Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30–250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1–20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

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Post-acute sequelae of COVID-19 in a non-hospitalized cohort: results from the Arizona CoVHORT

10.1101/2021.03.29.21254588 ◽

2021 ◽

Author(s):

Melanie L Bell ◽

Collin J Catalfamo ◽

Leslie V. Farland ◽

Kacey C Ernst ◽

Elizabeth T Jacobs ◽

...

Keyword(s):

Clinical Presentation ◽

Severe Disease ◽

Median Number ◽

Population Based ◽

Diverse Population ◽

Shortness Of Breath ◽

Persistent Symptoms ◽

Estimate Prevalence ◽

Hispanic White

AbstractClinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as post-acute sequelae of SAR-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of various symptoms of PASC, defined as experiencing at least one symptom 30 days or longer. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95%CI 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

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Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

ERJ Open Research ◽

10.1183/23120541.00542-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00542-2020 ◽

Cited By ~ 10

Author(s):

Yvonne M.J. Goërtz ◽

Maarten Van Herck ◽

Jeannet M. Delbressine ◽

Anouk W. Vaes ◽

Roy Meys ◽

...

Keyword(s):

Healthcare Utilisation ◽

Median Number ◽

Anecdotal Evidence ◽

Persistent Symptoms ◽

Healthcare Needs ◽

Unmet Healthcare Needs ◽

Hospitalised Patients ◽

Multiple Symptoms ◽

Over Time

BackgroundMany patients with COVID-19 did not require hospitalisation, nor underwent COVID-19 testing. There is anecdotal evidence that patients with “mild” COVID-19 may complain about persistent symptoms, even weeks after the infection. This suggests that symptoms during the infection may not resolve spontaneously. The objective of this study was to assess whether multiple relevant symptoms recover following the onset of symptoms in hospitalised and nonhospitalised patients with COVID-19.MethodsA total of 2113 members of two Facebook groups for coronavirus patients with persistent complaints in the Netherlands and Belgium, and from a panel of people who registered on a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, date of symptoms onset, COVID-19 diagnosis, healthcare utilisation, and the presence of 29 symptoms at the time of the onset of symptoms (retrospectively) and at follow-up (mean±sd 79±17 days after symptoms onset).ResultsOverall, 112 hospitalised patients and 2001 nonhospitalised patients (confirmed COVID-19, n=345; symptom-based COVID-19, n=882; and suspected COVID-19, n=774) were analysed. The median number of symptoms during the infection reduced significantly over time (median (interquartile range) 14 (11–17) versus 6 (4–9); p<0.001). Fatigue and dyspnoea were the most prevalent symptoms during the infection and at follow-up (fatigue: 95% versus 87%; dyspnoea: 90% versus 71%).ConclusionIn previously hospitalised and nonhospitalised patients with confirmed or suspected COVID-19, multiple symptoms are present about 3 months after symptoms onset. This suggests the presence of a “post-COVID-19 syndrome” and highlights the unmet healthcare needs in a subgroup of patients with “mild” or “severe” COVID-19.

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P128 INCIDENCE AND OUTCOMES OF HOME PARENTERAL NUTRITION IN PATIENTS WITH CROHN’S DISEASE IN OMLSTED COUNTY, MINNESOTA, USA

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.058 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S25-S25

Author(s):

Zeinab Bakhshi ◽

Siddhant Yadav ◽

William Harmsen ◽

William Tremaine ◽

Bradley Salonen ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Parenteral Nutrition ◽

Clinical Outcomes ◽

Severe Disease ◽

Bloodstream Infections ◽

Median Number ◽

Population Based ◽

Home Parenteral Nutrition ◽

Olmsted County

Abstract Introduction Patients (pts) with Crohn’s disease (CD) undergoing multiple surgeries are at risk of extensive bowel resections, short bowel syndrome (SBS) and malnutrition and may need home parenteral nutrition (HPN). The aim of our study was to estimate the incidence of HPN use in pts with CD in a population-based cohort, and to assess clinical outcomes and complications associated with nutritional intervention. Methods This study was a retrospective population-based cohort using Rochester Epidemiology Project to identify pts who were diagnosed with CD between 1970 and 2011 in Olmsted County, MN. To identify the individuals who required HPN, these Pts were crossed against the list of those who enrolled in the local HPN program. Descriptive statistics were used to evaluate incidence and clinical outcomes. Results Four hundred twenty nine pts with CD were diagnosed in Olmsted County between 1970 and 2011. Of these, 14 received HPN between 1992 and 2018. The pts were followed for a median of 16.85 years after diagnosis of CD (interquartile (IQR), 12.25–24.70) and required HPN a median of 7.67 years after diagnosis (IQR,1.6–15.89). Among the 14 receiving HPN, 85.71% were females. Eleven (78.57%) had moderate to severe CD and 12 (85.71%) pts involved with fistulizing disease. Crohn’s disease involved the ileum in 92.86%, colon in 71.43%, and proximal GI in 14.29% of the pts. Thirteen (92.86%) pts underwent surgery primarily due to obstruction (84.62%). Other indication included: failure of medical therapy (46.15%), fistulizing disease (46.15%), severe pain (30.77%), abdominal abscess (23.08%), bleeding (15.38%), and necrosis (15.38%). Median number of bowel resections was 4 (range, 0–7). Twelve pts (85.71%) had a stoma placed. The median duration of HPN was 2.48 years (range, 0.11–16.36). Indications for HPN included SBS in 64.28%, malnutrition in 28.57% and bowel rest in 21.43%. The mean number of hospitalizations after the start of HPN was 5 (range, 0–20). Catheter-related bloodstream infections occurred in 10 (71.43%) pts, and 3 (21.43%) had a thrombosis. Four pts had osteoporosis and 2 had osteopenia. Parenteral nutrition-associated liver disease occurred in 2 (14.29%) of pts. The pts’ body weight increased a median of 2.5 kilograms (kg) 6 months after the start of HPN but decreased a median of 1 kg at 12 months. Four (30.77%) pts were on HPN at time of last follow-up. Five (35.71%) pts deceased mainly due to CD. Conclusion Less than 4% of pts with CD need HPN. Most pts on HPN have moderate to severe disease who have undergone extensive bowel resection with resultant SBS and malnutrition. Approximately 70% were able to discontinue HPN. Interestingly, after 6 months, pts lost most of the weight they gained during the first 6 months of HPN. It was possible that this was due to noncompliance, or increased metabolic needs because of active disease.

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Characteristics and reoperation rates of paediatric tarsal coalitions: a population-based study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200177 ◽

2020 ◽

Vol 14 (6) ◽

pp. 537-543

Author(s):

Taylor J. Jackson ◽

Smitha E. Mathew ◽

A. Noelle Larson ◽

Anthony A. Stans ◽

Todd A. Milbrandt

Keyword(s):

Statistical Significance ◽

Population Based ◽

Population Based Study ◽

Persistent Symptoms ◽

Initial Surgery ◽

Tarsal Bones ◽

Operation Rate ◽

Reoperation Rates

Purpose Tarsal coalitions are congenital fusions of two or more tarsal bones and can lead to foot pain and stiffness. Few studies examine the long-term reoperation rates following paediatric tarsal coalition surgery. Methods A population-based database, linking medical records at all medical centres to capture the entire medical history of the full population of a Midwest county, was used to identify tarsal coalitions in children between 1966 and 2018. Records were reviewed for clinical data, surgical records and followed up to identify any subsequent surgical interventions. Results A total of 58 patients (85 coalitions) were identified; 46 calcaneonavicular (CN) coalitions, 30 talocalcaneal (TC) coalitions and nine other coalitions (seven talonavicular, one naviculocuboid, one naviculocuneiform). In all, 46 coalitions were treated surgically (43 coalition resections, three arthrodeses) and 39 were treated nonoperatively. Patients treated surgically were less likely to report ongoing symptoms at final follow-up compared with patients managed nonoperatively (33% versus 67%; p = 0.0017). With a median 14.4 years (interquartile range 9.3 to 19.7) follow-up, there was an overall re-operation rate of 8.7% (4/46). Differences in reoperation rates by initial surgery (resection versus arthrodesis; p = 0.2936), coalition type (CN versus TC versus Other; p = 0.6487) or composition (osseous versus fibrocartilaginous; p = 0.29) did not reach statistical significance. Conclusion This is the first population-based study demonstrating the durability of surgical management of tarsal coalitions in a paediatric population. At final follow-up, patients treated surgically are less likely to report persistent symptoms compared with patients managed nonoperatively. Long-term reoperation rates appear to be low (8.7%). Level of evidence: III

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Acute and Post-Acute COVID-19 Severity and Mortality in Patients with Hematologic Malignancies: A Population-Based Registry Study

Blood ◽

10.1182/blood-2021-152539 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 186-186

Author(s):

Joaquin Martinez-Lopez ◽

Javier De La Cruz ◽

Rodrigo Gil-Manso ◽

Angel Cedillo ◽

Adrian Alegre ◽

...

Keyword(s):

Myeloid Leukemia ◽

Research Funding ◽

Myeloproliferative Neoplasms ◽

Hematologic Malignancies ◽

Population Based ◽

Survival Probabilities ◽

Persistent Symptoms ◽

Early Cohort ◽

Population Based Registry

Abstract Introduction: The severity of acute clinical outcomes and mortality in hematologic malignancy (HM) patients infected by SARS-CoV-2 was exhaustively documented in the first weeks of the pandemic. A consistent increased mortality compared to non-cancer patients was observed across studies. In this study we aimed to estimate survival in COVID-19 HM patients by type of malignancy, to describe acute and post-acute clinical outcomes, and to compare outcomes in early and later pandemic periods. Methods: In this population-based registry study sponsored by the Madrid Society of Hematology (Asociación Madrileña de Hematología y Hemoterapia), we collected de-identified data on clinical characteristics, treatment and acute and post-acute outcomes in adult patients with hematologic malignancies and confirmed SARS-CoV-2 infection within the Madrid region of Spain. Our case series included all eligible patients admitted to 26 regional health service hospitals and 5 private healthcare centers between February 28, 2020 and February 18, 2021 with a coverage of 98% on a population of 6.6 million inhabitants. The study outcomes were all-cause mortality, severity of disease (WHO), oxygen support, ICU admission, and follow-up symptoms and signs and complications. Survival probabilities were estimated with the actuarial method and reported overall and stratified by type of malignancy and for two study periods (early cohort,-COVID-19 diagnosis from February 28 to 31 May, 2020, and later cohort, up to February 18, 2021). Results: Of the 1408 patients reported to the HEMATO-MADRID COVID-19 registry, 1166 were included in the present analyses; 839 (72%) had a lymphoid malignancy, including 325 (28%) with non-Hodgkin lymphoma, 50 (4%) with Hodgkin lymphoma and 263 (23%) with multiple myeloma; and 327 (28%) had a myeloid malignancy, including 115 (10%) with myelodysplastic syndrome, 92 (8%) with acute myeloid leukemia (AML) and 87 (7%) with Philadelphia chromosome (Ph)-negative myeloproliferative neoplasms. Overall COVID-19 clinical severity was classified as critical in 19% of patients, severe in 36%, moderate in 22%, and mild in 22%; 10% were admitted to an ICU; 8% were on mechanical ventilation and 19% on noninvasive ventilation. Mild disease increased between early and later period from 15% to 38% of patients; severe disease decreased from 42% to 24%, p<0.001. COVID-19 treatment with steroids increased from 38% to 59%, p<0.001. At follow-up, 22% reported persistent symptoms related to COVID-19 at 2 months, 16% at 4 months and 14% at 6 months. 381 of 1166 (33%) patients died. Overall 30-day survival was 68%; 2 and 3-month overall survival probabilities were 56% and 53%, respectively. Survival was more favorable for patients with myeloproliferative neoplasms (82%, 69% and 65% at 30-days, 2 and 3 months, respectively) than for those with lymphoid malignancies (68%, 56% and 54%) or myelodysplastic syndrome/acute myeloid leukemia (61%, 51%, 46%), p=001. 285 (37%) patients died in the early period vs 96 (24%) in the later, p<0.001, but median (interquartile range) follow-up time was much higher in the early vs later, 45 (20-116) days vs. 26 (11-86), respectively. Overall survival was not different between periods, p=0.5 (hazard ratio [95%C], 0.93 [0.73-1.17]). In the later cohort, 30 and 60-day survival probabilities were 71% and 56% vs. 67% and 56% in the early cohort Conclusions. A population-based registry in Spain provided strong evidence that although COVID-19 severity decreased over year 1 of the pandemic, mortality remained high, and survival was stable over time in the group of patients with hematological malignancy infected by SARS-Coc-2. A relevant proportion of the infected patients (1 in 6) referred persistent symptoms attributable to COVID-19. The improved clinical management of severe COVID-19 in non-cancer patients that followed the dissemination of evidence-based recommendations did not translate in more favorable survival in patients with hematological malignancies. Research is needed to address the specific characteristics and improve the clinical management of this vulnerable population. Disclosures Martinez-Lopez: Novartis: Consultancy, Speakers Bureau; BMS: Consultancy, Research Funding, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Incyte: Consultancy, Research Funding, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau; Astellas: Research Funding, Speakers Bureau. Jiménez-Yuste: Pfizer: Consultancy, Honoraria, Research Funding; Grifols: Consultancy, Honoraria, Research Funding; CSL Behring: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Research Funding; NovoNordisk: Consultancy, Honoraria, Research Funding; BioMarin: Consultancy; Sobi: Consultancy, Honoraria, Research Funding; Octapharma: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding. Kwon: Gilead: Honoraria.

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SARS-CoV-2 infections in people with PCD: neither frequent, nor particularly severe

10.1101/2020.12.20.20248420 ◽

2020 ◽

Author(s):

Eva SL Pedersen ◽

Myrofora Goutaki ◽

Amanda L Harris ◽

Lucy Dixon ◽

Michele Manion ◽

...

Keyword(s):

Incidence Rate ◽

Severe Symptom ◽

Demographic Data ◽

Severe Disease ◽

Median Number ◽

Disease Course ◽

Increased Risk ◽

Using Data ◽

Ciliary Dyskinesia

AbstractPeople with pre-existing chronic health conditions are reportedly at high risk of getting the coronavirus disease (COVID-19) and of having a severe disease course but little data exist on rare diseases such as Primary Ciliary Dyskinesia (PCD). We studied risk and severity of SARS-CoV-2 infections among people with PCD using data from the COVID-PCD, a participatory study that collects data in real-time directly from people with PCD. Data was collected using online questionnaires. A baseline questionnaire collected information on demographic data, information about the PCD diagnosis and severity. A short weekly questionnaire collected information about current symptoms and incident SARS-CoV-2 infections. 578 people participated in the COVID-PCD by December 7, 2020, with a median number of follow-up weeks of 9 (interquartile range: 4-19 weeks). 256 (45%) of the participants had been tested for SARS-CoV-2 and 12 tested positive prior to study entry or during study follow up (2.1% of the total included population, 95% confidence interval (CI) 1.1-3.6%). 4 people tested positive during the study follow-up, corresponding to an incidence rate of 2.5 per 100 person-years (95% CI: 0.9-6.5). Overall, reported severity was mild with two reporting no symptoms, eight reporting mild symptoms, one reporting severe symptom without hospitalisation, and one reporting hospitalisation for 9 days. The study suggests that with careful personal protection, people with PCD do not seem to have an increased risk of infection with SARS-COV-2, nor an especially severe disease course.Take home messageIn this longitudinal study of people with PCD followed weekly via online questionnaires, the incidence rate of COVID-19 and the proportion of participants infected were low, and the observed severity mostly mild.

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Deciphering Long Covid: Next Emergent Healthcare Dilemma

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.6.1096 ◽

2021 ◽

Vol 3 (6) ◽

pp. 39-43

Author(s):

Sana Abbas ◽

Beenish Abbas ◽

Haifsa Rafique ◽

Aisha Rafique ◽

Saima Zafar ◽

...

Keyword(s):

Severe Disease ◽

Male Gender ◽

Chronic Illnesses ◽

Age Group ◽

Shortness Of Breath ◽

Positive Polymerase Chain Reaction ◽

Disease Symptoms ◽

Pakistani Population ◽

Persistent Symptoms ◽

Loss Of Appetite

Objective: To determine the prevalence of Long Haul COVID–19 Syndrome among Pakistani Population. Methods: This cross-sectional analytical study was conducted after approval from the ethical review committee of the Foundation University College of Dentistry, Islamabad from June 2021 to September 2021. A non-probability consecutive sampling methodology was employed and a total of (168) participants after voluntary consent were enrolled in the study, after explaining the study protocol to the patients. The final Questionnaire is comprised of three sections. Section – I focused on the demographic profile (Age, Gender, Profession) of the participants. Section – II was designed to investigate COVID – 19 disease history, comorbid, coronavirus disease severity along with the number of individuals infected in the family, duration of positive polymerase chain reaction results, and management destination (Hospital or Home). Section – III addressed the frequency of persistent symptoms (Gastrointestinal, Systemic, Cardiovascular, Musculoskeletal, Immunological, Dermatological, Neuropsychiatric, Ophthalmological, Pulmonary, Otorhinolaryngological, Endocrine, Reproductive and Genitourinary systems). Results: 168 responders participated in this survey study,48 (28.6%) males while 120 (71.4%) females. About 36 (11.9%) were found to be suffering from comorbidity, 84 (50.0%) suffered from mild disease symptoms, while only 4 (2.4%) experienced the severe disease. The disease was managed at home for a major chunk of responders, 140 (83.3%).132 (78.6%) were found to have suffered from long COVID syndrome with the persistence of symptoms beyond four weeks of infection. The most common symptoms included fatigue (78.8%), fever (60.0%), loss of taste (57.8%), dry cough (45.5%), headache (42.4%), post-exertional malaise (45.5%), shortness of breath (39.4%), insomnia (39.0%), loss of smell (36.4%), loss of appetite (33.3%) and depression (33.3%).Male gender (p=0.009), with existing chronic illnesses (p<0.001), moderate and severe disease (p<0.001), higher age group (p<0.001) and isolated at hospital (p=0.002). Conclusion: In conclusion, this study has shown that persistence of COVID disease symptoms (most common symptoms included fatigue, fever, loss of taste, dry cough, headache, post-exertional malaise, shortness of breath, insomnia, loss of smell, loss of appetite, and depression) are common in Pakistani population. Male gender, existing chronic illnesses, moderate and severe disease, higher age group, and isolation at the hospital are the probable risk factors.

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Adrenocortical carcinoma and pregnancy: clinical and biological features and prognosis

Acta Endocrinologica ◽

10.1530/eje-10-0412 ◽

2010 ◽

Vol 163 (5) ◽

pp. 793-800 ◽

Cited By ~ 19

Author(s):

Gwenaëlle Abiven-Lepage ◽

Joël Coste ◽

Frédérique Tissier ◽

Lionel Groussin ◽

Line Billaud ◽

...

Keyword(s):

Adrenocortical Carcinoma ◽

Clinical Presentation ◽

Severe Disease ◽

Pregnant Patient ◽

Fetal Outcome ◽

Poor Overall Survival ◽

Biological Features ◽

Hormonal Secretion ◽

Observation Period

ObjectiveAdrenocortical carcinoma (ACC) is a rare, severe disease. Pregnancy-associated ACC has rarely been reported. We wished to evaluate the characteristics and prognosis of ACC diagnosed in patients during pregnancy or in thepostpartumperiod, comparing them with those for ACC diagnosed in nonpregnant women.DesignClinical presentation, hormonal secretion, staging, survival, and obstetric data are reported. Patients were included between 1963 and 2007. Mean follow-up was 48 months.Patients and methodsThis is a retrospective cohort study carried out at a referral center. All female patients aged 16–49 years diagnosed with ACC during the observation period were included (n=110). Twelve of these women were pregnant or in the first 6 months after delivery. Hormonal secretion, staging, obstetric data, and survival were analyzed. For the survival analysis, pregnant patients were compared with a subgroup of nonpregnant women matched for age, stage, and year of diagnosis (1 pregnant patient/2 controls).ResultsAdrenocortical tumors diagnosed during pregnancy or in thepostpartumperiod tend to be more often cortisol-secreting tumors (P=0.06) and to be discovered at a more advanced stage than those in nonpregnant women, although the differences were not significant. Fetal outcome was poor. Overall survival of the mother was worse than that of matched controls (hazard ratio of death: 3.98, confidence interval=1.34–11.85,P=0.013).ConclusionACC diagnosed during pregnancy or in thepostpartumperiod is associated with a poor fetal outcome and a poorer prognosis than ACC diagnosed in nonpregnant women.

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Risk of arterial (ATE) and venous thromboembolism (VTE) in a population-based cohort of bevacizumab-treated metastatic colorectal cancer (mCRC) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9624 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9624-9624

Author(s):

Irene S. Yu ◽

Leo Chen ◽

Winson Y. Cheung

Keyword(s):

Regression Models ◽

Median Number ◽

Population Based ◽

Prior History ◽

Routine Practice ◽

Specific Factors ◽

Baseline Characteristics ◽

Practice Methods ◽

Lost To Follow Up

9624 Background: Bevacizumab potentiates the risk of ATE and VTE in cancer patients who are in a prothrombotic state. Whether there are specific factors that add to this risk and how bevacizumab-related thromboembolisms are best managed remain unclear. Our objectives were to 1) characterize the incidence of ATE and VTE in a population-based cohort of mCRC patients, 2) describe patient and treatment factors associated with thromboembolisms, and 3) examine how ATE and VTE are managed in routine practice. Methods: All patients diagnosed with mCRC from 2006 to 2008, evaluated at 1 of 5 regional cancer centers in British Columbia, and offered bevacizumab were included. Multivariate regression models were constructed to explore the associations between clinical factors and thromboembolisms. Results: A total of 541 mCRC patients were identified: 27 never started bevacizumab and 14 were lost to follow-up. Of the 500 remaining patients: median age was 61 years (IQR 53-67), 297 (59%) were men, 309 (62%) had ECOG 0/1, and 39 (8%) reported prior ATE or VTE. Median number of bevacizumab cycles was 11 (IQR 7-15). After receiving bevacizumab, 91 (18%) patients developed 12 ATE and 88 VTE, with 8 patients experiencing >1 event. Baseline characteristics, such as median age (61 vs 61 years), gender distribution (61 vs 58% men), and ECOG 0/1 (66 vs 58%) were similar between patients with and without thromboembolisms, respectively (all p>0.05). In regression models, individuals who experienced ATE or VTE were more likely to have a prior history (14 vs 6%, p=0.02), reported greater pre-existing cardiac comorbidities (42 vs 32%, p=0.05), and received a higher median number of bevacizumab cycles (13 vs 9, p<0.01), suggesting a potential dose-related effect. Following the development of ATE or VTE, management varied: bevacizumab was discontinued in 46%, held temporarily in 14%, and continued in 40% of patients. Conclusions: In this population-based cohort, the thromboembolism risk is high, especially in patients with pre-existing risk factors and those heavily treated with bevacizumab. Management of bevacizumab-related ATE and VTE appears variable, underscoring the need for guidelines.

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What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review

F1000Research ◽

10.12688/f1000research.27284.2 ◽

2021 ◽

Vol 9 ◽

pp. 1455

Author(s):

Melina Michelen ◽

Vincent Cheng ◽

Lakshmi Manoharan ◽

Natalie Elkheir ◽

Drew Dagens ◽

...

Keyword(s):

Systematic Review ◽

Significant Proportion ◽

Depression And Anxiety ◽

Policy Makers ◽

Persistent Symptoms ◽

Meta Analyses ◽

Estimate Prevalence ◽

New Evidence

Although the majority of people with Covid-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for months after the acute phase of the illness. These symptoms include, among others, fatigue, problems breathing, lack of smell and taste, headaches, and depression and anxiety. It is also clear the virus has lasting fluctuating multiorgan sequelae, including affecting not only the respiratory system but also the heart, liver, and nervous system. We present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and characteristics of post-acute COVID-19. The living systematic review will be updated regularly, approximately every 6 months, as new evidence emerges. We will include studies that follow up at least 100 people with Covid-19 at 12 or more weeks post Covid-19 onset, with no restrictions regarding country, setting, or language. We will use descriptive statistics and, for outcomes reported in two or more studies, we will use meta-analyses to estimate prevalence with 95% confidence intervals (CIs) using the exact method. Heterogeneity between estimates will be assessed using the I2 statistic. Our findings will also be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from Covid-19. The protocol has been registered with PROSPERO ( CRD42020211131, 25/09/2020).

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