COVID-related Mortality Research Articles

The outcome of COVID-19 infection among Saudi oncology patients.

e23085 Background: Little data are available surrounding the outcomes and risk factors of COVID-19 in Saudi oncological patients. This study aims to elucidate the outcomes of COVID-19 infection among Saudi oncology patients and associated risk factors. Methods: We retrospectively reviewed the medical files of oncology patients who were diagnosed with COVID-19 at the King Faisal Specialist Hospital and Research Centre. The time from a positive PCR until death or last follow-up was calculated as COVID-specific survival. A p-value less than 0.05 was selected as the threshold for statistical significance. Results: 161 oncological patients were included in our analysis. The mean age was 53.83±15.81. 85 (52.8%) patients were female, 17 (10.6%) had a positive history of smoking, and 57 (35.4%) were obese. 70 (43.5%) patients had diabetes mellitus, 64 (39.8%) had hypertension, and 25 (15.5%) had dyslipidemia. The most common cancer in the group was breast cancer, which was present in 24 (14.9%), followed by non-Hodgkin lymphoma, colon cancer, and acute leukemia, respectively. 57 (35.4%) patients had no evidence of disease (NED) at presentation. Furthermore, 65 (40.4%) patients had received antineoplastic therapy within 30 days before infection. 25 (15.5%) patients had stage A COVID-19, 59 (36.6%) had stage B, 48 (29.8%) had stage C, and 29 (18%) had stage D. There was no difference between active and no NED patients in remission in regard to the stages of COVID-19 infection at presentation (p = 0.05). However, the stages of COVID were less severe in patients who received antineoplastic therapy (p = 0.02). 32 (19.9%) patients received tocilizumab during the acute phase of infection. Only 5 (3.1%) patients suffered COVID-specific death. Therefore, the median COVID-specific survival was not reached. Tocilizumab (p = 0.34), corticosteroids (p = 0.77), ACE inhibitors (p = 0.45) had no impact on COVID-specific death in our patient population. In patients who received steroid treatment, the duration of corticosteroid had no impact on survival (HR: 0.76, p = 0.39). Ventilation also had no impact on survival (p = 0.55). There was no difference between patients who received antineoplastic therapy within 30 days from infection and those who did not (p = 0.99). Finally, we noted no difference in survival between patients with active disease and NED patients (p = 0.17). Conclusions: COVID-related mortality is lower in Saudi oncology patients compared to other countries. Early management and admission of oncological patients may result in overall improved outcome. In line with some studies, antineoplastic therapy can reduce COVID-19 severity, possibly due to reduced ACE receptor expression.

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City.

Hospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality. In a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions), and crude and risk-adjusted inpatient mortality rates, also stratified by ICU use, in the first COVID wave across hospital quartiles (23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017-2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality. ICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1-4, respectively. The risk-adjusted mortality rates for ICU admissions were 36.4 (CI = 34.7,38.2), 43.6 (CI = 41.5,45.8), 45.9 (CI = 43.8,48.1), and 45.7 (CI = 43.6,48.0) per 100 admissions, and those for non-ICU admissions were 8.6 (CI = 8.3,9.0), 10.9 (CI = 10.6,11.3), 12.6 (CI = 12.1,13.0), and 12.1 (CI = 11.6,12.7) per 100 admissions by hospital quartile 1-4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.17 (95% CI = 1.10, 1.26), 2.63 (95% CI = 2.31, 3.00), and 3.26 (95% CI = 2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.28 (95% CI = 1.22, 1.34), 2.60 (95% CI = 2.40, 2.82), and 3.44 (95% CI = 3.11, 3.63) for inpatient mortality. Our findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.

Severe acute respiratory syndrome coronavirus 2 infection in patients with hematological malignancies in the Omicron era: Respiratory failure, need for mechanical ventilation and mortality in seronegative and seropositive patients.

