scholarly journals Pre-Existing HBV and HCV Infections Do Not Affect COVID-19-Related Outcomes: An Observational Retrospective Study

2021 ◽  
Vol 21 (5) ◽  
Author(s):  
Viola Guardigni ◽  
Elena Rosselli Del Turco ◽  
Lorenzo Badia ◽  
Silvia Galli ◽  
Kristian Scolz ◽  
...  

Background: A better understanding of the interaction between SARS-CoV-2 infection and HBV or HCV hepatitis is very important. Objectives: We aimed at determining the prevalence and the impact of pre-existing HBV and HCV infections in patients with COVID-19. Methods: We conducted a retrospective study and included all the subjects positive for SARS-CoV-2 from March to May 2020. We evaluated the prevalence of chronic HBV and HCV infections and performed a matched cohort analysis to compare COVID-19-related outcomes between patients with and without infections due to HBV or HCV. Results: Among 606 subjects, 12 cases (2%) had positive HBsAg, and 6 cases (0.99%) presented detectable HCV RNA. We recognized 80 individuals positive for SARS-CoV-2 with negative markers for HBV and HCV suitable for the matched analysis. No statistical differences in mechanical ventilation and mortality rates were found (P = 0.27 and P = 0.80, respectively). Moreover, individuals with viral hepatitis were more likely to be admitted to the Intensive Care Unit in comparison to those without HBV or HCV infections (29% vs. 15%). The median time of virus clearance was 27.5 days, with no difference between the two groups. Conclusions: In our cohort, the pre-existing viral liver infection did not have any impact on the clinical and virological evolution of COVID-19.

2020 ◽  
Author(s):  
Elena Rosselli Del Turco ◽  
Viola Guardigni ◽  
Silvia Galli ◽  
Kristian Scolz ◽  
Maria Carla Re ◽  
...  

Abstract BACKGROUND: To date, data about prevalence and clinical impact of viral hepatitis in COVID-19 are scarce and conflicting.METHODS: We conducted an observational, retrospective study including all subjects tested positive for SARS-CoV-2 from March to May 2020. We evaluated prevalence of chronic viral hepatitis and we performed a matched cohort analysis of patients with and without chronic viral hepatitis comparing COVID-related outcomes.RESULTS: 980 subjects resulted positive to SARS-CoV-2 on oropharyngeal swabs. Among them 12 (1,2%) were HBsAg positive and 6 (0,6%) had detectable HCV RNA. No one was receiving antiviral therapy. None of these had a documented liver cirrhosis.We identified 80 SARS-CoV-2 positive individuals with negative viral markers for HBV and HCV for the matched analysis. No statistical differences in hospitalization, need for MV and mortality rates (p 0.79, p 0.28 and p 0.8, respectively) were found. Although not statistically significant (p 0.12), a higher rate of those positive for viral hepatitis were admitted to ICU (29% Vs 15%). Median time of virus clearance was 27.5 (IQR 20,38) days, with no difference between the two groups (p 0.39, 95% CI (-12;4.8)). We found older age and male sex as factors associated with worse outcomes.CONCLUSION: Our analysis documented similar rates of chronic viral hepatitis among subjects with SARS-CoV-2 infection and general population. Furthermore, in our population, pre-existing viral liver infection did not have any impact on the clinical and virological course of COVID-19.


Author(s):  
Wouter C. Rottier ◽  
Mette Pinholt ◽  
Akke K. van der Bij ◽  
Magnus Arpi ◽  
Sybrandus N. Blank ◽  
...  

Abstract Objective: To study whether replacement of nosocomial ampicillin-resistant Enterococcus faecium (ARE) clones by vancomycin-resistant E. faecium (VRE), belonging to the same genetic lineages, increases mortality in patients with E. faecium bacteremia, and to evaluate whether any such increase is mediated by a delay in appropriate antibiotic therapy. Design: Retrospective, matched-cohort study. Setting: The study included 20 Dutch and Danish hospitals from 2009 to 2014. Patients: Within the study period, 63 patients with VRE bacteremia (36 Dutch and 27 Danish) were identified and subsequently matched to 234 patients with ARE bacteremia (130 Dutch and 104 Danish) for hospital, ward, length of hospital stay prior to bacteremia, and age. For all patients, 30-day mortality after bacteremia onset was assessed. Methods: The risk ratio (RR) reflecting the impact of vancomycin resistance on 30-day mortality was estimated using Cox regression with further analytic control for confounding factors. Results: The 30-day mortality rates were 27% and 38% for ARE in the Netherlands and Denmark, respectively, and the 30-day mortality rates were 33% and 48% for VRE in these respective countries. The adjusted RR for 30-day mortality for VRE was 1.54 (95% confidence interval, 1.06–2.25). Although appropriate antibiotic therapy was initiated later for VRE than for ARE bacteremia, further analysis did not reveal mediation of the increased mortality risk. Conclusions: Compared to ARE bacteremia, VRE bacteremia was associated with higher 30-day mortality. One explanation for this association would be increased virulence of VRE, although both phenotypes belong to the same well-characterized core genomic lineage. Alternatively, it may be the result of unmeasured confounding.


2020 ◽  
pp. bmjspcare-2020-002220
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Craig C Earle ◽  
Doris Howell ◽  
Nicole Mittman ◽  
...  

BackgroundIn 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).AimThe purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.DesignA retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.ResultsThe final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).ConclusionWe have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6509-6509 ◽  
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Craig Earle ◽  
Nicole Mittmann ◽  
Hsien Seow ◽  
...  

6509 Background: The study objective was to examine the impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival among adult cancer patients. We hypothesized that patients exposed to ESAS would have better overall survival rates than those who didn’t have ESAS. Methods: The effect of ESAS screening on survival was evaluated in a retrospective matched cohort study. The cohort included all Ontario patients aged 18 or older who were diagnosed with cancer between 2007 and 2015. Patients completing at least one ESAS assessment during the study were considered exposed. The index date was the day of their first ESAS assessment. Follow up time for each patient was segmented into one of three phases: initial, continuing, or palliative care. Exposed and unexposed patients were matched 1:1 using hard (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type and sex) and propensity-score matching (14 measures including cancer stage, treatments received, and comorbidity). Matched patients were followed until death or the end of study at Dec 31, 2015. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS on survival. Results: There were 128,893 pairs well matched on all baseline characteristics (standardized difference < 0.1). The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (73.8% vs. 72.0%, P-value < 0.0001). In the multivariable Cox regression model, ESAS assessment was significantly associated with a decreased mortality risk (HR: 0.49, 95% CI: 0.48-0.49) and this protective effect was seen across all phases. Conclusions: ESAS exposure is associated with improved survival in cancer patients, in all phases of care. To the extent possible, extensive matching methods have mitigated biases inherent to observational data. This provides real world evidence of the impact of routine symptom assessment in cancer care.


2021 ◽  
Vol 224 (2) ◽  
pp. S257-S258
Author(s):  
Madeleine N. Jones ◽  
Kan-Feng Zheng ◽  
Ben Mol ◽  
daniel L. Rolnik

Author(s):  
Ralph Rogers ◽  
Fadi Shehadeh ◽  
Evangelia Mylona ◽  
Josiah Rich ◽  
Marguerite Neill ◽  
...  

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods A matched cohort analysis of hospitalized patients with severe COVID-19. The impact of CP treatment on all cause in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on the time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. Overall in-hospital mortality was 14.9%. There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 − 2.20). There was also no significant difference in the overall rate of hospital discharge (rate ratio [RR} 1.28, 95% CI 0.91 − 1.81), but a subgroup analysis of patients 65-years-old or greater who received CP demonstrated a significantly increased hospital discharge rate among these patients (RR 1.86, 95% CI 1.03 − 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions The use of CP in this study was a safe treatment for COVID-19. There was no overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Further adequately powered randomized studies should target this subgroup when assessing the efficacy CP treatment.


Urology ◽  
2013 ◽  
Vol 82 (1) ◽  
pp. 136-141 ◽  
Author(s):  
Dharam Kaushik ◽  
Brian J. Linder ◽  
R. Houston Thompson ◽  
Manuel S. Eisenberg ◽  
Christine M. Lohse ◽  
...  

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110088
Author(s):  
Brian Forsythe ◽  
Ophelie Z. Lavoie-Gagne ◽  
Enrico M. Forlenza ◽  
Connor C. Diaz ◽  
Randy Mascarenhas

Background: Anterior cruciate ligament (ACL) rupture is one of the most common injuries afflicting soccer players and requires a lengthy recovery processes after reconstructive surgery. The impact of ACL reconstruction (ACLR) on return to play (RTP) time and player performance in professional soccer players remains poorly studied. Purpose/Hypothesis: To determine player performance and RTP rate and time after ACLR in elite professional soccer players with a retrospective matched-cohort analysis. We expected that the RTP time and rate will be similar to those of other professional-level athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 players from 1 of the 5 elite Union of European Football Associations (UEFA) soccer leagues who suffered a complete ACL rupture between 1999 and 2019. These athletes were matched by position, age, season of injury, seasons played, and height and compared to uninjured control players. Change in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate 2-group comparisons were performed using independent 2-group t tests; Wilcoxon rank-sum tests were used when normality of distributions was violated. Results: Overall, 41 players (80%) returned to play after ACL rupture, with 6 (12%) experiencing a subsequent ipsilateral or contralateral ACL tear. The mean (±SD) RTP time for soccer players after ACLR was 216 ± 109 days (26 ± 18 games). Injured athletes played significantly fewer games and minutes per season and recorded inferior performances for 2 seasons after their injury ( P < .001). However, the game performance of injured players equaled or exceeded that of their matched controls by season 3 after injury, with the exception of attackers, who demonstrated a continued decline in performance ( P < .001). Conclusion: Results indicated that the mean RTP time for soccer players after ACLR is short in comparison with other major sports leagues (216 days). However, RTP rates were high, and rerupture rates were comparable with those of other sports. With the exception of attackers, player performance largely equaled or exceeded that of matched controls by the third postinjury season.


Author(s):  
Ralph Rogers ◽  
Fadi Shehadeh ◽  
Evangelia K Mylona ◽  
Josiah Rich ◽  
Marguerite Neill ◽  
...  

Abstract Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.


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