Outcomes of COVID-19 in Patients With a History of Cancer and Comorbid Cardiovascular Disease

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19–associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11–3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

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High Levels of Pro B-Type Natriuretic Peptides Are Associated with Adverse Outcomes in COVID-19 Disease: A Single Center Experience

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.5.480 ◽

2020 ◽

Vol 2 (5) ◽

Author(s):

Kashif Bin Naeem ◽

Najiba Abdulrazzaq

Keyword(s):

Cardiovascular Disease ◽

Mechanical Ventilation ◽

Critical Illness ◽

Natriuretic Peptide ◽

Cardiac Injury ◽

Adverse Outcomes ◽

Risk Of Death ◽

Single Center Experience ◽

Lower Egfr ◽

History Of

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2, has caused widespread morbidity and mortality worldwide. Cardiac injury is reported to be common in hospitalized patients. We evaluated whether Pro B-type Natriuretic Peptide (proBNP) levels measured on admission in COVID-19 patients were associated with worse outcomes. A retrospective analysis of laboratory-confirmed COVID-19 patients who were admitted between February 2020 and July 2020 to Al Kuwait Hospital, Dubai, UAE. Patients were divided into two groups: normal proBNP (≤125 ng/L) and high proBNP (>125 ng/L) upon admission. Clinical characteristics and outcomes were compared between the two groups. A total of 389 patients were studied. Overall, mean age was 50.2 years (range 16-94 years), 77.3% were males, 35.7% diabetics, 35.2% hypertensives and 5.6% had history of cardiovascular disease. Compared to the group with normal proBNP; patients with high proBNP on admission were: older, more diabetics and hypertensives, with more history of cardiovascular disease; they presented with abnormal chest radiograph; and had lower lymphocytes, higher neutrophils, lower eGFR, higher D-dimers, higher CRP and higher procalcitonin on admission laboratory tests. These patients had more risk of developing critical illness during the hospitalization, undergoing mechanical ventilation and risk of death. Elevated pro B-type natriuretic peptide levels on admission in COVID-19 patients may predict subsequent risk of developing critical illness, undergoing mechanical ventilation, and significant high risk of death.

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Factors Associated with Postoperative Prolonged Mechanical Ventilation in Pediatric Liver Transplant Recipients

Anesthesiology Research and Practice ◽

10.1155/2017/3728289 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Olubukola O. Nafiu ◽

Katari Carello ◽

Anjana Lal ◽

John Magee ◽

Paul Picton

Keyword(s):

Mechanical Ventilation ◽

Liver Transplant ◽

Prolonged Mechanical Ventilation ◽

Severe Disease ◽

Multivariable Analysis ◽

Postoperative Mortality ◽

Early Postoperative Period ◽

Hospital Length Of Stay ◽

Multivariable Logistic Regression Analysis ◽

Duration Of Surgery

Introduction. Almost all pediatric orthotopic liver transplant (OLT) recipients require mechanical ventilation in the early postoperative period. Prolonged postoperative mechanical ventilation (PPMV) may be a marker of severe disease and may be associated with morbidity and mortality. We determined the incidence and risk factors for PPMV in children who underwent OLT. Methods. This was a retrospective analysis of data collected on 128 pediatric OLT recipients. PPMV was defined as postoperative ventilation ≥ 4 days. Perioperative characteristics were compared between cases and control groups. Multivariable logistic regression analysis was used to calculate odds ratios for PPMV after controlling for relevant cofactors. Results. An estimated 25% (95% CI, 17.4%–32.6%) required PPMV. The overall incidence of PPMV varied significantly by age group with the highest incidence among infants. PPMV was associated with higher postoperative mortality (p=0.004) and longer intensive care unit (p<0.001) and hospital length of stay (p<0.001). Multivariable analysis identified young patient age, preoperative hypocalcemia, and increasing duration of surgery as independent predictors of PPMV following OLT. Conclusion. The incidence of PPMV is high and it was associated with prolonged ICU and hospital LOS and higher posttransplant mortality. Surgery duration appears to be the only modifiable predictor of PPMV.

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COVID-19 in Cancer and non-Cancer Patients

International Journal of Cancer Management ◽

10.5812/ijcm.110907 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Farzad Taghizadeh-Hesary ◽

Pejman Porouhan ◽

Davood Soroosh ◽

Babak PeyroShabany ◽

Soodabeh Shahidsales ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Manifestations ◽

Laboratory Findings ◽

Patients With Cancer ◽

History Of ◽

Global Concern ◽

Novel Coronavirus ◽

Practice Methods ◽

Control Study ◽

Chest Ct Scan

Background: There is a global concern for the susceptibility of patients with cancer to the adverse effects of novel coronavirus disease (COVID-19). Objectives: Nevertheless, there is a signal of potentially increased vulnerability of patients with cancer to more COVID-19-induced mortality, this notion needs to be further evaluated in various societies with different cancer epidemiology and practice. Methods: In this case-control study, done in Iran, we evaluated the medical records of patients with cancer (Ca+ patients) who infected with COVID-19 and compare them with patients without a medical history of cancer (Ca- patients). Clinical data were collected from 19 February 2020 to 17 May 2020. The extracted data were classified into demographics, underlying medical conditions, clinical manifestations, imaging and laboratory findings, and clinical outcomes. Results: A total of 24 Ca+ patients were compared with 44 Ca- patients in terms of clinical manifestations and outcomes of COVID-19. The Ca- patients significantly developed more dry cough (75.0% vs 29.2%, P = 0.01) and fever (72.7% vs 45.8%, P = 0.02). Findings of the chest CT scan was comparable between groups, except for pleural effusion and lymphadenopathy that exclusively reported in Ca+ patients. (3% and 4%, respectively). At the end of observation, 13 (19.1%) patients died from COVID-19. This rate was significantly higher in Ca+ patients (41.7 vs 6.8%, P = 001). Likewise, Ca+ patients experienced more mechanical ventilation (25.0 vs 4.7%, P = 0.01). However, the rate of ICU admission was comparable between groups (P = 0.29). Conclusions: The patients with cancer had a higher rate of mechanical ventilation and COVID-19-induced mortality.

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2789. Respiratory Syncytial Disease in Hospitalized Adults: A Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2466 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S985-S986

Author(s):

Hannah Nam ◽

Michael G Ison

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Disease ◽

Solid Organ ◽

Cell Transplant ◽

Immunocompromised Patients ◽

Transplant Patients ◽

History Of

Abstract Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) and lung transplant recipients. Although RSV is responsible for ~177,000 hospitalizations and 14,000 deaths annually, few epidemiologic studies including all adults including those with immunocompromise have been conducted over multiple seasons. Methods A retrospective cohort study of adults admitted to a large academic medical center in Chicago, IL from 2009 to 2018 was conducted in patients with positive RSV PCR. Specific data on clinical presentation, management, and outcomes were collected by manual chart review. Descriptive statistics were calculated, and Pearson’s Chi-Squared test was utilized to assess association between severe disease status and comorbidities. Results A total of 140 patients* were admitted during part of the study period (2016–2018) with positive PCR for RSV. Most patients had otherwise underlying comorbidities prior to admission (lung 44.2%, heart 40.0%, diabetes 20.7%), history of immunocompromise (36.4%, 51) or history of smoking (39.2%, 55). Cough was the most common symptom among all hospitalized adults (90.7%, 127). However, patients with a history of transplant (both HSCT and SOT) more commonly displayed symptoms of fevers at presentation (50%, 10) when compared with non-immunocompromised patients (36.6%, 36). ICU admission occurred in one-third of the hospitalized patients, with no significant difference amongst transplant patients, immunocompromised patients, and non-immunocompromised patients. Need for mechanical ventilation was highest in patients with co-infections. None of the co-morbidities measured were independent risk factors for severe disease. Most patients (78.5%, 110) were discharged home. Among the 12 fatal cases, all were admitted to the ICU with seven (58.3%) requiring mechanical ventilation. Three (25.0%) were immunocompromised while two (16.7%) were HSCT patients, but none were solid-organ transplant patients. *Ongoing data collection. Conclusion RSV patients were diverse in their demographics, treatment, and outcomes. Large percentages of patients had underlying comorbidities such as immunocompromise due to HSCT, lung and heart disease. Disclosures All authors: No reported disclosures.

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Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection

Kidney360 ◽

10.34067/kid.0003792020 ◽

2020 ◽

Vol 1 (8) ◽

pp. 801-809 ◽

Cited By ~ 1

Author(s):

Imran Chaudhri ◽

Farrukh M. Koraishy ◽

Olena Bolotova ◽

Jeanwoo Yoo ◽

Luis A. Marcos ◽

...

Keyword(s):

Medical Center ◽

Invasive Mechanical Ventilation ◽

Multivariable Analysis ◽

The United States ◽

Adverse Outcomes ◽

Study Cohort ◽

Markers Of Inflammation ◽

Therapeutic Benefits ◽

History Of ◽

Inflammatory Burden

BackgroundData regarding the benefits or harm associated with the continuation of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), especially the effect on inflammation, in patients who are hypertensive and hospitalized with coronavirus disease 2019 (COVID-19) in the United States are unclear.MethodsThis is a single-center cohort study of patients sequentially hospitalized with COVID-19 at Stony Brook University Medical Center from March 7, 2020 to April 1, 2020, inclusive of these dates. Data collection included history of known comorbidities, medications, vital signs, and laboratory values (at admission and during the hospitalization). Outcomes include inflammatory burden (composite scores for multiple markers of inflammation), AKI, admission to the intensive care unit (ICU), need for invasive mechanical ventilation, and mortality.ResultsOf the 300 patients in the study cohort, 80 patients (27%) had history of ACEI or ARB use before admission, with 61% (49/80) of these patients continuing the medications during hospitalization. Multivariable analysis revealed that the history of ACEI or ARB use before hospitalization was not associated with worse outcomes. In addition, the continuation of these agents during hospitalization was not associated with an increase in adverse outcomes and predicted fewer ICU admissions (odds ratio, 0.25; 95% CI, 0.08 to 0.81) with a decrease in the severity of inflammatory burden (peak C-reactive protein, 6.9±3.1 mg/dl, P=0.03; peak inflammation score, 2.3±1.1 unit reduction, P=0.04).ConclusionsUse of ACEI or ARBs before hospitalization was not associated with adverse outcomes in COVID-19, and the therapeutic benefits of continuing ACEI or ARB in patients hospitalized with COVID-19 was not offset by adverse outcomes.

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Clinical features and outcomes of COVID-19 among people living with HIV in the United States: A multicenter study from a large global health research network (TriNetX)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab272 ◽

2021 ◽

Author(s):

George A Yendewa ◽

Jaime Abraham Perez ◽

Kayla Schlick ◽

Heather Tribout ◽

Grace A McComsey

Keyword(s):

Mechanical Ventilation ◽

African American ◽

Severe Disease ◽

The United States ◽

Adverse Outcomes ◽

Older Age ◽

Cd4 Count ◽

Research Network ◽

People Living With Hiv ◽

Risk Of Death

Abstract Background HIV infection is a presumed risk factor for severe COVID-19, yet little is known about COVID-19 outcomes in people with HIV (PLW). Methods We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV negative controls aged ≥ 18 years who sought care in 44 healthcare centers in the US from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care (ICU) and ICU admissions), mechanical ventilation, severe disease (ICU admission or death) and 30-day mortality. Results Of 297,194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with > 83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the two groups (2.9% vs 2.3%; p=0.123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, p<0.001), ICU admissions (4.2% vs 2.3%, p<0.001) and mechanical ventilation (2.4% vs 1.6%, p<0.005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use and low CD4 count; whereas severe disease was predicted by older age [adjusted odds ratio (aOR) 8.33, 95% confidence interval (CI) (1.06, 50.00); p=0.044] and CD4 <200 cells/mm 3 [aOR, 8.33, 95% CI (1.06, 50.00); p=0.044]. Conclusion PWH had higher rates of poor COVID-19 outcomes but were not more at risk of death than non-HIV infected counterparts. Older age and low CD4 count predicted adverse outcomes.

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Age and chest radiography as possible parameters for rapid triage in COVID-19 outbreak surge

10.21203/rs.3.rs-88104/v1 ◽

2020 ◽

Author(s):

Wei Enli Wycliffe ◽

Tan Cher Heng ◽

Monica Chan ◽

Tan Thuan TOng ◽

Surinder Kaur Pada ◽

...

Keyword(s):

Mechanical Ventilation ◽

Chest Radiography ◽

Disease Surveillance ◽

Characteristic Curve ◽

Severe Disease ◽

Clinical Status ◽

Supplemental Oxygen ◽

Receiver Operator Characteristic Curve ◽

Receiver Operator Characteristic ◽

Oxygen Supplementation

Abstract BackgroundTo evaluate the utility of age and chest radiography(CXR) in triaging COVID-19 patients for hospitalization versus isolation in non-hospital facilities, we examined how age and CXR at diagnosis were associated with clinical needs from late-January to early-April. MethodsClinical status of all COVID-19 cases was monitored for national disease surveillance. Cases were isolated in hospitals until SARS-CoV-2 RNA was undetectable on PCR. Age and CXR results on admission were analysed for association with oxygen supplementation and mechanical ventilation, the outcomes of interest.ResultsTill 4 April 2020, there were 1,481 COVID-19 cases in Singapore. Overall, 11.4% required supplemental oxygen while 4.8% required mechanical ventilation and intensive care. The respective proportions increased to 40.9% and 16.5% for cases aged ≥70 years. As a predictor of subsequent mechanical ventilation, age had an area under the receiver operator characteristic curve(AUROC) of 0.772 (95%CI:0.699-0.845). A combined criterion of either an abnormal CXR or age≥55 years had a sensitivity of 86.7% and specificity of 58.0% for the same outcome. A similar performance was observed for predicting oxygen supplementation needs.ConclusionsAge and CXR at diagnosis may be valuable in excluding severe disease, allowing safe triage for isolation in non-hospital facilities.

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Evaluation of Hospitalized Patient Outcomes in COVID-19 Infection for Continued versus Discontinued Use of Preadmission Antiplatelet Regimen

Journal of Pharmacy Practice ◽

10.1177/08971900211053294 ◽

2021 ◽

pp. 089719002110532

Author(s):

Angela Antoniello ◽

Alison Brophy ◽

Yekaterina Opsha

Keyword(s):

Mechanical Ventilation ◽

World Health Organization ◽

Disease Risk ◽

Severe Disease ◽

World Health ◽

Ordinal Scale ◽

Maximum Score ◽

Secondary Endpoints ◽

Potential Benefits ◽

Health Organization

Objective In SARS-CoV-2 (COVID-19) infection, it is unclear if continuation of preadmission antiplatelet regimens upon hospitalization will improve hypercoagulability outcomes. Methods This retrospective cohort study analyzed adult patients hospitalized with confirmed COVID-19 infection for a 6-week period from March 13, 2020, to April 27, 2020. Preadmission antiplatelet regimen continuation for less than 75% of admission was compared to continuation for at least 75% of admission. Pregnancy, either death or withdrawal of care within 24 hours of admission, and admission beyond the studied timeframe were excluded. The primary endpoint was difference in World Health Organization COVID-19 Ordinal Scale for Clinical Improvement values (World Health Organization [WHO] scores) between maximum score during admission to that upon discharge. Secondary endpoints were mechanical ventilation requirement, mortality, radiologically confirmed venous thromboembolism, major bleeding, and length of stay. Results This study included 171 patients. Patients failing to continue antiplatelet regimens for at least 75% of admission (n = 76) had significantly worse WHO score differences than those who did (n = 95) (median −1 vs 2; P < .05). Mechanical ventilation requirement (57% vs 27%; P < .05) and mortality (58% vs 29%; P < .05) also favored antiplatelet continuation. All other endpoints were not significantly different. Conclusion Significantly improved WHO scores, mechanical ventilation requirement, and mortality occurred in patients continuing preadmission antiplatelet regimens in COVID-19 infection. Future prospective studies of COVID-19 patients with consistently collected baseline hypercoagulability markers (platelets, D-dimer, fibrinogen, and coagulation studies) and similar severe disease risk factors are required to confirm potential benefits of antiplatelet therapy during hospitalization.

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Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population

Respiratory Research ◽

10.1186/s12931-021-01647-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Prateek Lohia ◽

Kalyan Sreeram ◽

Paul Nguyen ◽

Anita Choudhary ◽

Suman Khicher ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Clinical Outcomes ◽

Respiratory Diseases ◽

Severe Disease ◽

Primary Objective ◽

Icu Admission ◽

Disease Outcomes ◽

History Of ◽

Stage Renal Disease

Abstract Background Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. Methods This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. Results A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08–1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07–1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07–1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01–1.55; p = 0.03) in fully adjusted models. Conclusion Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

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Risk Factors for Mortality and Progression to Severe COVID-19 Disease in the Southeast United States (US): A Report from the SEUS Study Group

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1435 ◽

2021 ◽

pp. 1-33 ◽

Cited By ~ 1

Author(s):

Athena L. V. Hobbs ◽

Nicholas Turner ◽

Imad Omer ◽

Morgan K. Walker ◽

Ronald M. Beaulieu ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Mechanical Ventilation ◽

Multivariate Analysis ◽

Hospital Mortality ◽

Mortality Risk ◽

Severe Disease ◽

Increased Risk ◽

Male Sex ◽

Southeast Us

Abstract Objective Identify risk factors that could increase progression to severe disease and mortality in hospitalized SARS-CoV-2 patients in the Southeast US. Design, Setting, and Participants Multicenter, retrospective cohort including 502 adults hospitalized with laboratory-confirmed COVID-19 between March 1, 2020 and May 8, 2020 within one of 15 participating hospitals in 5 health systems across 5 states in the Southeast US. Methods The study objectives were to identify risk factors that could increase progression to hospital mortality and severe disease (defined as a composite of intensive care unit admission or requirement of mechanical ventilation) in hospitalized SARS-CoV-2 patients in the Southeast US. Results A total of 502 patients were included, and the majority (476/502, 95%) had clinically evaluable outcomes. Hospital mortality was 16% (76/476), while 35% (177/502) required ICU admission, and 18% (91/502) required mechanical ventilation. By both univariate and adjusted multivariate analysis, hospital mortality was independently associated with age (adjusted odds ratio [aOR] 2.03 for each decade increase, 95% CI 1.56-2.69), male sex (aOR 2.44, 95% CI: 1.34-4.59), and cardiovascular disease (aOR 2.16, 95% CI: 1.15-4.09). As with mortality, risk of severe disease was independently associated with age (aOR 1.17 for each decade increase, 95% CI: 1.00-1.37), male sex (aOR 2.34, 95% CI 1.54-3.60), and cardiovascular disease (aOR 1.77, 95% CI 1.09-2.85). Conclusions In an adjusted multivariate analysis, advanced age, male sex, and cardiovascular disease increased risk of severe disease and mortality in patients with COVID-19 in the Southeast US. In-hospital mortality risk doubled with each subsequent decade of life.

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