1.22, 4.02]; p= 0.01 respectively). Additionally, patients who received full anticoagulation dose with UFH (RR= 3.66; 95% CI [1.98, 6.75]; p= <0.0001) or were exposed to heparin products for more than 5 days also had an increased risk of HIT (RR= 5.51; 95% CI [2.48, 12.2]; p= <0.0001 if heparin given 5 to 10 days, RR= 7.66; 95% CI [3.31, 17.8]; p= <0.0001 if heparin given more than 10 days). Moreover, patients who were on hemodialysis, carried a diagnosis of autoimmune disease, gout or heart failure remained as a independent risk factor for HIT (RR= 9.68; 95% CI [4.90, 19.1]; p= <0.0001, RR= 3.47; 95% CI [1.93, 6.26]; p= <0.0001, RR= 2.89; 95% CI [1.09, 7.68]; p= 0.03, and RR= 2.10; 95% CI [1.09, 4.08]; p= 0.03 respectively) (Table 2). Conclusion: Among patients admitted to inpatient medicine service receiving heparin products, patients who were Asian or Hispanic, who were treated with full anticoagulation dose with UFH or who received heparin product >5 days were at increased risk of HIT. Furthermore, patients who were on hemodialysis, had autoimmune disease, gout and heart failure were also at increased risk of in-hospital HIT. The results suggest that when using heparin products in these patient cohorts, increased surveillance of HIT is necessary. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

2021 ◽  
pp. 003335492110094
Author(s):  
Jacqueline M. Ferguson ◽  
Hoda S. Abdel Magid ◽  
Amanda L. Purnell ◽  
Mathew V. Kiang ◽  
Thomas F. Osborne
Keyword(s):  
United States ◽  
African American ◽  
Low Income ◽  
The United States ◽  
Positive Test ◽  
Health Administration ◽  
Positive Test Result ◽  
Black African ◽  
Increased Risk ◽  
Test Result

Objective COVID-19 disproportionately affects racial/ethnic minority groups in the United States. We evaluated characteristics associated with obtaining a COVID-19 test from the Veterans Health Administration (VHA) and receiving a positive test result for COVID-19. Methods We conducted a retrospective cohort analysis of 6 292 800 veterans in VHA care at 130 VHA medical facilities. We assessed the number of tests for SARS-CoV-2 administered by the VHA (n = 822 934) and the number of positive test results (n = 82 094) from February 8 through December 28, 2020. We evaluated associations of COVID-19 testing and test positivity with demographic characteristics of veterans, adjusting for facility characteristics, comorbidities, and county-level area-based socioeconomic measures using nested generalized linear models. Results In fully adjusted models, veterans who were female, Black/African American, Hispanic/Latino, urban, and low income and had a disability had an increased likelihood of obtaining a COVID-19 test, and veterans who were Asian had a decreased likelihood of obtaining a COVID-19 test. Compared with veterans who were White, veterans who were Black/African American (risk ratio [RR] = 1.23; 95% CI, 1.19-1.27) and Native Hawaiian/Other Pacific Islander (RR = 1.13; 95% CI, 1.05-1.21) had an increased likelihood of receiving a positive test result. Hispanic/Latino veterans had a 43% higher likelihood of receiving a positive test result than non-Hispanic/Latino veterans did. Conclusions Although veterans have access to subsidized health care at the VHA, the increased risk of receiving a positive test result for COVID-19 among Black and Hispanic/Latino veterans, despite receiving more tests than White and non-Hispanic/Latino veterans, suggests that other factors (eg, social inequities) are driving disparities in COVID-19 prevalence.

Investigating the prevalence and risk of chemotherapy-induced neuropathy among cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12078-12078
Author(s):  
Philip Jordache ◽  
Keith Danahey ◽  
Natalie Marie Reizine ◽  
Peter H. O'Donnell
Keyword(s):  
African American ◽  
Cancer Patients ◽  
Alaska Native ◽  
Common Side Effect ◽  
Black African ◽  
Chemotherapy Drugs ◽  
Modifying Factors ◽  
Increased Risk ◽  
Treatment Medication ◽  
Future Work