Patients with hematological malignancies (HM) have a high risk of severe coronavirus disease 2019 (COVID-19), also in the Omicron period. Retrospective single-center study including HM patients with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) infection from January 2022 to March 2023. Study outcomes were respiratory failure (RF), mechanical ventilation (MV), and COVID-related mortality, comparing patients according to SARS-CoV2 serology. Note that, 112 patients were included: 39% had negative SARS-CoV2 serology. Seronegative were older (71.5vs. 65.0 years, p = 0.04), had more often a lymphoid neoplasm (88.6%vs. 69.1%, p = 0.02), underwent anti-CD20 therapy (50.0%vs. 30.9% p = 0.04) and had more frequently a severe disease (23.0%vs. 3.0%, p = 0.02) than seropositive.Kaplan-Meier showed a higher risk for seronegative patients for RF (p=0.014), MV (p=0.044), and COVID-related mortality (p=0.021). Negative SARS-CoV2 serostatus resulted in a risk factor for RF (hazards ratio [HR] 2.19, 95% confidence interval [CI] 1.03-4.67, p = 0.04), MV (HR 3.37, 95% CI 1.06-10.68, p = 0.04), and COVID-related mortality (HR 4.26, 95% CI 1.09-16.71, p = 0.04). : HM patients with negative SARS-CoV2 serology, despite vaccinations and previous infections, have worse clinical outcomes compared to seropositive patients in the Omicron era. The use of serology for SARS-CoV2 diagnosis could be an easy tool to identify patients prone to developing complications.

COVID-19 in a Dutch Nursing Home: A Longitudinal Retrospective Care-Home-Level Case Study on Infection Rate, Survival Rate, and Daily Functioning.

During the pandemic, nursing homes in the Netherlands were heavily affected by COVID-19. This study assesses the impact of COVID-19 on infection rate, survival rate, and daily functioning over the course of two years among residents of a nursing home in the Netherlands that was amongst the first nursing homes to be affected by the pandemic. This retrospective study followed 70 residents during a two-year period, starting in March 2020. Data were collected on baseline characteristics of participants and the onset, duration, and sequelae of COVID-19 infections. Primary outcomes were mortality and infection rate. The secondary outcome was daily functioning using the Barthel Index at intervals of six months. Within two years, 44 (62.9%) residents were diagnosed with COVID-19. During this study, 72.7% (n = 32) of the COVID-positive residents died, of which 22 deaths were related to the COVID-19 infection. Overall mortality was 60% (n = 42), while COVID-related mortality was 31.4% (n = 22). COVID-19 and multimorbidity (>3 morbidities) were independent risk factors for mortality. Barthel Index scores showed no significant difference in daily functioning. Overall, a high COVID-19 infection rate was seen and was the most common cause of death. COVID-19 did not affect functional status over time.

COVID-19 Related Mortality Does Not Correlate with Vaccine Availability in Leukemia Patients: 2020-2023 Analysis in the United States

Introduction: Leukemia patients have abnormal immune function due to both the innate characteristics of their disease and the treatments, which are almost invariably immunosuppressive in nature. Treatment modalities may lead to both temporary and long term immunosuppression. For these reasons, the coronavirus disease 2019 (COVID-19) pandemic has posed challenges to the management of patients with leukemia.With the approval of several types of COVID-19 vaccines, the first of which became available in December 2020, there has been a significant decrease in morality from COVID-19 among vaccinated adults compared to unvaccinated adults. It is unclear if the same trend applies to adults with leukemia who may have an impaired immune response to vaccination. To further elucidate the efficacy of COVID-19 vaccination in this inherently immunocompromised group of patients, we performed a nationwide analysis of COVID-19 mortality trends in adults over 25 years old with leukemia. Methods: Using the CDC Wonder Database, we reviewed death certificates for COVID-19 related mortality trends from March 2020 to June 2023 for all subtypes of leukemia in the United States in adults above 25 years old. We included respective ICD codes: C91 lymphoid leukemia, C92 myeloid leukemia, C93 monocytic leukemia, C94 other leukemias of specified cell types, and C95 leukemia of unspecified cell types. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people. Data was stratified by reported sex, race/ethnicity, and census region. Results: Deaths from COVID-19 in people with leukemia were reported as 1800 in 2020, 2813 in 2021, 2445 in 2022, and 481 as of June 2023 (Figure 1). There were fluctuations of COVID-19 AAMR per 100,000 people with all subtypes of leukemia from 2020 to 2023 (Table 1). The provisional and incomplete data in 2023 showed a sudden decrease of AAMR within all groups. In 2020 the overall AAMR in all groups was 0.7 which increased to 1.1 in 2021, decreased to 0.9 in 2022, and 0.2 as of June 2023. There is a difference in mortality rates between sex with male AAMR being greater than female in all 3 years. For example in 2021 the AAMR for males was 1.4 while for females it was 0.6. Analysis of racial and ethnic groups showed Asians with the lowest AAMR (0.3 AAMR, 2020) compared to Whites (1.5 AAMR, 2020), Blacks (0.9 AAMR, 2020), and Hispanics (0.6 AAMR, 2020). The trends between the census regions were also comparable. Conclusion: The data demonstrates variations in AAMRs from each year to the next. These variations can be affected by infection rates, public health measures, healthcare access, and socioeconomic factors. The 2023 data is still provisional and incomplete, however, they do offer a glimpse of the 2023 trends. The multiple subtypes of leukemia have different degrees of immunosuppression, thus not all leukemia patients have the same risk profile. Despite the type of Leukemia, it is widely accepted that these patients are in an immunocompromised state and at a higher risk to develop complications from COVID-19. It is recommended for all patients with leukemia to receive non-live, attenuated viral vaccines. Although considered safe and recommended, there is very limited data regarding efficacy of the COVID-19 vaccine in immunocompromised patients. One study showed patients with CLL about 36% of patients were seronegative after vaccination (Chatzikonstantinou et al., 2021) and seronegativity rates may be even higher in patients with acute leukemias. Certainly the absence of steady downward trend in mortality following the availability of vaccination suggests either that leukemia patients are not complying with vaccination recommendations or that vaccination is often ineffective in the setting of their inherent immunocompromise. Certainly a limitation of this analysis is the lack of data regarding COVID-related mortality in vaccinated versus unvaccinated individuals. Given the lack of improvement in AAMR among leukemic patients following the availability of a COVID 19 vaccination, it seems appropriate that physicians still recommend using additional preventative measures from COVID-19 including social distancing and mask wearing. It is important to continue studying the relationship between serology positivity, immunity, and overall outcomes.

527. A Descriptive, Retrospective Analysis of COVID-19 Antibody Therapy and its Effects on Morbidity and Mortality in Patients Receiving B-cell Depleting Therapies

Abstract Background Patients receiving B-cell-depleting therapies (BCDT) are at an increased risk for severe COVID-19. Passive antibody therapy (PAT), including COVID-19 convalescent plasma (CCP) and monoclonal antibodies (MAB), is hypothesized to be an effective treatment in this population. However, real-world data on their effectiveness is limited. Methods We conducted a retrospective chart review of patients who contracted COVID-19 within a year from their last BCDT treatment and later received PAT (Table 1). Response to treatment was assessed by 90-day COVID-related mortality and all-cause morbidity, defined through number of hospitalizations (Figure 1).Table 1.Inclusion and exclusion criteria.Figure 1.Patient flow. Sixty-five patients met initial criteria. Five were excluded from analysis due to non-COVID related death within 90 days from COVID diagnosis. Cause of death was established in the chart and confirmed by review of two investigators. Results From 60 included patients, the majority were Caucasians (97%), females (57%), and vaccinated (67%) (Table 2). Most patients received rituximab (53%) for treatment of a hematological malignancy (37%) or multiple sclerosis (37%) (Figure 2). Overall morbidity (3/39, 7.7%) and mortality (3/60, 5%) were low. All hospitalized and deceased patients were elderly Caucasian males receiving rituximab for underlying hematological malignancy. All deceased patients received inpatient treatment, 2 with CCP and one with MAB (Figure 3).Table 2.Basic characteristics of passive antibody therapy recipients. Demographics, vaccination status and number of comorbidities excluding the condition which is the indication for B-cell depleting therapy.Figure 2.Type of B-cell depleting therapy and indication for use.Evaluated B-cell depleting therapies are rituximab (n=32), ocrelizumab (n=21), obinutuzumab (n=6), ofatumumab (n=1). Evaluated underlying indications for B-cell depleting therapy are hematological malignancy (n=22), multiple sclerosis (n=22); rheumatoid arthritis (n=9) and others (n=7). Others include scleroderma (n=1), systemic lupus (n=2), granulomatosis with polyangiitis (n=4).Figure 3:Treatment location and type of passive antibody therapy.All patients treated outpatient (39) received monoclonal antibodies. Of inpatients (21), 14 received COVID-19 convalescent plasma. Of patients treated as outpatient, 3 were hospitalized, with only 1 hospitalized for a COVID-related illness. Conclusion COVID-19 patients undergoing BCDT and treated with PAT had low morbidity and mortality in our study, suggesting a possible benefit of PAT in this patient population. All deaths occurred in patients hospitalized at the time of treatment with PAT, implying advanced COVID-19 infection and highlighting the importance of early PAT administration. All deceased patients and 2/3 hospitalized patients were receiving rituximab, suggesting that rituximab may be a risk factor for severe COVID (Figure 4). All deceased and hospitalized patients had an underlying hematological malignancy, suggesting that the presence of hematologic malignancy may impact the outcome of COVID-19. In our study, elderly Caucasian males with multiple medical comorbidities and underlying hematological malignancy treated with BCDT, particularly rituximab, may have an increased risk for severe COVID-19. Early PAT administration may improve outcomes in this group of patients, and they should be prioritized for treatment when access to PAT is limited.Figure 4:Type of B-cell depleting therapy and mortality. All deaths were among patients being treated with rituximab for hematological malignancy. Disclosures All Authors: No reported disclosures

