Laboratory-confirmed COVID-19 Infection Research Articles

Incidence of and risk factors for suspected COVID-19 reinfection in Kyoto City: a population-based epidemiological study.

To determine the clinical characteristics of and risk factors for suspected reinfection with coronavirus 2019 (COVID-19). This was a retrospective cohort study using population-based notification records of residents in Kyoto City (1.4 M) with laboratory-confirmed COVID-19 infection between 1 March 2020 and 15 April 2022. Reinfection was defined by two or more positive COVID-19 test results ≧ 90 days apart. Demographic characteristics, the route and timing of infection and history of vaccination were analysed to identify risk factors for reinfection. Among the cohort of 107,475 patients, reinfection was identified in 0.66% (n = 709). The age group with the highest reinfection rate was 18-39 years (1.06%), followed by 40-59 years (0.58%). Compared to the medical and nursing professionals, individuals who worked in the construction and manufacturing industry (odds ratio [OR]: 2.86; 95% confidence interval [CI]: 1.66-4.92) and hospitality industry (OR: 2.05; 95% CI: 1.28-.31) were more likely to be reinfected. Symptomatic cases at initial infection, receiving more than 2 doses of vaccination and risk factors for severe infection at initial infection were protective factors against reinfection. Of the reinfected individuals, the reinfection route was unknown in 65%. Reinfection with COVID-19 is uncommon, with suspected reinfections more likely in adults, those with high exposure and unvaccinated individuals; the reinfection route was unknown in the majority of cases. This study confirmed the need to continue with self-protection efforts and to implement vaccination programs in high-risk populations.

Pharmacist-Led Antimicrobial Stewardship and Antibiotic Use in Hospitalized Patients With COVID-19.

During the COVID-19 pandemic, a significant increase in the use of empiric antibiotic therapy has been observed especially in patients hospitalized with COVID-19. Improving antibiotic prescribing is one of the main goals of the antimicrobial stewardship program (ASP). The ASP pharmacists have a scope of practice that authorizes changes in anti-infective therapy. We aimed to describe antibiotic prescribing in patients hospitalized with COVID-19 at Veterans Affairs Southern Nevada Healthcare System with a pharmacist-led ASP and to determine the prevalence of bacterial coinfection in this patient population. We performed a retrospective chart review of patients admitted to the facility from November 1, 2020, to January 31, 2021. A total of 199 patients were admitted to the hospital for laboratory-confirmed COVID-19 infection during the study period and 61 patients (31%) received ≥ 1 antibiotic on hospital admission and 138 (69%) did not receive antibiotics. Forty-seven patients (77%) had antibiotics discontinued by the ASP team within 72 hours of admission. Of the 199 admitted, 6 (3%) had microbiologically confirmed bacterial coinfection. Pseudomonas aeruginosa was the most common organism (3 sputum cultures) followed by Klebsiella oxytoca (2 sputum cultures). Sixteen patients (8%) developed a nosocomial infection during their hospital stay. Up to 31% of patients hospitalized for COVID-19 infection received empiric antibiotic treatment for concern of bacterial coinfection. Pharmacist-led ASP led to early discontinuation of antibiotics in many patients. A thorough clinical workup to determine the risk of bacterial coinfection in patients with COVID-19 is important before starting empiric antibiotic therapy. It is essential to continue promoting the ASP during the COVID-19 pandemic to ensure responsible antibiotic use and prevent antimicrobial resistance.

Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort.

This multicenter retrospective study was carried out in two tertiary care hospitals in Karachi, Pakistan. The study included adult patients admitted with a laboratory-confirmed coronavirus disease 2019 infection, with at least one measured d-dimer within 24h following admission. Discharged patients were compared with the mortality group for survival analysis. The study population of 813 patients had 68.5% males, with a median age of 57.0 years and 14.0 days of illness. The largest d-dimer elevation was between 0.51-2.00mcg/ml (tertile 2) observed in 332 patients (40.8%), followed by 236 patients (29.2%) having values greater than 5.00mcg/ml (tertile 4). Within 45 days of hospital stay, 230 patients (28.3%) died, with the majority in the ICU (53.9%). On multivariable logistic regression between d-dimer and mortality, the unadjusted (Model 1) had a higher d-dimer category (tertile 3 and tertile 4) associated with a higher risk of death (OR: 2.15; 95% CI: 1.02-4.54, P=0.044) and (OR: 4.74; 95% CI: 2.38-9.46, P<0.001). Adjustment for age, sex, and BMI (Model 2) yields only tertile 4 being significant (OR: 4.27; 95% CI: 2.06-8.86, P<0.001). Higher d-dimer levels were independently associated with a high risk of mortality. The added value of d-dimer in risk stratifying patients for mortality was not affected by invasive ventilation, ICU stays, length of hospital stays, or comorbidities.

Prevention of COVID-19 with oral vitamin D supplemental therapy in essential healthcare teams (PROTECT): protocol for a multicentre, triple-blind, randomised, placebo-controlled trial

IntroductionIn the COVID-19 pandemic, healthcare workers (HCWs) were at high risk of infection due to their exposure to COVID infections. HCWs were the backbone of our healthcare response to this...

Health Care–Associated Infections Among Hospitalized Patients With COVID-19, March 2020-March 2022

The reported incidence of many health care-associated infections (HAIs) increased during the COVID-19 pandemic; however, it is unclear whether this is due to increased patient risk or to increased pressure on the health care system. To assess HAI occurrence among patients admitted to hospitals with and without COVID-19. A cross-sectional retrospective analysis of inpatients discharged both with and without laboratory-confirmed COVID-19 infection was conducted. Data were obtained between January 1, 2019, and March 31, 2022, from community hospitals affiliated with a large health care system in the US. COVID-19 infection. Occurrence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridioides difficile infection as reported to the National Healthcare Safety Network. Among nearly 5 million hospitalizations in 182 hospitals between 2020 and 2022, the occurrence of health care-associated infections (HAIs) was high among the 313 200 COVID-19 inpatients (median [SD] age, 57 [27.3] years; 56.0% women). Incidence per 100 000 patient-days showed higher HAIs among those with COVID-19 compared with those without. For CLABSI, the incidence for the full 9 quarters of the study was nearly 4-fold higher among the COVID-19 population than the non-COVID-19 population (25.4 vs 6.9). For CAUTI, the incidence in the COVID-19 population was 2.7-fold higher in the COVID-19 population (16.5 vs 6.1), and for MRSA, 3.0-fold higher (11.2 vs 3.7). Quarterly trends were compared with the same quarter in 2019. The greatest increase in the incidence of HAI in comparison with the same quarter in 2019 for the entire population occurred in quarter 3 of 2020 for CLABSI (11.0 vs 7.3), quarter 4 of 2021 for CAUTI (7.8 vs 6.8), and quarter 3 of 2021 for MRSA (5.2 vs 3.9). When limited to the non-COVID-19 population, the increase in CLABSI incidence vs the 2019 incidence was eliminated, and the quarterly rates of MRSA and CAUTI were lower vs the prepandemic 2019 comparator quarter. In this cross-sectional study of hospitals during the pandemic, HAI occurrence among inpatients without COVID-19 was similar to that during 2019 despite additional pressures for infection control and health care professionals. The findings suggest that patients with COVID-19 may be more susceptible to HAIs and may require additional prevention measures.

Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial.

The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Factors Associated With Nosocomial COVID-19 Infection Among Health Care Workers in an Urban-Setting Malaysia Hospital

This single-center study aimed to explore the factors associated with coronavirus disease (COVID-19) transmission in a hospital. All laboratory-confirmed COVID-19 cases among health care workers (HCWs) in a tertiary hospital in Malaysia were analyzed cross-sectionally from January 25, 2020, to September 10, 2021. A total of 897 HCWs in the hospital had laboratory-confirmed COVID-19 infection during the study period. Around 37.4% of HCWs were suspected to acquire COVID-19 infection from the hospital workplace. Factors associated with lower odds of workplace COVID-19 transmission were being females, ≥30 years old, fully vaccinated, and working as clinical support staff. Involvement in COVID-19 patient care was significantly associated with higher odds (adjusted odds ratio = 3.53) of workplace COVID-19 transmission as compared with non-workplace transmission. Most HCWs in the tertiary hospital acquired COVID-19 infection from non-workplace settings. During a pandemic, it is important to communicate with HCWs about the risk of both workplace and non-workplace COVID-19 transmission and to implement measures to reduce both workplace and non-workplace COVID-19 transmission.

Impact of comorbidities on hospitalised Syrian patients with COVID-19: a retrospective study

ObjectivesThis study aims to compare the clinical manifestations, laboratory findings, outcomes and overall survival time of patients with COVID-19 with and without comorbidities.DesignRetrospective design.SettingThis study was undertaken at two hospitals...

Exposure to psychotropic medications and COVID-19 course after hospital admission: Results from a prospective cohort study

ObjectiveThere is evidence of a bidirectional association between COVID-19 disease and psychiatric disorders. We aimed to assess whether exposure to psychotropic medications prior to hospitalization was associated with mortality or discharge within 30 days after hospital admission. MethodsIn this prospective study, we included all individuals with a laboratory-confirmed COVID-19 infection who were admitted to the Bologna University Hospital between 1st March 2020 and 31st January 2021. We collected data about pre-existing psychiatric disorders and the use of psychotropic medications at the admission. As univariate analyses, we estimated cumulative incidence functions for 30-day mortality and discharge stratifying by exposure to each of the psychotropic medication classes. Finally, we fitted Cox regression models to estimate cause-specific Hazard Ratios (HR) of 30-day mortality and discharge. Results were adjusted for sociodemographic (age, sex), clinically relevant variables (comorbidity, c-reactive protein levels, severity of disease at presentation, history of smoking, study period), and psychiatric variables (psychiatric disorder diagnosis, number of psychotropic medications). ResultsOut of a total of 1238 hospitalized patients, 316 were prescribed psychotropic medications at the time of admission. Among these, 45 (3.6%) were taking a first-generation antipsychotics (FGA) and 66 (5.3%) a second generation antipsychotic (SGA). Exposure to SGA was associated with increased rates of 30-day mortality (HR = 2.01, 95%CI = 1.02–3.97) and exposure to FGA was associated with decreased rates of 30-day discharge (HR = 0.55, 95%CI = 0.33–0.90). ConclusionPatients with COVID-19 infection exposed to FGA and SGA may have worse COVID-19 infection outcomes.

Pulse Oximetry Improves COVID-19 Screening Sensitivity by Detecting Asymptomatic and Afebrile Infections in a Case Control Study.

SARS-CoV-2 has spread quickly despite the implementation of various strategies to limit the spread of the disease. Current screening procedures are unable to detect asymptomatic infections. This study reports the prevalence of abnormal vital signs among incarcerated individuals with asymptomatic infections and proposes an enhanced screening algorithm that may detect asymptomatic infections. A case control study used a retrospective electronic chart review of COVID-19 infected people and matched controls housed in one Federal Bureau of Prisons institution. Data were collected on age, body mass index, medical history, temperature, blood oxygen saturation (SpO2), and symptoms. Fifty-seven laboratory-confirmed COVID-19 infections and 81 confirmed controls were identified. Asymptomatic infections were present in 35/57 people (61%) with a group minimum SpO2 94.4% (standard deviation [SD] 1.4) and a maximum oral temperature of 99.19°F (SD 0.36). An enhanced screening algorithm that uses pulse oximetry yields a sensitivity of 84.2%, 95% confidence interval [72.1-92.5]. Among asymptomatic people, there is a high prevalence of abnormal SpO2 and temperature measurements. A screening algorithm that uses both of these measures can detect asymptomatic infections with a low false positive rate.

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Frequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19. We did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344). We included 148 studies of 362 976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I2=95%). Although infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed. WHO.

Association of Interleukin-32 and Interleukin-34 with Cardiovascular Disease and Short-Term Mortality in COVID-19.

Excess cardiovascular (CV) morbidity and mortality has been observed in patients with COVID-19. Both interleukin-32 (IL-32) and interleukin-34 (IL-34) have been hypothesized to contribute to CV involvement in COVID-19. This prospective, observational study of patients with laboratory-confirmed COVID-19 infection was conducted from 6 June to 22 December 2020 in a tertiary care hospital in Vienna, Austria. IL-32 and IL-34 levels on admission were collected and tested for their association with CV disease and short-term mortality in patients with COVID-19. CV disease was defined by the presence of coronary artery disease, heart failure, stroke or atrial fibrillation and patients were stratified by CV disease burden. A total of 245 eligible patients with COVID-19 were included, of whom 37 (15.1%) reached the primary endpoint of 28-day mortality. Of the total sample, 161 had no CV disease (65.7%), 69 had one or two CV diseases (28.2%) and 15 patients had ≥three CV diseases (6.1%). Median levels of IL-32 and IL-34 at admission were comparable across the three groups of CV disease burden. IL-32 and IL-34 failed to predict mortality upon both univariable and multivariable Cox regression analysis. The two CV disease groups, however, had a significantly higher risk of mortality within 28 days (one or two CV diseases: crude HR 4.085 (95% CI, 1.913-8.725), p < 0.001 and ≥three CV diseases: crude HR 13.173 (95% CI, 5.425-31.985), p < 0.001). This association persisted for those with ≥three CV diseases after adjustment for age, gender and CV risk factors (adjusted HR 3.942 (95% CI, 1.288-12.068), p = 0.016). In our study population of hospitalized patients with COVID-19, IL-32 and IL-34 did not show any associations with CV disease or 28-day mortality in the context of COVID-19. Patients with multiple CV diseases, however, had a significantly increased risk of short-term mortality.

Assessment of the Function of Respiratory Muscles in Patients after COVID-19 Infection and Respiratory Rehabilitation.

The MIP (maximum inspiratory pressure) and MEP (maximum expiratory pressure) are sensitive indicators of respiratory muscle function. The aim of the study was to assess the function of respiratory muscles in patients after COVID-19 infection, before and after hospitalisation at the Pulmonary Rehabilitation Ward. The study was conducted on a group of 19 people with laboratory-confirmed COVID-19 infection, who, in the period from 1 February to 31 May 2021, were hospitalised at the Independent Public Pulmonary Hospital and underwent respiratory rehabilitation in hospital conditions. A statistical analysis was performed using the STATISTICA package, ver. 10. A respiratory pressure meter (RP Check) was used to measure muscle strength. Measurements were performed twice on each patient-before admission and after hospitalisation in the Pulmonary Rehabilitation Ward. We show that conducting pulmonary rehabilitation contributes to the increase in MIP and MEP, which are associated with increased strength of the inspiratory and expiratory muscles. The average value of MIP increased by 11.95 cmH2O and MEP by 26.16 cmH2O. The improvement was visible in both female and male patients. Pulmonary rehabilitation contributes to the improvement of respiratory muscle function indicators among patients after COVID-19 infection. Assessment of the MIP and MEP indices is a simple and quick way to reliably assess the function of the respiratory muscles.

Olfactory Dysfunction during the COVID-19 Era

Objective: There is a strong association between the onset of COVID-19 and olfactory dysfunction (OD) during infection or postinfection as a complication. This study is dedicated to measuring the prevalence of olfactory impairment and its clinical course among patients after COVID-19 infection. Methodology: A cross-sectional study was performed on patients with laboratory-confirmed COVID-19 infection. All participants had completed a validated questionnaire to evaluate the clinical course of OD. Results: Among the 305 participants, 138 reported sudden loss of smell. The mean time between the confirmation of COVID-19 and the onset of OD was 3.59 days. Olfactory impairment, accompanied by other symptoms prior to loss of smell, was reported in 67 participants and as an isolated disorder in 21 participants. Those affected reported nasal obstruction before loss of smell. A total of 138 participants complained of persistence of loss of smell even after the resolution of other symptoms. There is not a statistically significant relationship between the time of loss of smell relative to the confirmation of COVID-19 and the time of resolution of OD. In terms of gender, the prevalence of OD is equal among males and females, and results showed no significant relationship between them. Conclusions: The prevalence of OD is considered a complication among patients with COVID-19. The prognosis for spontaneous recovery from OD is favorable. Due to the lack of an objective measure for olfactory testing, further studies are needed to objectively measure the alteration of the smell.

Association of body mass index with COVID-19-related neurologic sequelae: a retrospective cohort study.

We sought to explore the relationship between body mass index (BMI) and neurologic outcomes following acute COVID-19 infection.We conducted a retrospective electronic medical record-based cohort study enrolling adults with laboratory-confirmed acute COVID-19 infection who presented to 1 of 12 academic and community hospitals in Southwestern Ontario, Canada between April 1, 2020 and July 31, 2021. Primary subjective (anosmia, dysgeusia, and/or headache) and objective (aseptic meningitis, ataxia, delirium, encephalopathy, encephalitis, intracranial hemorrhage, ischemic stroke, and/or seizure) composite neurologic outcomes were assessed, comparing obese and overweight individuals to those with underweight/normal BMI indices, adjusting for baseline characteristics. Secondary outcomes (severity of illness, length of hospital stay, SARS-CoV-2 viral load, mortality) were similarly analyzed. A total of 1437 enrolled individuals, of whom307 (21%), 456 (32%), and 674 (47%) were underweight/normal, overweight, and obese, respectively. On multivariable analysis, there was no association between BMI category and the composite outcome for subjective (odds ratio [OR] 1.17, 95% CI 0.84-1.64, Bonferroni p = 1.00 for obese; OR 1.02, 95% CI 0.70-1.48; Bonferroni p = 1.00 for overweight) and objective (OR 0.74, 95% CI 0.42-1.30, p = 0.29 for obese; OR = 0.80, 95% CI 0.45-1.43, p = 0.45 for overweight) neurologic manifestations. There was no association between BMI category and any secondary outcome measure and no evidence of effect modification by age or sex. This study demonstrates the absence of an association between BMI and neurologic manifestations following acute COVID-19 illness. Prospective studies using standardized data collection tools and direct measures of body fat are warranted to obtain more valid effect estimates.

907. Impact of Antimicrobial Stewardship Prospective Audit and Feedback on Antibiotic Utilization in Hospitalized COVID-19 Patients

Abstract Background Studies have consistently shown a high proportion of antimicrobial usage in hospitalized COVID-19 patients despite low prevalence of bacterial co-infection. Improving antibiotic utilization is one of the main goals of antimicrobial stewardship program (ASP). This study aimed to determine the impact of prospective audit and feedback intervention (PAF) performed by ASP pharmacists on antibiotic utilization in hospitalized COVID-19 patients. Methods A retrospective chart review was conducted at a 90-bed Veteran Affairs hospital. This study included patients who were admitted to the hospital due to laboratory confirmed COVID-19 infection from November 1, 2020 to January 31, 2021. The primary outcome of this study was to evaluate the impact of ASP PAF on avoiding the unnecessary use of antibiotics in hospitalized patients with acute COVID-19. The secondary outcomes included the prevalence of bacterial co-infection in hospitalized COVID-19 patients and the clinical outcomes. Results A total of 199 patients were included in this study. Sixty-one patients (30.7%) had antibiotics started empirically upon hospital admission. Fifty (82%) out of 61 patients had antibiotics discontinued due to the lack of indication for antibiotics during their hospital admission, with 47 (94%) was done by ASP team versus 3 of them (6%) was done by Internal Medicine. Fifty-eight of these patients were followed by ASP team, with 28 patients (48.3%) met SIRS criteria upon admission and 25 (43.1%) with elevated procalcitonin level. The overall readmission rate was 5.8%, with readmission rate of the intervention group to be 6.4% and the non-intervention group to be 5.6% (p = 0.29). The overall mortality rate was 13.1% in hospitalized COVID-19 patients, with 19% reported in the intervention group and 10.1% in the non-intervention group (p = 0.09). Overall, only 5 patients (2.5%) had laboratory-confirmed bacterial co-infection upon admission. Sixteen patients (8%) were found to have microbiologically confirmed nosocomial infection. Conclusion The findings suggested that ASP PAF safely and effectively avoided the unnecessary use of antibiotics in hospitalized patients with acute COVID-19 infection. In addition, low prevalence of microbiologically confirmed bacterial co-infection was observed. Disclosures All Authors: No reported disclosures.

Impact of COVID-19 on perinatal mental health among pregnant mothers infected with COVID-19, during the first wave of the epidemic in Jordan

BackgroundData concerning the impact of Coronavirus disease (COVID-19) infection on the mental health of pregnant women are still limited. The study explored baseline information regarding the impact of COVID-19 on mental health in the perinatal period, among mothers infected with COVID-19, during the first wave of the epidemic in Jordan. The current study aimed to examine the anxiety levels of pregnant women infected with coronavirus over the COVID-19 pandemic. MethodsA cross-sectional study was conducted during the period from March to December 2021, using an online survey that addressed key issues related to the role of COVID-19 infection in developing anxiety among pregnant women using the Edinburgh Postnatal Depression Scale (EPDS). The study population was pregnant women with laboratory-confirmed COVID-19 infection, and who agreed to participate in the study (n = 530). ResultsThe results indicated that one-third of the women had contracted coronavirus infection in each trimester. Most had no pregnancy complications (78.0%), 42.0% had no symptoms of coronavirus infection, 10.0% were hospitalized and 2.0% were admitted to the Intensive Care Unit (ICU). Approximately half declared that they did not receive support from the medical staff, although 71.0% had very good support from their families. Nearly a quarter of respondents stopped smiling while infected, 19% did not want to have any entertainment, and one-third had sleep problems. Moreover, more than half of the pregnant women were feeling anxiety (58.0%) and fear (59.0%). The prevalence of depression and anxiety was 67%. The EPDS scores were statistically significant and associated with being a smoker, method of delivery, getting COVID-19, experiencing COVID-19 symptoms, and being admitted to a hospital or ICU. ConclusionsThis study highlights that healthcare providers and family members should pay more attention to maternal mental health during a pandemic. Fear and anxiety among pregnant women need to be taken into account more during the period of international crises, taking into account the mental health of the pregnant woman when developing health plans, developing health programs, and providing diagnostic and therapeutic management in the maternal care departments.

Accuracy and Prediction of D-Dimers for Pulmonary Embolism in Patients with COVID-19 Infection

Background: D-dimer values in patients with SARS-2 COVID-19 infection are known to be elevated and have been shown to be a predictor for disease severity, mortality, and venous thromboembolism (VTE). Patients presenting with COVID-19 infection may endorse many of the same symptoms as patients with pulmonary emboli (PE) and the associated elevation of the d-dimer as a component of the inflammatory state has led to unanswered questions regarding the diagnostic utility of d-dimer testing. Methods: Computed tomography (CT) scans of the chest with intravenous contrast were searched from a unified data platform between 1/1/2020 and 5/31/2022 across the Mayo Clinic enterprise. Imaging was matched to patients with COVID-19 if it occurred between 10 days before and 30 days after the laboratory confirmed COVID-19 infection. Next, patients were matched to laboratory records of d-dimer testing within 1 day of the imaging. D-dimer testing was performed using the HemosIL D-dimer HS 500 kit on the Instrumentation Laboratory ACL TOP instrument. A negative result is ≤500ng/ml fibrinogen equivalent units (FEU) with a lower limit of detection of 220ng/ml. The primary outcome was acute PE on the imaging study as determined by a validated natural language processing algorithm. Results: A total of 6,747 d-dimer/CT pairs were examined in 5,971 unique patients with COVID-19. Pulmonary emboli were identified on 7.7% of CTA of the pulmonary arteries (n=6,222), 6.6% of CTA-other (n=241), and 3.9% of CTs with IV contrast (n=284). Patients diagnosed with PE were older (median age 67 vs 61, p<0.001), more likely to be male (60.0% vs 53.8%, p=0.03), white (91.3% vs 87.3%, p=0.02), and have dementia, cancer, hyperlipidemia, or ischemic stroke (Table 1). Median d-dimer values in patients found to have PE was 5432ng/ml compared 941ng/ml in those without PE. A prior history of VTE (by ICD-10 codes) was seen more frequently in the group diagnosed with PE (41.4% vs 6.8%, p =0.03). In the overall group of patients with CT imaging of the chest with some form of intravenous contrast, the sensitivity at the standard d-dimer threshold was 99.2% [negative predictive value (NPV) 99.3%], decreased to 98.0% with the age-adjusted cutoff (NPV 99.0%), and decreased further with an increased d-dimer threshold of 1000ng/ml (NPV 98.5%) (Table 2). Due to the strong association seen between patients with a history of VTE and positive findings of PE with COVID-19 infection, we performed additional sensitivity and specificity testing after excluding patients with prior VTE. Within this group and among CTA of the pulmonary arteries only, the sensitivity of the d-dimer was 99.0% using the standard threshold of 500ng/ml, was 98.4% using the age-adjusted d-dimer cutoff, and was 92.1% at an elevated threshold of 1000ng/ml. The NPV of d-dimer was high irrespective of the threshold used: 1000ng/ml (99.2%), age-adjusted cutoff (99.4%) and standard cutoff (99.3%). Conclusion: This study of COVID-19 positive patients more than doubles the number of patients examining the diagnostic utility of d-dimer in PE diagnosis compared to recent meta-analyses and with a consistent d-dimer methodology performed in close proximity to diagnostic imaging. D-dimer was highly predictive of PE with strong and expected NPVs at standard thresholds and using age-adjusted thresholds. We demonstrate that a higher d-dimer threshold of 1000ng/ml would maintain a very high NPV and overall AUC. A fixed and higher d-dimer threshold in patients with COVID-19 infection with possible PE would significantly reduce the need for CT angiography (by 42%). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study

BackgroundA growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation’s incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy.MethodsWe included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients.ResultsWe included 241 patients (median age 62 years [53–70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37–2.49, p < 0.001).ConclusionAgitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge.