Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study.

BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15-37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guidelines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020-September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22-29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02-1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00-1.04]), diabetes (yes vs no, aOR 1.73 [1.46-2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19-4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51-208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66-0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 4 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.

Design of the SPIROMICS Study of Early COPD Progression: SOURCE Study.

The biological mechanisms leading some tobacco-exposed individuals to develop early-stage chronic obstructive pulmonary disease (COPD) are poorly understood. This knowledge gap hampers development of disease-modifying agents for this prevalent condition. Accord-ingly, with National Heart, Lung and Blood Institute support, we initiated the SPIROMICS Study of Early COPD Progression (SOURCE), a multicenter observational cohort study of younger individuals with a history of cigarette smoking and thus at-risk for, or with, early-stage COPD. Our overall objectives are to identify those who will develop COPD earlier in life, characterize them thoroughly, and by contrasting them to those not developing COPD, define mechanisms of disease progression. SOURCE utilizes the established SPIROMICS clinical network. Its goal is to enroll n=649 participants, ages 30-55 years, all races/ethnicities, with ≥10 pack-years cigarette smoking, in either Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups 0-2 or with Preserved Ratio Impaired Spirometry (PRISm); and an additional n=40 never-smoker controls. Participants undergo baseline and three-year follow-up visits, each including high-resolution computed tomography; respiratory oscillometry and spirometry (pre- and post-bronchodilator administration), exhaled breath condensate (baseline only); and extensive biospecimen collection, including sputum induction. Symptoms, interim healthcare utilization, and exacerbations are captured every six months via follow-up phone calls. An embedded bronchoscopy sub-study involving n=100 participants (including all never-smokers) will allow collection of lower airway samples for genetic, epigenetic, genomic, immunological, microbiome, mucin analyses, and basal cell culture. SOURCE should provide novel insights into the natural history of lung disease in younger individuals with a smoking history, and its biological basis.

2-[1-(2-Hy-droxy-4-meth-oxy-phen-yl)ethyl-idene]-N-methyl-hydrazinecarbo-thio-amide.

In the title compound, C11H15N3O2S, the dihedral angle between the mean planes of the benzene ring and hydrazinecarbo-thio-amide group is 9.2 (1)°. An intra-molecular O-H⋯N hydrogen bond is observed, serving to maintain an approximately planar conformation for the molecule. In the crystal, inversion dimers linked by C-H⋯O inter-actions occur. Further C-H⋯O contacts link dimers into (010) chains.

Crystal structure of 2-[2-(hy-droxy-imino)-1-phenyl-propyl-idene]-N-phen-ylhydrazinecarbo-thio-amide.

In the title compound, C16H16N4OS, an intra-molecular C-H⋯S hydrogen bond is observed. With the exception of the phenyl ring of the phenyl-propyl-idene unit, the remainder of the mol-ecule has an almost planar skeleton with an r.m.s. deviation of 0.121 (5) Šfrom the plane through the remaining 16 atoms. In the crystal O-H⋯N hydrogen bonds are observed between the terminal hy-droxy-imino groups, forming inverson dimers with R 2 (2)(6) graph-set motifs. Additional C-H⋯N contacts stack the dimers along [100]. While no π-π inter-actions are present, weak C-H⋯O and O-H⋯Cg inter-actions are also observed and help stabilize the crystal packing.

The crystal structure of 1-(2-hydroxy-5-meth-oxy-phen-yl)ethanone 4,4-di-methyl-thio-semicarbazone.

The asymmetric unit of the title compound, C12H17N3O2S, contains two independent mol-ecules, A and B. Both mol-ecules are nearly planar with the dihedral angle between the mean planes of the thio-amide group and benzene ring being 7.5 (1)° in A and 4.3 (2)° in B. In each mol-ecule, the hy-droxy group participates in intra-molecular O-H⋯N hydrogen bonding, while the amino H atom is not involved in hydrogen bonding because of the steric hinderence caused by two neighboring methyl groups. In the crystal, the individual molecules are linked by weak C-H⋯O hydrogen bonds, forming A-A and B-B inversion dimers. The dimers are linked via C-H⋯π inter-actions which help stabilize the packing.