Doxorubicin, cardiac risk factors and cardiac toxicity in elderly patients with diffuse b-cell non-Hodgkin's lymphoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9050-9050
Author(s):  
D. L. Hershman ◽  
A. Eisenberger ◽  
J. Wang ◽  
J. Jacobson ◽  
V. Grann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Regression Models ◽  
Proportional Hazards ◽  
Cardiac Toxicity ◽  
B Cell Lymphoma ◽  
Female Gender ◽  
Cox Proportional Hazards ◽  
Black Race ◽  
Increased Risk

9050 Background: Anthracyclines are known to cause acute and chronic cardiotoxicity. In a population-based sample of elderly patients with diffuse large B-cell lymphoma (DLBCL), we studied the cardiac effects of doxorubicin (DOX)-containing regimens and of pre-existing diabetes (DM), hypertension (HTN), and heart disease (HD). Methods: Patients aged =65 years diagnosed with DLBCL 1/1/1992–12/31/2000 in the SEER/Medicare database were grouped by treatment: no chemotherapy, doxorubicin-based chemotherapy, or other chemotherapy. We developed multivariable logistic regression models of the associations of DOX-based chemotherapy with demographic and clinical variables and pre-diagnosis DM, HTN, and HD. We then developed Cox proportional hazards regression models of the association between treatment and subsequent congestive heart failure (CHF) taking the predictors of treatment into account. Results: Of 6,413 patients with DLBCL, 2,536 (39%) received doxorubicin-based chemotherapy. DOX use was associated with later year of diagnosis, female gender, younger age, and being married. Black race (HR 0.50, 95% CI 0.33–0.75), comorbidities, preexisting CHF, HD, and DM (HR 0.73, 95% CI 0.62–0.86) were associated with decreased DOX use. The post-treatment HR for CHF following DOX treatment vs. no chemotherapy was 1.39 (95% CI 1.15–1.67); CHF risk increased with duration of DOX use. It was also associated with increasing age, comorbidities, black race, DM, HTN, and HD. There was a significant interaction between race and DOX (P=0.01); For black patients treated with DOX the HR for CHF was 3.4, as compared to a HR of 1.3 for white patients. Conclusions: Among patients with DLBCL, black race, CRFs and pre-existing HD are all associated with both a reduced likelihood of receiving anthracyclines, and an increased risk of CHF. We have previously found a powerful effect of DOX on survival in this patient population; thus, for most patients, the benefits of treatment would appear to outweigh the risks of cardiac toxicity. However, as the number of long-term survivors grows, the need for research on the side effects of treatment, on host factors that may increase the risk of adverse effects, and on ways to minimize such risks will also grow. No significant financial relationships to disclose.

scholarly journals Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroki Yoshikawa ◽  
Kosaku Komiya ◽  
Takashi Yamamoto ◽  
Naoko Fujita ◽  
Hiroaki Oka ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Regression Models ◽  
Proportional Hazards ◽  
Community Acquired Pneumonia ◽  
Cox Proportional Hazards ◽  
Erector Spinae ◽  
Cross Sectional ◽  
Proportional Hazards Regression ◽  
Survivor Group

AbstractErector spinae muscle (ESM) size has been reported as a predictor of prognosis in patients with some respiratory diseases. This study aimed to assess the association of ESM size on all-cause in-hospital mortality among elderly patients with pneumonia. We retrospectively included patients (age: ≥ 65 years) admitted to hospital from January 2015 to December 2017 for community-acquired pneumonia who underwent chest computed tomography (CT) on admission. The cross-sectional area of the ESM (ESMcsa) was measured on a single-slice CT image at the end of the 12th thoracic vertebra and adjusted by body surface area (BSA). Cox proportional hazards regression models were used to assess the influence of ESMcsa/BSA on in-hospital mortality. Among 736 patients who were admitted for pneumonia, 702 patients (95%) underwent chest CT. Of those, 689 patients (98%) for whom height and weight were measured to calculate BSA were included in this study. Patients in the non-survivor group were significantly older, had a greater frequency of respiratory failure, loss of consciousness, lower body mass index, hemoglobin, albumin, and ESMcsa/BSA. Multivariate analysis showed that a lower ESMcsa/BSA independently predicted in-hospital mortality after adjusting for these variables. In elderly patients with pneumonia, quantification of ESMcsa/BSA may be associated with in-hospital mortality.

scholarly journals Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People—A National Registry Study

2020 ◽  
Vol 17 (17) ◽  
pp. 6159
Author(s):  
Caroline Daly ◽  
Eve Griffin ◽  
Elaine McMahon ◽  
Paul Corcoran ◽  
Roger T. Webb ◽  
...  
Keyword(s):  
Young People ◽  
Drug Overdose ◽  
Regression Models ◽  
Proportional Hazards ◽  
Cumulative Risk ◽  
National Registry ◽  
Cox Proportional Hazards ◽  
Young Males ◽  
Increased Risk ◽  
Self Harm

Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.

High risk patients with diffuse large B cell lymphoma are not enrolled on clinical trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19058-e19058
Author(s):  
Alfadel Alshaibani ◽  
Christina Lee ◽  
Sarah Camp Rutherford ◽  
Kah Poh Loh ◽  
Andrea M Baran ◽  
...  
Keyword(s):  
Clinical Trials ◽  
B Cell ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Large B Cell Lymphoma ◽  
Large B Cell

e19058 Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. In this study, we explore reasons for non-enrollment in clinical trials for DLBCL and implications on trial design and interpretation. Methods: This is a retrospective analysis of patients (pts) with a pathological diagnosis of DLBCL or high grade B-cell lymphoma (HGBL) at University of Rochester (4/14-6/16) and New York-Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM) (4/14-4/17).Ten clinical trials were opened during this time. Participants were divided into 3 groups: those treated in trial, those not enrolled in trial because of need for urgent treatment, and those not enrolled in trial for any other reason. We used a center-stratified Cox proportional hazards model to estimate association of trial enrollment with progression-free survival (PFS; time from start of treatment until progression/death or the last date the pt was known to be progression free) and overall survival (OS). Results: We identified 263 pts; 17% (n = 45) enrolled in a trial. Reasons for non-enrollment included not meeting eligibility criteria (n = 98), physician choice (n = 50), and pt choice (n = 38). For 32 pts, reasons were unclear. Of the 50 pts who were not enrolled because of physician choice, the primary reason for non-enrollment was the need for urgent treatment (n = 46). Pts who needed urgent treatment had higher risk clinical features compared with pts in trial (Table). Compared with those treated in trial and those not enrolled in trial for any other reason, those not enrolled in trial due to need for urgent treatment had an inferior PFS (HR 2.61, 95% CI 1.23–5.16) and OS (HR 2.27, 95% CI 1.21–4.06). Conclusions: At 2 academic institutions, 52% of patients with DLBCL or HGBL required urgent chemotherapy and failed to enroll on trials. Exclusion of such patients limits the applicability and generalizability of clinical trials in DLBCL. This barrier must be overcome so clinical trials may better reflect true DLBCL demographics. [Table: see text]

Abstract 140: Association Between Epilepsy and the Risk of Ischemic Stroke or Myocardial Infarction

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Matthew A Mercuri ◽  
Alexander E Merkler ◽  
Neal S Parikh ◽  
Michael E Reznik ◽  
Hooman Kamel
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Proportional Hazards ◽  
Predictor Variable ◽  
Cox Proportional Hazards ◽  
Vascular Events ◽  
Increased Risk ◽  
Acute Mi

Background: Vascular brain injury can result in epilepsy. It is posited that seizures in elderly patients might reflect subclinical vascular disease and thus herald future clinical vascular events. Hypothesis: Seizures in elderly patients are associated with an increased risk of ischemic stroke or myocardial infarction (MI). Methods: We obtained inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries ≥66 years of age. The predictor variable was epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure. The primary outcome was a composite of ischemic stroke or acute MI. The predictors and outcomes were all ascertained with previously validated ICD-9-CM code algorithms. Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors. Patients were censored at the first occurrence of a stroke or MI, at the time of death, or on December 31, 2014. Results: Among 1,548,556 beneficiaries with a mean follow-up of 4.4 (±1.8) years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI. Patients with seizures were older (76.1 versus 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort. The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10-3.47%) in those with seizures versus 1.79% (95% CI, 1.78-1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78-2.00). After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29-1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65-1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86-1.04). Conclusions: We found an association between epilepsy in elderly patients and future ischemic stroke but not acute MI. Therefore, seizures might signify occult cerebrovascular disease but not necessarily occult disease in other vascular beds.

scholarly journals Symptomatic presentation of cervical cancer in emergency departments in California

2021 ◽  
Author(s):  
Frances B. Maguire ◽  
Julianne J. P. Cooley ◽  
Cyllene R. Morris ◽  
Arti Parikh-Patel ◽  
Vanessa A. Kennedy ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Low Socioeconomic Status ◽  
Emergency Departments ◽  
Regression Models ◽  
Proportional Hazards ◽  
Hpv Vaccination ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Risk Of Death ◽  
Increased Risk

Abstract Purpose Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis with cervical cancer and to describe their characteristics and outcomes. Methods We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use and multivariable Cox proportional hazards regression models examined associations with survival. Results Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06–1.27) or no insurance (OR 4.81; CI 4.06–5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52–2.04), late-stage disease (OR 5.29; CI 4.70–5.96), and had a 37% increased risk of death (CI 1.28–1.46). Conclusion Nearly a third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.

Impact of peritoneal dialysis-related peritonitis on PD discontinuation and mortality: A population-based national cohort study

2021 ◽  
pp. 089686082110189
Author(s):  
Mu-Chi Chung ◽  
Tung-Min Yu ◽  
Ming-Ju Wu ◽  
Ya-Wen Chuang ◽  
Chih-Hsin Muo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Female Gender ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
The Impact

Background: The impact of peritoneal dialysis-associated peritonitis (PD peritonitis) on long-term outcomes is uncertain. This nationwide retrospective study was conducted in Taiwan to understand the incidence, risk factors and long-term outcomes of PD peritonitis. Methods: A total of 11,202 incident adult peritoneal dialysis (PD) patients from 2000 to 2010 were collected from a Longitudinal Health Insurance Database and followed up until the end of 2011. Definition of peritonitis, the primary outcome, simultaneously met the diagnosis of peritonitis (International Classification of Diseases, Ninth Revision, Clinical Modification 567) and antibiotic use. Secondary outcomes included the impact of peritonitis on PD discontinuation and survival. Cox proportional hazards models with and without time-dependent variables were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: There were 7634 peritonitis episodes in 4245 patients during the follow-up period. The overall incidence of peritonitis was 0.18 episodes per patient-year. Peritonitis-associated risk factors included older age, female gender, chronic heart failure, cerebrovascular disease, liver cirrhosis and lower monthly income. In an adjusted Cox hazard proportional regression with the time-dependent model, peritonitis patients had a higher risk of PD discontinuation (HR 2.71, 95% CI 2.52–2.92) and mortality (HR 1.68, 95% CI 1.57–1.81) compared to patients without peritonitis. The adjusted HRs for mortality increased with each prior episode: one episode, two episodes and more than two episodes (all p < 0.05). The adjusted HRs for PD discontinuation also increased with the frequency of peritonitis. These negative effects were greatest during the first year and persisted significantly after 5 years. In a sensitivity analysis in which peritonitis within 30 days of death or PD discontinuation was excluded, peritonitis patients still had significantly increased risk of PD discontinuation and mortality compared to patients without peritonitis. Conclusions: Although peritonitis incidence was low, our findings reveal that peritonitis carried acute and long-term sequelae of higher PD discontinuation and lower patient survival.

scholarly journals Risk of Subsequent Malignant Neoplasms in Long-Term Hereditary Retinoblastoma Survivors After Chemotherapy and Radiotherapy

2014 ◽  
Vol 32 (29) ◽  
pp. 3284-3290 ◽  
Author(s):  
Jeannette R. Wong ◽  
Lindsay M. Morton ◽  
Margaret A. Tucker ◽  
David H. Abramson ◽  
Johanna M. Seddon ◽  
...  
Keyword(s):  
Regression Models ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Malignant Neoplasms ◽  
Follow Up Study ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
Long Term Follow Up

Purpose Hereditary retinoblastoma (Rb) survivors have increased risk of subsequent malignant neoplasms (SMNs). Previous studies reported elevated radiotherapy (RT) -related SMN risks, but less is known about chemotherapy-related risks. Patients and Methods In a long-term follow-up study of 906 5-year hereditary Rb survivors diagnosed from 1914 to 1996 and observed through 2009, treatment-related SMN risks were quantified using cumulative incidence analyses and multivariable Cox proportional hazards regression models with age as the underlying time scale. Results Nearly 90% of Rb survivors were treated with RT, and almost 40% received alkylating agent (AA) –containing chemotherapy (predominantly triethylenemelamine). Median follow-up time to first SMN diagnosis was 26.3 years. Overall SMN risk was not significantly elevated among survivors receiving AA plus RT versus RT without chemotherapy (hazard ratio [HR], 1.27; 95% CI, 0.99 to 1.63). AA-related risks were significantly increased for subsequent bone tumors (HR, 1.60; 95% CI, 1.03 to 2.49) and leiomyosarcoma (HR, 2.67; 95% CI, 1.22 to 5.85) but not for melanoma (HR, 0.74; 95% CI, 0.36 to 1.55) or epithelial tumors (HR, 0.89; 95% CI, 0.48 to 1.64). Leiomyosarcoma risk was significantly increased for survivors who received AAs at age < 1 (HR, 5.17; 95% CI, 1.76 to 15.17) but not for those receiving AAs at age ≥ 1 year (HR, 1.75; 95% CI, 0.68 to 4.51). Development of leiomyosarcoma was significantly more common after AA plus RT versus RT (5.8% v 1.6% at age 40 years; P = .01). Conclusion This comprehensive quantification of SMN risk after chemotherapy and RT among hereditary Rb survivors also demonstrates an AA-related contribution to risk. Although triethylenemelamine is no longer prescribed, our findings warrant further follow-up to investigate potential SMN risks associated with current chemotherapies used for Rb.

scholarly journals R-COMP Regimen in B Cell Non Hodgkin Lymphoma Patients with Cardiovascular Comorbidities

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5096-5096 ◽  
Author(s):  
Ombretta Annibali ◽  
Francesca Chiodi ◽  
Chiara Sarlo ◽  
Natalia Cenfra ◽  
Simona Tomassini ◽  
...  
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Cardiac Toxicity ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Prognostic Scores ◽  
Non Hodgkin Lymphoma ◽  
Cardiovascular Comorbidities

Abstract Backgroung: Anthracyclines-based regimens remain the gold standard for the treatment of Lymphomas, although the associated cardiac toxicity may limit their use, especially in frail and elderly patients. Patients and Methods: From October 2008 to January 2015 we treated 51 newly diagnosed patients B cell with poor-risk non Hodgkin lymphoma and cardiovascular comorbidities using the R-COMP regimen (rituximab, cyclophosphamide, non-pegylated liposome-encapsulated doxorubicin, vincristine and prednisone). Median age was 72 years (range:46-82 yrs ; 62% ≥ 70 years). As for histology, 26/51 (50%) were Diffuse Large B-cell Lymphoma; 10/51 (20%) Follicular Lymphoma; 8/51 (16%)mantle cell lymphoma; 5/51 (10%) Nodal Marginal Zone Lymphoma; 2/51 (4%) other B-cell indolent Lymphoma. IPI and FLIPI prognostic scores were Intermediate to High in the majority (39/51 = 76%) of the patients. Stage III and IV according to Ann-Arbor staging system was present in 40/51 patients (78%). The median age adjusted Charlsons comorbidity index was 6 (range: 3 to 11). Cardiovascular risk factors were considered: hypertension (39/51pts = 76%), a history or recent acute myocardial infarction (9/51 pts = 17%) and Atrial fibrillation (4/51 = 8%). According to National Institute of Aging/National Cancer Institute (NIA/NCI index), a large portion of patients (39%) presented high-impact conditions mainly consisting of ischemic and arrhythmic diseases, under active treatment. Treatment was well tolerated and toxicities were limited grade III/IV cytopenia. RESULTS: Complete remission was achieved in 37/51 (72%) and partial response in 8/51 (15%). The remaining 12% of patients had a progressive disease . As of July 2015, after a median follow up period of 25 months (range 3-79), the OS, RD, EFS, TTF were not reached ( Figure 1, panel A,B,C respectively). In particular, at 5 years from the treatment starting, OS and RD are both 70% and EFS is 54% .Cardiac toxicity was observed in one patients who died for pulmonary edema, while two patients developed arrhythmias. Conclusions: This study confirm the efficacy and tolerability of R-COMP regimen in elderly patients with cardiovascular comorbidities. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Incidence, Clinical Characteristics and Outcome of Cardiac Toxicity in Elderly Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5416-5416
Author(s):  
Wei Ping Liu ◽  
Yan Feng Xu ◽  
Yan Xie ◽  
Xiaopei Wang ◽  
Yuqin Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
B Cell ◽  
Cardiac Toxicity ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Cancer Hospital ◽  
Cardiac Disorders ◽  
Large B Cell

Abstract Backgroud: Cardiac toxicity is a life-threatening complication in elderly patients with lymphoma, which lead to a delay or premature termination of chemotherapy. Methods: A total of 462 consecutive patients with diffuse large B-cell lymphoma over 60 years old between 2007 and 2017 were reviewed. Of these, 87 patients were excluded from the study. Finally, 375 lymphoma patients were included. Data about general information, clinical feature, laboratory examination, pathological results, therapeutic methods and cardiac toxicity were collected by case retrieval system. Cardiac toxicity was graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). Results: The incidence of cardiac disorders was 5.3% (20/375). The median number of chemotherapy cycles before cardiac toxicity was 1 (range, 1-4). Ventricular arrhythmia was the most frequent cardiac disorder (n=6), followed by palpitations (n=4), left ventricular systolic dysfunction (n=3), heart failure (n=3), atrial fibrillation (n=2), myocardial infarction (n=1) and paroxysmal atrial tachycardia (n=1). At the end of treatment, grades 3 to 5 cardiac events were observed in 8 patients. In a multivariate Cox regression analysis, ECOG performance status ≥2 and history of cardiovascular disease were identified as risk factors for IP. The cumulative incidence of cardiac disorders were 2.3% (6/266) for patients without risk factors, 11.6% (11/95) for patients with 1 risk factors, and 21.4% (3/14), respectively. Conclusion: Cardiac toxicity is not rare in elderly patients with lymphoma, and a comprehensive management strategy is needed. Disclosures Song: Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zhu:Beijing Cancer Hospital: Employment.

scholarly journals Evolution of SARS-CoV-2 Seroprevalence Among Employees of a United States Academic Children’s Hospital During the COVID-19 Pandemic

2021 ◽  
pp. 1-24
Author(s):  
Brian T. Fisher ◽  
Anna Sharova ◽  
Craig L. K. Boge ◽  
Sigrid Gouma ◽  
Audrey Kamrin ◽  
...  
Keyword(s):  
Patient Care ◽  
Proportional Hazards ◽  
Healthcare Setting ◽  
Cox Proportional Hazards ◽  
Direct Patient Care ◽  
Black Race ◽  
Children's Hospital ◽  
Increased Risk ◽  
Children’S Hospital ◽  
Post Hoc

Abstract Objectives: Describe cumulative seroprevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among employees of a large pediatric healthcare system. Design, Setting, and Participants: Prospective observational cohort study open to adult employees at Children’s Hospital of Philadelphia, conducted April 20 – December 17, 2020. Methods: Employees were recruited starting with high-risk exposure groups, utilizing emails, flyers, and announcements at virtual town halls. At baseline, 1-month, 2-month, and 6-month timepoints, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity. Results: 1740 employees were enrolled. At 6-months, cumulative seroprevalence was 5.3%, below estimated community point seroprevalence; seroprevalence was 5.8% and 3.4% among employees with and without direct patient care, respectively. Most participants seropositive at baseline remained positive at follow-up assessments. In post hoc analysis, direct patient care (HR: 1.95, 95% CI: 1.03 to 3.68), Black race (HR: 2.70, 95% CI: 1.24 to 5.87), and exposure to a confirmed case in a non-healthcare setting (HR: 4.32, 95% CI: 2.71 to 6.88) were associated with statistically significant increased risk for seropositivity. Conclusions: Employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates. Provision of direct patient care, Black race, and exposure to a confirmed case in non-healthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID waves or other epidemics.

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