Supporting Solidarity

Supporting Solidarity

Age-period-cohort analysis of mortality and its association with deprivation in Hungary, 2007-2021

Abstract Background Severe spatial inequalities in health and its determinants are a well-known and long-standing phenomenon in Central-Eastern European countries, including Hungary. The aim of our study was to perform an age-period-cohort (APC) analysis to provide information on mortality trends and their association with deprivation in Hungary using the latest available data for the period 2007-2021. Methods The extended APC model, allowing estimation of mortality risk considering deprivation, time, age, and cohort effects and their interactions, was used to analyse the trajectories of several outcome variables along complex dimensions. Model fitting and inference were carried out by using Bayesian computation with INLA methodology. Results Mortality risk was the lowest in the 5-9 year age group and increased with age. Between 2007-19, the mortality risk showed a decreasing trend, which returned to the 2007 level by 2020-21 due to the COVID-19 pandemic. Considering the birth cohort effect, the mortality risk peaked in the 1953-57 cohort, then decreased until the 1972-76 cohort, followed by a steady state, and then decreased from the 1988-92 cohort onwards. Deprivation was positively associated with higher mortality risk. The interaction of deprivation and period effect on mortality risk showed a steeper increasing trend for deprived groups for 2020-21. In terms of the interaction of deprivation and cohort effect, the risk of mortality in the most deprived group was higher than the national risk for all birth cohorts. The risk increased until the 1967-71 cohort, then decreased until the 1992-96 cohort, and then again showed an increasing trend. The risk of mortality for the least deprived population was lower than the national average risk, while the opposite difference could be observed for the most deprived group. Conclusions Deprivation was associated with higher mortality risk, COVID-related mortality and cohort effect during the study period. Key messages • The COVID epidemic-associated increase in mortality affected groups of different deprivation status to varying degree. • Different cohort effects were found behind the mortality risk in different deprivation groups.

Gender Differences in COVID-19 Among Liver Transplant Recipients - Results from a Multicenter Brazilian Cohort

Introduction: Existing literature presents varying perspectives on the impact of COVID-19 on liver transplant recipients. However, no research has specifically investigated the role of gender differences in the manifestation of COVID-19 among liver transplant recipients. This study aims to examine the effects of COVID-19 on liver transplant recipients, with a focus on gender differences in disease presentation and progression. Methods: Conducted as a multicenter historical cohort study, this research collected patient records through an online questionnaire. Assessing COVID-related mortality was the main objective. Additionally, demographic, clinical, and laboratory data pertaining to disease presentation and progression were collected. Results:The study included a total of 283 patients, of whom 76 were female and 206 were male. The median follow-up period for males was 99 days (IQR 38-283), while for females, it was 126 days (IQR 44-291). A higher prevalence of cardiovascular disease was observed in males (p=0.002). Females frequently experienced a loss of smell (p=0.021), whereas males commonly exhibited fever (p=0.031). Levels of ALT and gamma-glutamyl transferase were significantly elevated in males (p=0.008 and 0.004, respectively). Although there was a trend towards increased mortality in males, it did not reach statistical significance.Conclusion: This study is the first attempt to investigate gender differences in COVID-19 among liver transplant recipients. Our findings highlight the need for a comprehensive and personalised approach to treating this patient population and underscore the importance of further elucidating the disease presentation in these individuals

COVID-19 vaccine uptake in mental healthcare users: Czech nationwide register study

BackgroundThe excessive covid-related mortality of psychiatric patients was reduced by vaccination. The vaccine uptake in patients diagnosed with different mental health disorders is, however, not fully described. AimsA nationwide, record-based retrospective cross-sectional study examines the effect of substance use, psychotic, affective, anxiety, and personality disorders on COVID-19 vaccination rates in August and December 2021. Further, it quantifies the effect of receiving mental healthcare on vaccine uptake. MethodsThe COVID-19 vaccine rates of mental healthcare users in August and December 2021 were examined using logistic regression models adjusted for sex and age on a sample of 7,235,690 adult inhabitants of the Czech Republic. The probability of vaccine uptake in the week following mental healthcare appointment or hospitalization on any day in the fall 2021 was compared to the general probability of getting vaccinated during that week. ResultsThe vaccination rate in August 2021 was related to history of hospitalization due to substance use (OR = 0.71), personality (OR = 0.87), psychotic (OR = 0.92), and anxiety (OR = 1.15) disorders, while mood disorders had no effect (OR = 1.00). Compared to general population, mental healthcare users were undervaccinated in August but not in December 2021. Vaccine uptake was low in those with history of psychiatric hospitalizations but higher in those utilizing inpatient or outpatient mental healthcare recently, predominantly for affective disorders. Increased vaccine uptake was observed following utilization of mental healthcare as well as in those with repeated psychiatric hospitalizations. ConclusionsThe vaccination rates of mental healthcare users relative to general population largely differ across nosological categories and during the vaccination campaign. Psychiatrists were successful in promoting vaccination against COVID-19.

Racial-ethnic Differences in Anticipatory Stress about COVID-19 Mortality: An Evaluation of Multiple Mechanisms

The COVID-19 pandemic has disproportionately affected the health of people of color in the United States. In this study, we use national survey data ( n = 1,844) to examine racial-ethnic variation in people’s worries about COVID-19 mortality and the mechanisms that underlie these differences. Consistent with stress theory, we find that Black and Latinx respondents are more likely than Whites to worry about the possibility that they, a romantic partner, or a child will die from the virus. Black and Latinx respondents are also more likely to report prior COVID-19 infection, to know someone who has tested positive for the virus, to work in essential jobs, to live in more densely populated counties with higher infection rates, and to contend with more same-race COVID-19 infections at the national level. Across these different layers of social context, however, only prior COVID infection and knowing someone who has tested positive for the virus are linked to greater worry about COVID-related mortality. Mediation analyses indicate the greater prevalence of prior infection among Black and Latinx respondents explains little of the gap in anticipatory stress, whereas approximately one-fifth of the Black-White and Latinx-White discrepancy in worries about COVID-19 mortality are attributable to the greater social connectivity of Black and Latinx respondents to family and friends who have been affected by the virus. We outline the implications of these findings for future scholarship.

Long Covid - Into the Third Year.

As the COVID-19 pandemic reaches the end of its third year, and as COVID-related mortality in North America wanes, long Covid and its disabling symptoms are attracting more attention. Some individuals report symptoms lasting more than 2 years, and a subset report continuing disability. This article will provide an update on long Covid, with a particular focus on disease prevalence, disability, symptom clustering and risk factors. It will also discuss the longer-term outlook for individuals with long Covid.

Long Covid - Into the Third Year.

As the COVID-19 pandemic reaches the end of its third year, and as COVID-related mortality in North America wanes, long Covid and its disabling symptoms are attracting more attention. Some individuals report symptoms lasting more than 2 years, and a subset report continuing disability. This article will provide an update on long Covid, with a particular focus on disease prevalence, disability, symptom clustering and risk factors. It will also discuss the longer-term outlook for individuals with long Covid.

Investigating the association of measures of epigenetic age with COVID-19 severity: evidence from secondary analyses of open access data

Epigenetic modifications may contribute to inter-individual variation that is unexplainable by presently known risk factors for COVID-19 severity (e.g., age, excess weight, or other health conditions). Estimates of youth capital (YC) reflect the difference between an individual's epigenetic - or biological - age and chronological age, and may quantify abnormal aging due to lifestyle or other environmental exposures, providing insights that could inform risk-stratification for severe COVID-19 outcomes. This study aims to thereby a) assess the association between YC and epigenetic signatures of lifestyle exposures with COVID-19 severity, and b) to assess whether the inclusion of these signatures in addition to a signature of COVID-19 severity (EPICOVID) improved the prediction of COVID-19 severity. This study uses data from two publicly-available studies accessed via the Gene Expression Omnibus (GEO) platform (accession references: GSE168739 and GSE174818). The GSE168739 is a retrospective, cross-sectional study of 407 individuals with confirmed COVID-19 across 14 hospitals in Spain, while the GSE174818 sample is a single-center observational study of individuals admitted to the hospital for COVID-19 symptoms (n = 102). YC was estimated using the (a) Gonseth-Nusslé, (b) Horvath, (c) Hannum, and (d) PhenoAge estimates of epigenetic age. Study-specific definitions of COVID-19 severity were used, including hospitalization status (yes/no) (GSE168739) or vital status at the end of follow-up (alive/dead) (GSE174818). Logistic regression models were used to assess the association between YC, lifestyle exposures, and COVID-19 severity. Higher YC as estimated using the Gonseth-Nusslé, Hannum and PhenoAge measures was associated with reduced odds of severe symptoms (OR = 0.95, 95% CI = 0.91-1.00; OR = 0.81, 95% CI = 0.75 - 0.86; and OR = 0.85, 95% CI = 0.81-0.88, respectively) (adjusting for chronological age and sex). In contrast, a one-unit increase in the epigenetic signature for alcohol consumption was associated with 13% increased odds of severe symptoms (OR = 1.13, 95% CI = 1.05-1.23). Compared to the model including only age, sex and the EPICOVID signature, the additional inclusion of PhenoAge and the epigenetic signature for alcohol consumption improved the prediction of COVID-19 severity (AUC = 0.94, 95% CI = 0.91-0.96 versus AUC = 0.95, 95% CI = 0.93-0.97; p = 0.01). In the GSE174818 sample, only PhenoAge was associated with COVID-related mortality (OR = 0.93, 95% CI = 0.87-1.00) (adjusting for age, sex, BMI and Charlson comorbidity index). Epigenetic age is a potentially useful tool in primary prevention, particularly as an incentive towards lifestyle changes that target reducing the risk of severe COVID-19 symptoms. However, additional research is needed to establish potential causal pathways and the directionality of this effect.

The association between respiratory diseases and periodontitis: A systematic review and meta-analysis.

To evaluate (1) whether periodontitis has an influence on the prevalence/incidence of respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma, community-acquired pneumonia [CAP], obstructive sleep apnoea [OSA] and COVID-19), and (2) what is the impact of periodontal therapy on the onset or progression of respiratory diseases. An electronic search was performed on Pubmed, Cochrane Library and Scopus databases up to October 2021, to identify studies answering the PECOS and PICOS questions. Seventy-five articles were selected. Meta-analyses identified statistically significant associations of periodontitis with COPD (nstudies = 12, odds ratio [OR]=1.28, 95% confidence interval [CI] [1.16; 1.42], p< .001), and OSA (ns = 6, OR=1.65, 95% CI [1.21; 2.25], p= .001), but not for asthma (ns = 9, OR=1.53, 95% CI [0.82; 2.86], p= .181). For acute conditions, two studies were found for CAP, while for COVID-19, significant associations were found for the need of assisted ventilation (ns = 2, OR=6.24, 95% CI [2.78; 13.99], p< .001) and COVID-related mortality (ns = 3, OR=2.26, 95% CI [1.36, 3.77], p= .002). Only four intervention studies were found, showing positive effects of periodontal treatment on COPD, asthma and CAP. A positive association between periodontitis and COPD, OSA and COVID-19 complications has been found, while there is a lack of intervention studies.

CHRONIC CONDITIONS DURING THE COVID PANDEMIC: MORTALITY PATTERNS IN THE UNITED STATES

Abstract Patients with chronic diseases, especially the older adults, are at increased risk of death during the COVID pandemic. We analyzed monthly patterns of mortality rates for patients with diabetes, arterial hypertension, cerebrovascular disease, heart failure, and kidney disease using the provisional Multiple Cause of Death data (2018-2022), for age-, gender, and race/ethnicity-specific population groups. Since population is available at annual basis, we used interpolation of population at risk to have the estimates of population at monthly basis. For all studied diseases, there were substantial increases in mortality among patients that peaked in late-Spring 2020 and Winter 2020/2021. Increases of COVID-related deaths were greater in older (aged 65+) than in younger (55-64) patients. For majority of diseases, Black patients predominantly had their maximum/peaks of COVID-related mortality in late-Spring 2020, while White, American Indian, and Hispanic patients had their max in Winter 2020/2021, and Asian patients had both peaks. Additionally to increased COVID-related deaths, higher mortality rates were also observed among patients with above diseases who did not have COVID in their death records. These increases were more pronounced in younger (55-64) than in older (65+) age groups, and they varied by the studied disease. Increased mortality not directly related to COVID could be due to the relocations of medical resources, lower access to medical care (e.g., limited use of telemedicine), non-COVID related complications caused by the earlier COVID infection, undiagnosed and/or unregistered COVID cases in patients with chronic disease, or other causes. Disease-specific differences in mortality patterns were analyzed and discussed.

Cardiac Characteristics of the First Two Waves of COVID-19 in Denmark and the Prognostic Value of Echocardiography: The ECHOVID-19 Study

Introduction: COVID-19 has spread globally in waves, and Danish treatment guidelines have been updated following the first wave. We sought to investigate whether the prognostic values of echocardiographic parameters changed with updates in treatment guidelines and the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, 20E (EU1) and alpha (B.1.1.7), and further to compare cardiac parameters between patients from the first and second wave. Methods: A total of 305 patients hospitalized with COVID-19 were prospectively included, 215 and 90 during the first and second wave, respectively. Treatment in the study was defined as treatment with remdesivir, dexamethasone, or both. Patients were assumed to be infected with the dominant SARS-CoV-2 variant at the time of their hospitalization. Results: Mean age for the first versus second wave was 68.7 ± 13.6 versus 69.7 ± 15.8 years, and 55% versus 62% were males. Left ventricular (LV) systolic and diastolic function was worse in patients hospitalized during the second wave (LV ejection fraction [LVEF] for first vs. second wave = 58.5 ± 8.1% vs. 52.4 ± 10.6%, p < 0.001; and global longitudinal strain [GLS] = 16.4 ± 4.3% vs. 14.2 ± 4.3%, p < 0.001). In univariable Cox regressions, reduced LVEF (hazard ratio [HR] = 1.07 per 1% decrease, p = 0.002), GLS (HR = 1.21 per 1% decrease, p < 0.001), and tricuspid annular plane systolic excursion (HR = 1.18 per 1 mm decrease, p < 0.001) were associated with COVID-related mortality, but only GLS remained significant in fully adjusted analysis (HR = 1.14, p = 0.02). Conclusion: Reduced GLS was associated with COVID-related mortality independently of wave, treatment, and the SARS-CoV-2 variant. LV function was significantly impaired in patients hospitalized during the second wave.

Vaccination rates and COVID outcomes across U.S. states

Rates of COVID deaths, hospitalizations, and cases differ markedly across U.S. states, as do rates of vaccination. This study uses cross-state regressions to assess impacts of vaccinations on COVID outcomes. A number of familiar issues arise concerning cross-sectional regressions, including omitted variables, behavioral responses to vaccination, and reverse causation. The benefits from a field context and from the broad range of observed variations suggest the value from dealing with these issues. Results reveal sizable negative effects of vaccination on deaths, hospitalizations, and cases up to early December 2021, although vaccine efficacy seems to wane over time. The findings for deaths apply to all-cause excess mortality as well as COVID-related mortality. The estimates imply that one expected life saved requires 248 additional doses, with a marginal cost around $55000, far below typical estimates of the value of a statistical life. Results since December 2021 suggest smaller effects of vaccinations on deaths and, especially, hospitalizations and cases, possibly because of diminished effectiveness of vaccines against new forms of the virus, notably the omicron variant. A further possibility is that confidence engendered by vaccinations motivated individuals and governments to lessen non-pharmaceutical interventions, such as masking and social distancing.

Older Age and Neutrophil-to-Lymphocyte Ratio (NLR) Are Predictors of Illness Severity and COVID-Related Mortality in a Multiethnic Urban Cohort of Hematologic Neoplasms Patients: An Updated Analysis

