Hospitalisation For COVID-19 In People Research Articles

Onset of Mental Disorders Following Hospitalization for COVID-19: A 6-Month Follow-Up Study

(1) Background: The present study aimed to investigate the onset of mental disorders in the six months following hospitalization for COVID-19 in people without a previous psychiatric history. (2) Methods: This was a longitudinal study carried out among adults who had been hospitalized due to COVID-19 infection. Six months after discharge, a series of questionnaires were administered (the World Health Organization Well-being Index (WHO-5), the Patient Health Questionnaire-9, the General Anxiety Disorder Questionnaire-7, and the Drug Abuse Screen Test, among others). Based on these scores, a compound Yes/No variable that indicated the presence of common mental disorders was calculated. A multivariate logistic regression was built to explore the factors associated with the presence of common mental disorders. (3) Results: One hundred and sixty-eight patients (57.34%) developed a common mental disorder in the 6 months following hospital discharge after COVID-19 infection. Three variables were independently associated with the presence of common mental disorders after hospitalization for COVID-19, and the WHO-5 duration of hospitalization), and severity of illness. (4) Conclusions: Among people with no previous psychiatric history, we observed a high incidence of mental disorders after COVID-19 hospitalization. A moderate (1–2 weeks) duration of hospitalization may pose a higher risk of post-COVID-19 onset of a mental health condition than longer or shorter durations of medical hospitalization. Further research is needed to better understand the mechanisms underlying the psychopathological consequences of COVID-19 and their predictors.

Protecting the vulnerable: SARS-CoV-2 vaccination in immunosuppressed patients with interstitial lung disease

Protecting the vulnerable: SARS-CoV-2 vaccination in immunosuppressed patients with interstitial lung disease

Defining COVID-19-associated hyperinflammatory syndrome in specific populations.

Defining COVID-19-associated hyperinflammatory syndrome in specific populations.

The role of antirheumatics in patients with COVID-19

The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immunosuppressive drugs, which are widely used in rheumatological practice, have been proposed as treatments for patients with moderate or severe COVID-19. In this Review, we provide an overview of what is currently known about the efficacy and safety of antirheumatic therapies for the treatment of patients with COVID-19. Dexamethasone has been shown to reduce COVID-19 related mortality, interleukin-6 inhibitors to reduce risk of cardiovascular or respiratory organ support, and baricitinib to reduce time to recovery in hospitalised patients requiring oxygen support. Further studies are needed to identify whether there is any role for glucocorticoids in patients with less severe COVID-19. Although evidence on the use of other antirheumatic drugs has suggested some benefits, results from adequately powered clinical trials are urgently needed. The heterogeneity in dosing and the absence of uniform inclusion criteria and defined stage of disease studied in many clinical trials have affected the conclusions and comparability of trial results. However, after the success of dexamethasone in proving the anti-inflammatory hypothesis, the next 12 months will undoubtedly bring further clarity about the clinical utility and optimal dose and timing of other anti-rheumatic drugs in the management of COVID-19.

Changing COVID-19 outcomes in patients with rheumatic disease-are we really getting better at this?

Changing COVID-19 outcomes in patients with rheumatic disease-are we really getting better at this?

Divergent effects of acute versus chronic glucocorticoids in COVID-19.

Divergent effects of acute versus chronic glucocorticoids in COVID-19.

Characteristics and outcomes of COVID-19 in patients with autoimmune bullous diseases: A retrospective cohort study

Characteristics and outcomes of COVID-19 in patients with autoimmune bullous diseases: A retrospective cohort study

Effect of anti–tumor necrosis factor therapy on the risk of respiratory tract infections and related symptoms in patients with psoriasis—A meta-estimate of pivotal phase 3 trials relevant to decision making during the COVID-19 pandemic

To the Editor: The COVID-19 pandemic turned attention to how immune-targeted therapies affect respiratory tract infections (RTIs). We reported meta-estimates of the risk of RTI associated with biologics that target interleukin (IL) 17 (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.04-2.33)1Wan M.T. Shin D.B. Winthrop K.L. Gelfand J.M. The risk of respiratory tract infections and symptoms in psoriasis patients treated with IL-17-pathway inhibiting biologics: a meta-estimate of pivotal trials relevant to decision-making during the COVID-19 pandemic.J Am Acad Dermatol. 2020; 83: 677-679Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar and IL-23 (OR, 1.24; 95% CI, 0.98-1.56)2Syed M.N. Shin D.B. Wan M.T. Winthrop K.L. Gelfand J.M. The risk of respiratory tract infections in psoriasis patients treated with IL-23-pathway inhibiting biologics: a meta-estimate of pivotal trials relevant to decision-making during the COVID-19 pandemic.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.06.1014Abstract Full Text Full Text PDF Scopus (12) Google Scholar based on publicly available pivotal trial data. We now evaluate tumor necrosis factor inhibitors (TNFi) using a similar approach. TNF-α plays an important role in defense against viral infection, possibly through lysis of virus-infected cells and/or induction of an antiviral state in normal cells. In contrast, some models suggest that TNF may mediate significant tissue damage in RTIs.3Feldmann M. Maini R.N. Woody J.N. et al.Trials of anti-tumour necrosis factor therapy for COVID-19 are urgently needed.Lancet. 2020; 395: 1407-1409Abstract Full Text Full Text PDF PubMed Scopus (376) Google Scholar Despite extensive studies of TNF inhibitors over the past 2 decades, there are limited data on the effect of these biologics on the risk of RTIs. To rapidly assess the risk of RTI associated with TNFi, terms consistent with RTI were evaluated from data reported in publications of US Food and Drug Administration–approved, phase 3, placebo-controlled clinical trials listed in the prescribing information for adalimumab, infliximab, etanercept, and certolizumab. This data source was used because most trials were conducted before the initiation of clinicaltrials.gov. RTI events were summed and divided by the total number of individuals at risk in each study and compared to the placebo group by a meta-estimate. A significant increased risk of RTI was not observed in TNFi compared to placebo (OR, 1.08; 95% CI, 0.84-1.38; P = .55) (Fig 1). The events reported in our primary analysis used varying drug dosages. In our secondary analysis, we limited the exposure to only US Food and Drug Administration–approved dosing regimens and found similar results (OR, 1.06; 95% CI, 0.81-1.40; P = .66) (Fig 2). Sensitivity analyses were conducted, combining drugs with similar mechanisms of action and structure (ie, adalimumab and infliximab), which yielded similar results (OR, 1.14; 95% CI, 0.86-1.51; P = .36). We also evaluated certolizumab individually because its clinical trials occurred more recently, but the results were similar (OR, 1.18; 95% CI, 0.50-2.79; P = .70).Fig 2Meta-estimate of respiratory tract infections from publications of US Food and Drug Administration–approved dosages of phase 3 pivotal trials adverse events tables (includes “upper respiratory tract infections,” “nasopharyngitis,” “rhinitis,” “rhinorrhea,” “pneumonia,” “bronchitis,” “sinusitis,” “pharyngitis,” “flu syndrome,” and “cough”). CI, Confidence interval; REML, restricted maximum likelihood.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In conclusion, we found no evidence of an increased risk of RTI in pivotal trials of TNFi in psoriasis. Caution is advised in comparing these results to our prior analyses of biologics targeting IL-17 and IL-23 because of statistical imprecision, different populations, and time periods studied; therefore, one should not necessarily conclude that TNFi are more or less safe than biologics targeting IL-17 and IL-23 with respect to risk of RTI and COVID-19. Furthermore, we could not estimate viral RTI specifically because objective confirmatory testing was not reported. Nevertheless, the findings are reassuring, and recent data suggest that TNFi are associated with a 60% reduction in the risk of hospitalization for patients with rheumatism infected with severe acute respiratory syndrome coronavirus 2, possibly related to a TNFi-suppressing cytokine storm.4Gianfrancesco M. Hyrich K.L. Al-Adely S. et al.Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry.Ann Rheum Dis. 2020; 79: 859-866Crossref PubMed Scopus (719) Google Scholar However, these data are derived from spontaneous case reports and should be interpreted with caution. TNFi are currently being tested in clinical trials of patients with COVID-19.5Lythgoe M.P. Middleton P. Ongoing clinical trials for the management of the COVID-19 pandemic.Trends Pharmacol Sci. 2020; 41: 363-382Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar Trial data and large-scale, prospective cohort studies are urgently needed to better define the impact of TNFi on infections with severe acute respiratory syndrome coronavirus 2 and outcomes from COVID-19 illness.

B-cell depletion with rituximab in the COVID-19 pandemic: where do we stand?

B-cell depletion with rituximab in the COVID-19 pandemic: where do we stand?

SARS-CoV-2 Positive Hospitalized Cancer Patients during the Italian Outbreak: The Cohort Study in Reggio Emilia.

In the coronavirus disease (COVID-19) pandemic, cancer patients could be a high-risk group due to their immunosuppressed status; therefore, data on cancer patients must be available in order to consider the most adequate strategy of care. We carried out a cohort study on the risk of hospitalization for COVID-19, oncological history, and outcomes on COVID-19 infected cancer patients admitted to the Hospital of Reggio Emilia. Between 1 February and 3 April 2020, a total of 1226 COVID-19 infected patients were hospitalized. The number of cancer patients hospitalized with COVID-19 infection was 138 (11.3%). The median age was slightly higher in patients with cancers than in those without (76.5 vs. 73.0). The risk of intensive care unit (ICU) admission (10.1% vs. 6.7%; RR 1.23, 95% Confidence Interval (CI) 0.63–2.41) and risk of death (34.1% vs. 26.0%; RR 1.07, 95% CI 0.61–1.71) were similar in cancer and non-cancer patients. In the cancer patients group, 89/138 (64.5%) patients had a time interval >5 years between the diagnosis of the tumor and hospitalization. Male gender, age > 74 years, metastatic disease, bladder cancer, and cardiovascular disease were associated with mortality risk in cancer patients. In the Reggio Emilia Study, the incidence of hospitalization for COVID-19 in people with previous diagnosis of cancer is similar to that in the general population (standardized incidence ratio 98; 95% CI 73–131), and it does not appear to have a more severe course or a higher mortality rate than patients without cancer. The phase II of the COVID-19 epidemic in cancer patients needs a strategy to reduce the likelihood of infection and identify the vulnerable population, both in patients with active antineoplastic treatment and in survivors with frequently different coexisting medical conditions.

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

ObjectivesCOVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.MethodsCase series...