12078 Background: Neuropathy is a common side effect of some chemotherapies. Clinical and other factors may confer neuropathy risk, but rates and risk factors across neuropathy-causing chemotherapies are incompletely understood. Methods: We examined 15 chemotherapy drugs known to confer neuropathy. Within a broad population of cancer patients who underwent treatment with these agents at the University of Chicago Medicine between 2012-2018, we determined prevalence of chemotherapy-induced neuropathy, defined as patients with initiation of a neuropathy treatment medication (amitriptyline, carbamazepine, duloxetine, gabapentin, or pregabalin) after starting chemotherapy. We then analyzed chemotherapy-induced neuropathy risk for different drugs and based on clinical demographic factors. Results: We analyzed 7,866 patients (65.3% White, 53.7% Female, 27.6% Black/African-American, 5.6% Hispanic or Latino, 3.1% Asian/Mideast Indian, 2.4% More than one Race, 0.2% American Indian or Alaska Native, 0.2% Native Hawaiian/Other Pacific Islander). The overall prevalence of chemotherapy-induced neuropathy was 24.3% across our patient population. Black/African-American patients had an increased risk of chemotherapy-induced neuropathy compared to the rest of the patient cohort (OR 1.4, 95% CI 1.3-1.6, P = 1.6e-10). Females also exhibited an increased risk of chemotherapy-induced neuropathy compared to males (OR 1.2, 95% CI 1.1-1.3, P = 1.5e-3). Conclusions: Certain chemotherapy agents confer substantial risk of chemotherapy-induced neuropathy, and risk is increased in Blacks and females. Future work will investigate additional risk-modifying factors including the potential role of germline polymorphisms on chemotherapy neuropathy risk.[Table: see text]

scholarly journals Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry

2020 ◽  
Author(s):  
Christian Kirkup ◽  
Colin Pawlowski ◽  
Arjun Puranik ◽  
Ian Conrad ◽  
John C. O’Horo ◽  
...  
Keyword(s):  
African American ◽  
Mortality Rate ◽  
Unfractionated Heparin ◽  
Risk Ratio ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Respiratory Illness ◽  
P Value ◽  
Black African ◽  
Increased Risk

AbstractCOVID-19 patients are at an increased risk of thrombosis and various anticoagulants are being used in patient management without an established standard-of-care. Here, we analyze hospitalized and ICU patient outcomes from the Viral Infection and Respiratory illness Universal Study (VIRUS) registry. We find that severe COVID patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (311 deceased patients out of 760 total patients = 41%) compared to patients administered enoxaparin but not unfractionated heparin (214 deceased patients out of 1,432 total patients = 15%), presenting a risk ratio of 2.74 (95% C.I.: [2.35, 3.18]; p-value: 1.4e-41). This difference persists even after balancing on a number of covariates including: demographics, comorbidities, admission diagnoses, and method of oxygenation, with an amplified mortality rate of 39% (215 of 555) for unfractionated heparin vs. 23% (119 of 522) for enoxaparin, presenting a risk ratio of 1.70 (95% C.I.: [1.40, 2.05]; p-value: 2.5e-7). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to those administered enoxaparin, including acute kidney injury (227 of 642 [35%] vs. 156 of 608 [26%] respectively, adjusted p-value 0.0019), acute cardiac injury (40 of 642 [6.2%] vs. 15 of 608 [2.5%] respectively, adjusted p-value 0.01), septic shock (118 of 642 [18%] vs. 73 of 608 [12%] respectively, adjusted p-value 0.01), and anemia (81 of 642 [13%] vs. 46 of 608 [7.6%] respectively, adjusted p-value 0.02). Furthermore, a higher percentage of Black/African American COVID patients (375 of 1,203 [31%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (595 of 2,488 [24%]), for a risk ratio of 1.3 (95% C.I.: [1.17, 1.45], adjusted p-value: 1.6e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (272 of 959 [28%] for Black/African American vs. 213 of 959 [22%] for White/Caucasian, adjusted p-value: 0.01, relative risk: 1.28, 95% C.I.: [1.09, 1.49]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research in order to elucidate potential socioeconomic, racial, or other disparities underlying the use of anticoagulants to treat severe COVID patients.

Sumoylated HSP-90 Is a Frequent Autosomal-Inherited Target of Paraproteins in Monoclonal Gammopathies

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 26-26
Author(s):  
Klaus-Dieter Preuss ◽  
Natalie Fadle ◽  
Evi Regitz ◽  
Michael Pfreundschuh
Keyword(s):  
African American ◽  
Posttranslational Modification ◽  
Conflicts Of Interest ◽  
Family Members ◽  
Significant Proportion ◽  
Carrier State ◽  
Antigenic Stimulation ◽  
Chronic Antigenic Stimulation ◽  
Increased Risk ◽  
Hsp 90

Abstract Background Chronic antigenic stimulation might have a role in the pathogenesis of monoclonal gammopathy of unknown significance (MGUS) and multiple myeloma. We previously identified a group of 11 autoantigenic paraprotein targets (paratargs) of which paratarg-7 is the most frequent, found in ~15 % of all MGUS/MM/Waldenstrom patients. These paratarg autoantigens all have in common to be 1) recognised by patients paraprotein with an extreme high titer (>1:1011), 2) hyperphosphorylated in patients, and 3) their phosphorylation carrier state is autosomal-dominant inherited in patients families. The finding that all these paratargs were permanently hyperphosphorylated in patients in contrast to healthy controls brought up the assumption that abnormal posttranslational modification of autoantigens might be a frequent finding in those patients. Methods A RZPD macroarray representing more than 30.000 different human proteins was subjected to in-vitro posttranslational modification using sumoylation-competent recombinant enzymes followed by screening with paraprotein-containing sera at high dilution (1:107). Immunopositive signals were identified and characterized by DNA sequencing, SDS-PAGE, isoelectric focusing, western blotting and ELISA. Findings Twenty-seven of 226 (11.9%) paraproteins from European, 9/80 (11.2%) from African-American and 9/176 (5.1%) from Japanese patients reacted specifically with the sumoylated heat shock protein-90β isoform-α (HSP90-SUMO). No reactivity was detected in >800 controls. All patients with HSP90-SUMO-binding paraproteins carried HSP90-SUMO. HSP90-SUMO carrier state is autosomal-dominantly inherited and was sown to be caused by the inability of SENP2 to desumoylate HSP90-SUMO. Five of 550 (0.9%) European, 2/100 (2%) African-American and 2/178 (0.8%) Japanese controls carried HSP90-SUMO, resulting in odds ratios of 14.8, 6.2 and 7.4, respectively, of healthy carriers for MGUS/MM/WM. Only, but all MGUS/MM/WM patients who were HSP90-SUMO carriers had HSP90-SUMO-specific paraproteins suggesting that sumoylated HSP-90 is involved in the pathogenesis of MGUS/MM/WM by chronic antigenic stimulation. Demonstration of HSP90-SUMO carriership identifies family members of HSP90-SUMO patients at risk. Interpretation A significant proportion of MGUS/MM/WM are associated with a dominant inheritance of posttranslationally modified autoantigens as shown for members of the paratarg autoantigen family and for HSP90-SUMO, enabling family members at increased risk for MGUS/MMWM to be identified by simple analysis of their peripheral blood. That only patients with MGUS/MM/WM who are carriers of such modified autoantigens have target-specific paraproteins suggests that the posttranslational modification induces auto-immunity and is involved in the pathogenesis of MGUS/MM/WM, for example, by chronic antigenic stimulation. Supported by Deutsche Forschungsgemeinschaft DFG, Deutsche José Carreras Leukämie Stiftung, Wilhelm-Sander-Stiftung, Deutsche Krebshilfe e.V. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prejudicial beliefs and COVID-19 disruptions among sexual minority men living with and not living with HIV in a high SARS-CoV-2 prevalence area

2021 ◽  
Author(s):  
Seth C Kalichman ◽  
Renee El-Krab ◽  
Bruno Shkembi ◽  
Moira O Kalichman ◽  
Lisa A Eaton
Keyword(s):  
African American ◽  
African American Men ◽  
People Living With Hiv ◽  
Sex Partners ◽  
Black African ◽  
Sexual Minority Men ◽  
Mediation Analyses ◽  
Personal Action ◽  
Male Sex ◽  
Living With Hiv

Abstract The COVID-19 pandemic has had profound health and social impacts. COVID-19 also affords opportunities to study the emergence of prejudice as a factor in taking protective actions. This study investigated the association of COVID-19 concerns, prejudicial beliefs, and personal actions that involve life disruptions among people not living with and people living with HIV. 338 Black/African American men not living with HIV who reported male sex partners and 148 Black/African American men living with HIV who reported male sex partners completed a confidential survey that measured COVID-19 concern, COVID-19 prejudice, and personal action and institutionally imposed COVID-19 disruptions. Participants reported having experienced multiple social and healthcare disruptions stemming from COVID-19, including reductions in social contacts, canceling medical appointments, and inability to access medications. Mediation analyses demonstrated that COVID-19 concerns and COVID-19 prejudice were associated with personal action disruptions, indicating that these social processes are important for understanding how individuals modified their lives in response to COVID-19. It is imperative that public health efforts combat COVID-19 prejudice as these beliefs undermine investments in developing healthcare infrastructure to address COVID-19 prevention.

Facility of Origin Predicts Mortality After Colonic Perforation

2020 ◽  
pp. 000313482097162
Author(s):  
Samuel D. Butensky ◽  
Emma Gazzara ◽  
Gainosuke Sugiyama ◽  
Gene F. Coppa ◽  
Antonio Alfonso ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chronic Care ◽  
Care Facility ◽  
Colonic Perforation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Chronic Care Facility ◽  
Partial Colectomy ◽  
Emergent Surgery ◽  
Perforated Viscus

Introduction Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation. Materials and Methods Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed. Results 4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, P < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, P < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, P < .0001), sepsis vs. none (OR 1.57, P = .00045), transfer from chronic care facility vs. home (OR 1.87, P < .0001), and increased time from admission vs. operation (OR 1.01, P = .0055) were independently associated with increased risk of death. Discussion Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.

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