Introduction: We have previously shown that older age and increased NLR were associated with worse outcomes among patients with hematologic neoplasms diagnosed with COVID-19 from March to June 2020. We sought to perform an updated and expanded analysis including follow-up data on the original patient cohort as well as evaluation of additional COVID cases among the hematologic neoplasms population up until February 2022. Methods: A retrospective analysis of patients with hematologic neoplasms diagnosed with COVID-19 from March 17th, 2020 to February 1st, 2022 was conducted. Subjects included were censored at last point of contact. Variables collected included age, gender, race/ethnicity, hematologic diagnosis, cancer treatment status, date of COVID-19 infection, COVID-19 vaccination status, absolute neutrophil and lymphocyte counts, need for hospital and/or intensive care unit (ICU) admission, oxygen therapy, intubation, length of stay (LOS), and COVID-related and all-cause mortality. For survival analysis, associations between hematologic diagnosis, cancer treatment status, age, gender, race/ethnicity, neutrophil-to-lymphocyte ratio (NLR), date of COVID-19 infection, COVID-19 vaccination status, and overall survival (OS) were assessed using the Kaplan-Meier method with logrank test. A competing risks analysis was performed to assess COVID-related and all-cause mortality using Gray's test for comparing incidence curves. Univariate associations between NLR and hospital and/or ICU admission, oxygen therapy, and LOS were assessed using Fisher's and Kruskal-Wallis tests for categorical and continuous variables, respectively. Results: A total of 248 subjects with hematologic neoplasms and COVID-19 infection treated in Montefiore Health system were identified. One-hundred and sixteen (47%) subjects were undergoing active treatment, including 84 (34%) receiving conventional chemotherapy agents, 19 (7%) targeted therapy, 3 (1%) immunotherapy alone, and 10 (4%) combination therapy. Of those subjects, 63 (55%) experienced delay or discontinuation of treatment due to COVID-19 infection. Thirty-two (13%) had received one or more COVID-19 vaccine doses at time of COVID-19 diagnosis. Sixty-two (25%) subjects expired as a result of COVID-19 disease at the time of analysis. Disease type, treatment status, race/ethnicity, age, gender, date of COVID-19 infection, and COVID-19 vaccination status showed no significant association with mortality. Age older than 70 and NLR >9 were significantly associated with worse OS (p=0.0012 and p=0.0024, respectively). Competing risk analysis further showed that age over 70 and NLR >9 were associated with COVID-related mortality, but not all-cause mortality (p=0.0002 and p=0.002717, respectively). NLR >9 was significantly associated with ICU admission (p=0.0322) and oxygen therapy (p=0.0155), but not hospital admission (p=0.0883), LOS (p=0.8819), or intubation though the latter trended toward significance (p=0.06778). Conclusions: Despite the advent of the COVID-19 vaccine and new therapeutics, infection continues to portend adverse outcomes for many patients with hematologic neoplasms. Worse prognosis for patients over 70 years old persisted in our updated analysis. In addition, across multiple COVID-19 variants during the past two years, high NLR continues to correlate with illness severity including ICU admission and oxygen therapy, and COVID-related mortality among the hematologic neoplasms population. Elevated NLR may represent a useful prognostic to not only identify high-risk hematologic neoplasm patients, but also guide therapeutic interventions, and warrants further investigation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of the COVID-19 Epidemic on Patients with Myeloproliferative Neoplasia: The French Prospective Observational Study Covim

Methods. The aim of the observational COVIM study was to assess the rate of severe COVID-19 infection in subgroups of French patients with MPN during the pandemic. To this avail, it included all consecutive patients from 21 French centers seen in consultation or teleconsultation between May 12, 2020, and may 31, 2021. Information was collected about MPN characteristics and treatment as well as the occurrence, management and outcome of COVID-19 infection and follow-up. The study has been registered on ClinicalTrial.gov (NCT 04416438). Results. A total of 1793 consecutive patients (47% males) was included. The median age at inclusion was 67 yo (IQR 56-75). MPN subtypes were 37% PV, 45% ET and 18% MF. MPN driver mutations were 78% JAK2V617F, 14% CALR and 3% MPL while 5% of the patients had no driver mutation detected. The most frequent MPN treatments were hydroxyurea (HU) or pipobroman (51%), interferon (IFN) (19%), ruxolitinib (12%) and anagrelide (3%) alone or in combination; 15% of the patients did not receive cytoreductive therapy. The majority of patients (80%) received antiplatelet therapy as thrombosis prevention. A total of 295 episodes of COVID-19 infection were identified in 287 patients, documented in 196 cases by SARS-Cov-2 PCR and/or serology and by clinical history or CT scan for the remaining cases. Seven episodes were asymptomatic, 6 associated with thrombosis (4 pulmonary embolisms, 1 splanchnic, 1 stroke) and 27 with acute respiratory failure. Hospitalization was required for 63 patients (only conventional n= 38, intensive care unit n=25). Cytoreductive treatment was maintained in 88% of the cases, discontinued in 12% and decreased in 1 patient respectively. At last follow-up, 20 patients with COVID-19 had died, as a consequence of the infection for 15 and of MPN (acute transformation) in 3 (2 unknown causes). This yields a global COVID-19 related death rate of 5,2% in these 287 patients. Comparison between the MPN population with and without a COVID infection showed that older age and arterial hypertension were significant risk factors. In contrast, treatment with IFN was associated with less severe forms of COVID-19, the median age of these patients being however younger. Conclusions. This large observational and prospective cohort of patients with MPN demonstrated a rate of COVID-19 infection of 16%. Among patients with COVID-19, 22% required hospitalization. These rates indicate that the pandemic did not so dramatically affect this specific population of patients, with an overall COVID-related mortality 0.8%. Two hypotheses could be raised for this low rate of infection. One is that MPNs do not constitute an additional risk factor for SARS-CoV-2 infection. On the other hand, patients with MPN may have applied very strictly preventive measures as they were informed of a potentially higher risk in patients with hematological malignancies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal