PCR-confirmed COVID-19 Infections Research Articles

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

BackgroundCancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan.Patients and MethodsWe did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher’s exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality.ResultsSeventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003).ConclusionPakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.

AB223. SOH21AS253. The misguided catheter: a case report

: Critically ill patients in an intensive care unit (ICU) require venous catheters to maintain and monitor their physiology. Peripherally inserted central catheter (PICC) and central venous catheters (CVC) are placed by experienced physicians using a standardised Seldinger technique in an aseptic environment, they are also associated with a myriad of complications. It is standard practice to confirm the position of catheters and assess for complications on a chest x-ray (CXR) before use. Here we present a case where the position of a previously sited right sided PICC was altered by the insertion of a left internal jugular CVC. A 64-year-old gentleman 3 days post laparoscopic Hartmann’s procedure for perforated diverticular disease developed type 1 respiratory failure requiring ICU admission. His respiratory deterioration resulted from a combination of post-operative ileus, hospital acquired pneumonia, para-pneumonic effusion and PCR confirmed COVID-19 infection (Image1). He required intubation and placement of a left sided CVC. A post-procedural CXR revealed drastic displacement of his right sided PICC, the tip now residing in the left brachiocephalic vein. We hypothesised that while a standardised approach and sequence was followed: the blunted, ‘hook-like’ guidewire was the culprit in the dislodgement of the previously sited PICC. Curiously the PICC spontaneously returned to its optimal position in the SVC without intervention. This case illustrates an unusual and interesting complication of CVC insertion despite standardised technique and safety precautions.

Gender‐based disparities in COVID-19 patient outcomes

Studies reported to date suggest that men with COVID-19 have more severe disease and worse outcomes when compared with women. The explanation for this finding is not entirely clear. The...

Predicting pulmonary embolism in patients infected with COVID-19 based on D-dimer levels and days between diagnosis of the infection and D-dimer determination.

Ruling out pulmonary embolism (PE) can be challenging in a situation of elevated D-dimer values such as in a case of COVID-19 infection. Our objective was to evaluate the difference in D-dimer values of subjects infected with COVID-19 in those with PE and those without and to analyze the predictive value of D-dimer for PE in these subjects based on the day of D-dimer determination. This was an observational, retrospective study, conducted at a tertiary hospital. All subjects with PCR-confirmed COVID-19 infection requiring hospital admission at our institution between the months of March and April 2020 were included in the study. We compared D-dimer levels in subjects who went on to develop a PE and those who did not. We then created a model to predict the subsequent development of a PE with the current D-dimer levels of the subject. D-dimer levels changed over time from COVID-19 diagnosis, but were always higher in subjects who went on to develop a PE. Regarding the predictive model created, the area under the curve of the ROC analyses of the cross-validation predictions was 0.72. The risk of pulmonary embolism for the same D-dimer levels varied depending on the number of days elapsed since COVID-19 diagnosis and D-dimer determination. To conclude, D-dimer levels were elevated in subjects with a COVID-19 infection, especially in those with PE. D-dimer levels increased during the first 10 days after the diagnosis of the infection and can be used to predict the risk of PE in COVID-19 subjects.

P09.44 Outcomes of Covid-19 Infection in Lung Cancer Patients: Experience from a Large Tertiary Care Cancer Center

SARS-COV-2 or Covid-19 has become a major contributor of significant morbidity and mortality around the world. Patients with cancer constitute a high risk group. Furthermore, presence of lung cancer, advanced stage and active immune-suppressive treatment has been associated with poor outcomes. We sought to evaluate the outcomes of lung cancer patients with PCR confirmed Covid-19 infection at a large tertiary care referral cancer center.

Analysis of Tongue Color-Associated Features among Patients with PCR-Confirmed COVID-19 Infection in Ukraine

Objective: To evaluate and systematize tongue color-related manifestations among patients with PCR-confirmed COVID-19 infection. Material and Methods: This retrospective study included analysis of tongue images obtained from patients with PCR-confirmed COVID-19 infection. Evaluation of coronavirus disease severity (mild, moderate, severe, critical) was provided, considering clinical symptomatology and results of laboratorial and instrumental diagnostic methods. Each picture was analyzed considering the parameters of color of the tongue and color of the tongue plaque by two dental specialists. Cochran-Armitage test for trend was used to evaluate associations between the tongue color and tongue plaque color, and coronavirus disease severity. Results: The most prevalent tongue colors were pale pink, red and dark red (burgundy color). A total of 64.29% of patients with mild disease demonstrated pale pink color of the tongue. Patients with moderate coronavirus disease were characterized with the adverse trend: 62.35% of them presented with red-colored tongue, while in 37.64% of cases, the tongue was pale pink. Severe COVID-19 patients, almost in 90% of the cases, had either red or burgundy color of the tongue. Conclusion: SARS-COV-2 infection is not manifested by tongue-targeted or tongue-specific signs and features; however, coronavirus disease itself provokes changes within the tongue color and tongue plaque color similar to those registered during other internal pathologies.

Early extrapulmonary prognostic features in chest computed tomography in COVID-19 pneumonia: Bone mineral density is a relevant predictor for the clinical outcome - A multicenter feasibility study.

BackgroundBesides throat-nose swab polymerase chain reaction (PCR), unenhanced chest computed tomography (CT) is a recommended diagnostic tool for early detection and quantification of pulmonary changes in COVID-19 pneumonia caused by the novel corona virus. Demographic factors, especially age and comorbidities, are major determinants of the outcome in COVID-19 infection. This study examines the extra pulmonary parameter of bone mineral density (BMD) from an initial chest computed tomography as an associated variable of pre-existing comorbidities like chronic lung disease or demographic factors to determine the later patient's outcome, in particular whether treatment on an intensive care unit (ICU) was necessary in infected patients.MethodsWe analyzed 58 PCR-confirmed COVID-19 infections that received an unenhanced CT at admission at one of the included centers. In addition to the extent of pulmonary involvement, we performed a phantomless assessment of bone mineral density of thoracic vertebra 9–12.ResultsIn a univariate regression analysis BMD was found to be a significant predictor of the necessity for intensive care unit treatment of COVID-19 patients. In the subgroup requiring intensive care treatment within the follow-up period a significantly lower BMD was found.In a multivariate logistic regression model considering gender, age and CT measurements of bone mineral density, BMD was eliminated from the regression analysis as a significant predictor.ConclusionPhantomless assessed BMD provides prognostic information on the necessity for ICU treatment in course of COVID-19 pneumonia. We recommend using the measurement of BMD in an initial CT image to facilitate a potentially better prediction of severe patient outcomes within the 22 days after an initial CT scan.Consequently, in the present sample, additional bone density analysis did not result in a prognostic advantage over simply considering age. Significantly larger patient cohorts with a more homogenous patient age should be performed in the future to illustrate potential effects.Clinical relevanceWhile clinical capacities such as ICU beds and ventilators are more crucial than ever to help manage the current global corona pandemic, this work introduces an approach that can be used in a cost-effective way to help determine the amount of these rare clinical resources required in the near future.

Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study

BackgroundCOVID-19 has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer with either a PCR-confirmed COVID-19 infection or a probable diagnosis according to chest CT scan.MethodsWe conducted a case control study in a referral hospital on confirmed COVID-19 adult patients with and without a history of cancer from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases including ischemic heart disease (IHD), diabetes mellitus (DM), and hypertension (HTN). Demographic features, clinical data, comorbidities, symptoms, vital signs, laboratory findings, and chest computed tomography (CT) images have been extracted from patients’ medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes.ResultsFifty-three confirmed COVID-19 patients with history of cancer were recruited and compared with 106 non-cancerous COVID-19 patients as controls. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea and fever were the most common presenting symptoms in our population with 57.86 and 52.83% respectively. Moreover, dyspnea was significantly associated with an increased rate of mortality in the cancer subgroup (p = 0.013). Twenty-six patients (49%) survived among the cancer group while 89 patients (84%) survived in control (p = 0.000). in cancer group, patients with hematologic cancer had 63% mortality while patients with solid tumors had 37%. multivariate analysis model for survival prediction showed that history of cancer, impaired consciousness level, tachypnea, tachycardia, leukocytosis and thrombocytopenia were associated with an increased risk of death.ConclusionIn our study, cancer increased the mortality rate and hospital stay of COVID-19 patients and this effect remains significant after adjustment of confounders. Compared to solid tumors, hematologic malignancies have been associated with worse consequences and higher mortality rate. Clinical and para-clinical indicators were not appropriate to predict death in these patients.

S1476 COVID-19-Associated Atypical Acute Pancreatitis!!

INTRODUCTION: The clinical presentation of pancreatitis in the course of novel coronavirus infection (COVID-19) is not well understood. The etiology may be a direct cytopathic effect mediated by local SARS-CoV-2 replication versus an injury caused by the cytokine release induced by the infection. We present 2 cases of COVID-19-associated pancreatitis. Both had severe multi-organ failure requiring ventilator and dialysis support. CASE DESCRIPTION/METHODS: Case 1: 57 year old man with diabetes mellitus type 2 and hypertension presented with a PCR-confirmed COVID-19 infection. Leukocytes were 14.6 K/uL and C-reactive protein was 89⋅7 g/L, AST was 98 IU/L, ALT was135 IU/L, and INR was 1⋅3. Serum amylase and lipase levels were 398 IU/L and 2726 IU/L, respectively. Triglyceride level was179 mg/dL. He had no alcohol use and viral hepatitis panel and urine drug scree were all negative. After extubation, he ate well with minimal symptoms despite lipase levels peaking at 3,369 IU/L on day 11 and declined only to peak again on day 20 to 4,620 IU/L. C-reactive protein remained under 10 g/L during the first peak and began to climb only with the second peak. He was discharged on day 23 with lipase declining to 2,856 IU/L while asymptomatic and off dialysis. Case 2: 70 year old man was admitted with PCR confirmed COVID19 systemic infection requiring mechanical ventilation. Two weeks after extubation, he developed mild abdominal pain and anorexia that promptly resolved but his lipase level was found to be 1,874 IU/L. This continued to fluctuate mildly down to 1,247 IU/L over 10 days despite lack of symptoms. DISCUSSION: Viral pancreatitis has been reported with Coxsackie virus, CMV, HIV, HSV, mumps, VZV, among others. We describe pancreatitis associated with COVID-19 that may be related to direct viral invasion. Both persons had conspicuously absent symptoms despite substantial elevations of lipase levels. In both, the amylase paralleled the lipase levels trending while but there was no correlation between these enzyme levels and those of C-reactive protein making cytokine release less probable as an etiology.

Clinical course and prognostic factors of COVID-19 infection in an elderly hospitalized population

IntroductionOlder subjects have a higher risk of COVID-19 infection and a greater mortality. However, there is a lack of studies evaluating the characteristics of this infection at advanced age. Patients and methodsWe studied 404 patients ≥ 75 years (mean age 85.2 ± 5.3 years, 55 % males), with PCR-confirmed COVID-19 infection, attended in two hospitals in Madrid (Spain). Patients were followed-up until they were discharged from the hospital or until death. ResultsSymptoms started 2–7 days before admission, and consisted of fever (64 %), cough (59 %), and dyspnea (57 %). A total of 145 patients (35.9 %) died a median of 9 days after hospitalization. In logistic regression analysis, predictive factors of death were age (OR 1.086; 1.015–1.161 per year, p = 0.016), heart rate (1.040; 1.018–1.061 per beat, p < 0.0001), a decline in renal function during hospitalization (OR 7.270; 2.586–20.441, p < 0.0001) and worsening dyspnea during hospitalization (OR 73.616; 30.642–176.857, p < 0.0001). Factors predicting survival were a female sex (OR 0.271; 0.128–0.575, p = 0.001), previous treatment with RAAS inhibitors (OR 0.459; 0.222–0.949, p = 0.036), a higher oxygen saturation at admission (OR 0.901; 0.842–0.963 per percentage point increase, p = 0.002), and a greater platelet count (OR 0.995; 0.991–0.999 per 106/L, p = 0.025). ConclusionElderly patients with COVID-19 infection have a similar clinical course to younger individuals. Previous treatment with RAAS inhibitors, and demographic, clinical and laboratory data influence prognosis.

COVID-19 presenting as stroke

ObjectiveAcute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. MethodsWe searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. ResultsWe identified four patients who presented with radiographic confirmation of acute stroke and PCR-confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. ConclusionsTimely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should don appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection.