Increased post-hospital mortality of polypathological patients during COVID-19 pandemic

Maintaining Safe Elective Aneurysm Surgery in the COVID-19 Era

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Resuming liver transplantation amid the COVID-19 pandemic

Parallel epidemics, or nearly so: Certainties and uncertainties about SARS-CoV-2 in Italy

Poor clinical outcomes for patients with cancer during the COVID-19 pandemic.

Introduction: With the recent worldwide outbreak of COVID-19, it became clear that certain comorbidities are associated with an increased risk of complications and death. Several publications have reported an increased rate of ICU admission and mortality in cancer patients. This has led to guidelines advising more conservative approaches to cancer therapy, including chemotherapy. In the absence of prospective, disease-specific outcome data, there is a risk of overestimating the risk of COVID-19 and thus increasing cancer-specific mortality or of underestimating. MammaPrint has been validated for selecting clinically high-risk breast cancer patients in whom chemotherapy can be avoided safely. Methods: We evaluated the current published literature related to the potential risk of breast cancer and chemotherapy in association with COVID-19. We estimated the potential risk of severe events in COVID-19 breast cancer patients receiving adjuvant chemotherapy to assess whether MammaPrint could help us further in making chemotherapy decisions specific to an infectious epidemic risk. Results: The risk of COVID-19 morbidity and mortality in patients receiving chemotherapy could be greater than 1.5 to 2 times higher than usual. However, other associated conditions frequently found in the breast cancer population seem to still play a significant role in a worse outcome. We found no data to quantify the effect of chemotherapy or data allowing us to adapt the MammaPrint Score to risk in an infectious epidemic. Conclusion: Adjuvant chemotherapy carries a potential risk for morbidity and mortality. Data from the current literature do not show the magnitude of the added risk for breast cancer patients on adjuvant chemotherapy in association with SARS Cov-2 infection. By using MammaPrint in hormone receptor-positive patients with up to three nodes in whom chemotherapy is considered, the treatment-related risk can be limited, allowing safe de-escalation of therapy without increased cancer-specific mortality. We plan to pursue the statistical question of how the level of risk at any of the sites on the spectrum relates to distant metastasis-free survival so that mortality risks can be better estimated during an infection. Citation Format: Elizabeth M. Murray, Ettienne J. Myburgh, Ersan Lujinovic, Lorenza Mittempergher, Duncan J. Robertson, Josephus J. de Jager, Maritha J. Kotze. Using MammaPrint to reduce the need for chemotherapy in early breast cancer during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-056.

Protecting the vulnerable during a crisis - TAVR during the COVID-19 pandemic

ObjectiveWe aimed to compare mortality and complication rates in patients treated for obstructive jaundice before and during the COVID-19 pandemic in a tertiary care center in Serbia.MethodsWe conducted a retrospective cohort study among a first group of patients treated between 1 January 2017 and 1 January 2019. The second group was treated between 1 March 2020 and 1 March 2022.ResultsThe first group comprised 35 patients, and the second group (in which all patients were SARS-CoV-2 positive) included 18 patients; 37 and 16 patients were treated for malignant and benign diseases, respectively. The groups did not differ significantly regarding the diagnoses and treatment received. The second group showed significantly higher aspartate aminotransferase levels and lower white blood cell, C-reactive protein, and interleukin 6 levels. Mortality and complication rates did not differ significantly between groups. All deceased patients in the second group had significant radiologic findings associated with COVID-19 pneumonia.ConclusionsCOVID-19 infection is a risk factor in treating obstructive jaundice. This study illustrates the potential influence of COVID-19 on mortality after obstructive jaundice treatment. COVID-19 pneumonia may be a significant risk factor for mortality in patients treated for obstructive jaundice.

ObjectiveA previous study revealed a preliminary trend towards higher in hospital mortality in patients admitted as an emergency with acute stroke during the COVID-19 pandemic in Germany. The current study aimed to further examine the possible impact of a confirmed SARS-CoV-2 infection on in hospital mortality.MethodsThis was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalised for ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, acute limb ischaemia (ALI), aortic rupture, acute stroke, or transient ischaemic attack (TIA) between 1 January 2017, and 31 October 2020, were included. Admission rates per 10 000 insured and mortality were compared between March − June 2017 – 2019 (pre-COVID) and March − June 2020 (COVID). Mortality rates were determined by the occurrence of a confirmed SARS-CoV-2 infection.ResultsA total of 316 718 hospitalisations were included (48.7% female, mean 72.5 years), and 21 191 (6.7%, 95% CI 6.6% – 6.8%) deaths occurred. In hospital mortality increased during the COVID-19 pandemic when compared with the three previous years for patients with acute stroke from 8.3% (95% CI 8.0 – 8.5) to 9.6% (95% CI 9.1 – 10.2), while no statistically significant changes were observed for STEMI, NSTEMI, ALI, aortic rupture, and TIA. When comparing patients with confirmed SARS-CoV-2 infection (2.4%, 95% CI 2.3 – 2.5) vs. non-infected patients, a higher in hospital mortality was observed for acute stroke (12.4% vs. 9.0%), ALI (14.3% vs. 5.0%), and TIA (2.7% vs. 0.3%), while no statistically significant differences were observed for STEMI, NSTEMI, and aortic rupture.ConclusionThis retrospective analysis of claims data has provided hints of an association between the COVID-19 pandemic and increased in hospital mortality in patients with acute stroke. Furthermore, confirmed SARS-CoV-2 infection was associated with increased mortality in patients with stroke, TIA, and ALI. Future studies are urgently needed to better understand the underlying mechanism and relationship between the new coronavirus and acute stroke.

Transcatheter Aortic Valve Implantation During the COVID-19 Pandemic

Timely diagnosis and effective use of available resources are urgent to avoid the loss of time, medical, and technological resources, particularly in COVID-19 pandemic. This study aimed to identify the most dominant predicting factor for mortality in moderate-severe COVID-19 patients. This retrospective cohort study included a total of 253 patients diagnosed with moderate-severe COVID-19. The primary outcome measure was mortality during hospitalization. The receiver operating characteristic (ROC) curve was used to determine cut-off points. The data were categorized according to the cut-off points in ROC curve and analyzed using Chi-square and by binary logistic regression test to identify the independent predictors associated with mortality. The mean number of leukocytes (/µL), neutrophils (%), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP, mg/L), and D-dimer (mg/L) in the non-survived group was significantly higher than those of the survived group. Meanwhile, the mean number of platelet count/µL, absolute lymphocyte count (ALC), in the non-survived group was significantly lower than those of the survived group. CRP level predicted mortality with a cut-off point of ≥8.41 mg/L, sensitivity of 98.1%, and specificity of 72.0% (P = .000). High leukocyte count, low platelet count, high NLR, high CRP level, and high D-dimer on admission predicted mortality of COVID-19 patients. In addition, CRP was found to be the most dominant predicting factor of mortality in moderate-severe COVID-19 patients.

The COVID-19 pandemic has intensified the challenges of managing venous thromboembolic events (VTE), with SARS-CoV-2 infection linked to a higher risk of deep vein thrombosis (DVT) and progression to pulmonary embolism (PE), often resulting in elevated mortality. This retrospective case-control study evaluates the effects of anticoagulant and corticosteroid therapies on survival in DVT patients with and without COVID-19, examining factors associated with PE progression. Key clinical markers, including Sepsis-Induced Coagulopathy (SIC) scores, were assessed for their predictive value in mortality outcomes. Our findings reveal that while anticoagulants are essential in thrombotic management, they may raise cancer- or sepsis-related mortality in non-PE patients. Corticosteroids, though beneficial in severe COVID-19 cases, were linked to increased cancer-related mortality in PE patients, likely due to immunosuppression. These results underscore the need for tailored therapeutic approaches and individualized risk assessments to improve survival outcomes in high-risk populations during COVID-19.

Hospitalizations and mortality of patients with heart failure in the COVID-19 era in Peru

BackgroundThe purpose of the current study was to investigate the incidence of postoperative medical complications and 3-month mortality in patients ≥ 70 years old with hip fracture following hip arthroplasty (HA) and independent risk factors associated with postoperative medical complications and 3-month mortality during the Coronavirus Disease 2019 (COVID-19) pandemic.MethodsA multicenter retrospective study was conducted, patients ≥ 70 years old with HA for hip fracture under general anesthesia were included during COVID-19 and before COVID-19 pandemic. The outcome was defined as postoperative medical complications and 3-month mortality. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors for postoperative medical complications and 3-month mortality.ResultsA total of 1096 patients were included during COVID-19 pandemic and 1149 were included before COVID-19 pandemic in the study. Patients ≥ 70 years with hip fracture for HA had longer fracture to operation duration (7.10 ± 3.52 vs. 5.31 ± 1.29, P < 0.001), and the incidence of postoperative medical complications (21.90% vs. 12.53%, P < 0.001) and 3-month mortality (5.20% vs. 3.22%, P = 0.025) was higher during COVID-2019 pandemic. Multivariate logistic regression analysis showed that dementia (OR 2.73; 95% CI 1.37–5.44; P = 0.004), chronic obstructive pulmonary disease (COPD) (OR 3.00; 95% CI 1.92–4.71; P < 0.001), longer fracture to operation duration (OR 1.24; 95% CI 1.19–1.30; P < 0.001) were associated with increased risk for postoperative medical complications. COPD (OR 2.10; 95% CI 1.05–4.17; P = 0.035), dementia (OR 3.00; 95% CI 1.11–7.94; P = 0.031), postoperative medical complications (OR 4.99; 95% CI 2.68–9.28; P < 0.001), longer fracture to operation duration (OR 1.11; 95% CI 1.04–1.19; P = 0.002) were associated with increased risk for 3-month mortality.ConclusionsIn conclusion, we found that postoperative medical morbidity and 3-month mortality in patients with hip fracture underwent HA were 21.90% and 5.20%, respectively, during the COVID-19. COPD, dementia and longer fracture to operation duration were associated with negative outcome in patients with hip fracture underwent HA during the COVID-19.

Stroke is the second leading cause of death worldwide. Recent studies have shown that the COVID-19 pandemic has been associated with a higher frequency of stroke. This study aimed to investigate the epidemiologic aspects of stroke two years before and during the COVID-19 pandemic in Kerman. This cross-sectional study was conducted in Kerman. The participants included all patients with a confirmed diagnosis of stroke. COVID-19 confirmation was based on a positive PCR test. The data was analyzed with SPSS.V24 software. In this study, 4152 patients with stroke were evaluated. The frequency of stroke before and during the COVID-19 pandemic was the same. The total number of stroke patients with COVID-19 was 298 (8.16%). The frequency of ischemic stroke patients before the COVID-19 pandemic was 1751 and during the pandemic was 1770. Before and after the pandemic, the mean age of ischemic stroke patients was 67.42±14.14 and 64.49±14.46 respectively, which showed a statistically significant difference (P>0.001). Our findings showed a significant difference between the NIHSS of ischemic stroke before and after the pandemic (P<0.001). The mortality rate of stroke patients was 111 before COVID-19 and 115 patients in the first two years of COVID-19. Except for the mortality rate (P<0.001), there was no significant difference in other demographic variables between ischemic stroke patients with and without COVID-19. The patients with ischemic stroke during the COVID-19 pandemic were younger and had more neurological deficits than the ischemic stroke patients before the pandemic. COVID-19 was associated with higher mortality in patients with ischemic stroke.