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INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle
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Background: Based on recent publications suggesting an association between COVID-19 and vascular Inflammation. Objectives: Our aim was to explore new associations between coronavirus infections and vasculitis utilizing semantic mining of PubMed results. Methods: The following literature search string: (vasculitis OR vascular inflammation OR vascular damage) AND (coronavirus OR SARS virus OR MERS-CoV OR Covid-19) was used to retrieve abstracts from the whole PubMed database, using Semantic MEDLINE 2. on 6/7/2020. This application represents a network of semantic predications (triples of the form subject-predicate-object, e.g. COVID-19 causes Disease) on a knowledge graph. The system allows for choosing the maximum number of nodes represented, the central topic, and the length of the network. For our network we chose to display all relations, COVID-19 (31 edges) as the central term, 3 lengths, and selecting the most informative nodes. Automatic summarization eliminated the less informative predications. Results: The search string retrieved 152 citations from PubMed and identified 1,028 predications. The network (Figure 1), displayed using COVID-19 as the central term, consisted of 72 nodes and 140 edges. The 5 most connected nodes were 'Patients: 19 nodes', COVID-19: 13', 'Inflammation: 13', 'Lung: 11', and 'Disease: 11'. Multiple links have been found between coronavirus and vasculitis. Animal coronaviruses, including the one causing feline infectious peritonitis (FIP), the murine coronavirus mouse hepatitis virus (MHV), the SARS-CoV in transgenic mice and coronavirus in ferrets, are known to cause vasculitis in animals. It is known that coronaviruses that infect animals can evolve and become new human coronaviruses. SARS produces inflammation in blood vessels. In 2005, a link between the coronavirus HCoV-NL63 or New Haven Coronavirus (HCoV-NH) and KD was reported, although later studies concluded that HCoV-NH did not play a dominant role in the etiology or pathogenesis of KD. In 2014, serological testing suggested the possible involvement of CoV-229E in the development of KD. There has also been a report of KD patients being infected by coronavirus OC43/HKU1.COVID-19 may infect the vessels and trigger inflammatory reactions like those of vasculitis, including vasculitis-like cutaneous lesions. COVID-19 patients develop thrombosis, and increased risk of thrombosis is also present in primary vasculitic syndromes. Children, many of whom tested positive for COVID-19 antibodies, developed Multisystem Inflammatory Syndrome in Children (MIS-C), an inflammatory condition similar to Kawasaki Disease (KD). Conclusion: Knowledge integration and discovery methods are an efficient and powerful way of retrieving and analyzing relevan information from multiple papers. Their main advantages are finding relations among biomedical concepts, generating new hypotheses, and opening them to literature-based discovery. SARS-CoV-2 may cause vasculitis or vasculitis-like syndromes. The KD-like syndrome reported mainly in children with COVID-19 revives the previous suspicion of coronavirus as a possible triggering agent of KD and the decades-old hypothesis of infection involvement in the pathogenesis of vasculitis.