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1.
Signal Transduct Target Ther ; 7, 2022.
Artigo em Inglês | PubMed Central | ID: covidwho-2160188

RESUMO

The high effectiveness of the third dose of BNT162b2 in healthy adolescents against Omicron BA.1 has been reported in some studies, but immune responses conferring this protection are not yet elucidated. In this analysis, our study (NCT04800133) aims to evaluate the humoral and cellular responses against wild-type and Omicron (BA.1, BA.2 and/or BA.5) SARS-CoV-2 before and after a third dose of BNT162b2 in healthy adolescents. At 5 months after 2 doses, S IgG, S IgG Fc receptor-binding, and neutralising antibody responses waned significantly, yet neutralising antibodies remained detectable in all tested adolescents and S IgG avidity increased from 1 month after 2 doses. The antibody responses and S-specific IFN-γ+ and IL-2+ CD8+ T cell responses were significantly boosted in healthy adolescents after a homologous third dose of BNT162b2. Compared to adults, humoral responses for the third dose were non-inferior or superior in adolescents. The S-specific IFN-γ+ and IL-2+ CD4+ and CD8+ T cell responses in adolescents and adults were comparable or non-inferior. Interestingly, after 3 doses, adolescents had preserved S IgG, S IgG avidity, S IgG FcγRIIIa-binding, against Omicron BA.2, as well as preserved cellular responses against BA.1 S and moderate neutralisation levels against BA.1, BA.2 and BA.5. Sera from 100 and 96% of adolescents tested at 1 and 5 months after two doses could also neutralise BA.1. Our study found high antibody and T cell responses, including potent cross-variant reactivity, after three doses of BNT162b2 vaccine in adolescents in its current formulation, suggesting that current vaccines can be protective against symptomatic Omicron disease.

2.
Undersea & Hyperbaric Medicine ; 49(3):295-305, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2146075

RESUMO

Introduction: Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval.

3.
Journal of Medical Imaging and Radiation Oncology ; 66(Supplement 1):157, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2136563

RESUMO

Purpose: The COVID-19 pandemic has impacted the health industry including cancer care in unprecedented ways, leading to rapid adoption of strategies in radiation oncology departments to ensure safe delivery of treatments without compromising the quality of care (1,2). We aimed to evaluate the impact of the COVID-19 strategies on patients and staff across Queensland, New South Wales, and Victoria. Methods and Materials: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies related to key areas including patient care, quality assurance (QA), staff education, research. Additionally, the survey examined the influence of flexible working arrangements on patient care and staff wellbeing. Result(s): 210 responses from seven institutions collected between November 2020 to April 2021, were analysed. Virtual solutions were adopted (79%, 165/201) for QA activities. Due to disruption in education programmes, respondents (38% 79/210) reported negative impact on junior staff. All institutions recommenced trials/research activities during the survey period. Strong support for ongoing incorporation of virtual platforms for QA (50.8%, 60/118), research (67.4%, 58/86) and education (81.4%, 171/210) purposes. Despite existing stress and burnout support (38.6% 81/210), burnout was captured in 44.8% (94/210) of the respondents. Continued flexible work through remote access was preferred by 86% (131/153). Interestingly, 38% (15/39) of the radiation oncologists reported improved work-life balance during the pandemic following the introduction of remote working (73%, 11/15). Conclusion(s): Despite the pandemic challenges, radiation oncology departments continued to deliver quality patient care. Our study confirms an ongoing challenge within the community related to burnout but also a suggests a potential solution with improved productivity and work-life balance with the introduction of remote working and virtual platforms.

4.
Journal of Sleep Research Conference: 26th Conference of the European Sleep Research Society Athens Greece ; 31(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2114139

RESUMO

Objectives: We explored in this study whether insomnia, viral anxiety, reassurance-seeking behavior, and preoccupation with COVID-19 are related among the general population. As well, we explored the possibility that insomnia may mediate the association between COVID-19 viral anxiety and preoccupation. Method(s): During November 9-15, 2021, 400 participants voluntarily completed this survey, and participants' age, sex, living location, and marital status were collected. Responses to questions about COVID- 19, were also gathered, and their symptoms were rated using the Obsession with COVID-19 scale (OCS), Coronavirus Reassurance- Seeking Behaviors Scale (CRBS), Fear of COVID-19 scale (FCV-19S), and Insomnia Severity Index (ISI). The mean and standard deviation of participants' demographic characteristics and rating scale scores are summarized. Two-tailed significance was determined by a p value of 0.05. Correlation analysis was performed using Pearson's correlation coefficient. We used linear regression to examine which variables can predict obsession with COVID-19. The bootstrap method with 2,000 resamples was implemented to determine whether insomnia mediates the influence of viral anxiety or reassurance seeking behavior on preoccupation with COVID-19. Result(s): A total of 400 participants were analyzed in this study. Preoccupation with COVID-19 was predicted by young age (beta = -0.08, p = 0.012), CRBS (beta = 0.52, p < 0.001), FCV-19S (beta = 0.30, p < 0.001), and ISI (beta = 0.07, p = 0.029) (adjusted R2 = 0.62, F = 163.6, p < 0.001). Mediation analysis showed that insomnia partially mediates the influence of reassurance seeking behavior and viral anxiety on preoccupation with COVID-19. Conclusion(s): Sleep disturbances can contribute to a vicious cycle of hypochondriacal preoccupation with COVID-19. In order to reduce an individual's viral anxiety, insomnia symptoms must be addressed.

5.
Sleep Medicine Research ; 13(2):68-74, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2091117

RESUMO

Background and Objective We explored in this study whether insomnia, viral anxiety, reassurance-seeking behavior, and preoccupation with coronavirus disease (COVID-19) are related among the general population. As well, we explored the possibility that insomnia may mediate the association between COVID-19 viral anxiety and preoccupation. Methods During November 9-15, 2021, 400 participants voluntarily completed this survey, and participants' age, sex, living location, and marital status were collected. Responses to questions about COVID-19 were also gathered, and their symptoms were rated using the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Fear of COVID-19 scale (FCV-19S), and Insomnia Severity Index (ISI). Results Preoccupation with COVID-19 was predicted by young age (beta = -0.08, p = 0.012), CRBS (beta = 0.52, p < 0.001), FCV-19S (beta = 0.30, p < 0.001), and ISI (beta = 0.07, p = 0.029) (adjusted R2 = 0.62, F = 163.6, p < 0.001). Mediation analysis showed that insomnia partially mediates the influence of reassurance seeking behavior and viral anxiety on preoccupation with COVID-19. Conclusions Sleep disturbances can contribute to a vicious cycle of hypochondriacal preoccupation with COVID-19. In order to reduce an individual's viral anxiety, insomnia symptoms must be addressed. Copyright © 2022 The Korean Society of Sleep Medicine

6.
American Journal of Transplantation ; 22(Supplement 3):404, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2063367

RESUMO

Purpose: The OPTN DTAC, a multidisciplinary group, evaluates potential donor derived transmission events (PDDTE) to assess the likelihood of disease transmission. Method(s): Retrospective study of PDDTE cases reported to the OPTN between 01/20 and 12/20. DTAC reviewed cases using a standardized classification algorithm. Result(s): During 2020, there were 18,318 donors and 37,583 unique recipients. DTAC reviewed 261/427 PDDTE from donor (111) or recipient (150) findings. 64/261 (25%) donors had proven/probable transmission (P/P Tr) of infection, malignancies or other to 84/206 (41%) exposed recipients [figure]. 12 involved living donors. Infection occurred with 44/64 P/P cases affecting 63 recipients. Viruses were most frequent P/P infections with 29 recipients having P/P Tr from 19 donors. COVID-19 PDDTE represented 11% (29/261) of all cases reviewed involving 29 donors and 15 lung and 76 non-lung recipients. One lung recipient had P/P Tr and died;none of the non-lung recipients developed P/P Tr. For bacteria, 20 recipients had P/P Tr from 14 donors. Deaths from infection (N=10) occurred at a median of 20 days (5-89 days). Attributable death was highest for fungal (4/12, 33%) and bacterial infections (6/20, 30%). 7 donors with malignancies were classified as P/P impacting 15 recipients with 1 attributable death. 53 non-infection, non-malignancy PDDTE were reported;13 resulted in P/P Tr to 14 recipients. Conclusion(s): Although P/P events remain rare, 1/4 reviewed cases resulted in unanticipated P/P Tr. This is a conservative estimate due to passive reporting and empiric interventions. In 29 COVID-19 PDDTE only 1 lung recipient had P/P Tr. The DTAC continues to evaluate PDDTE to maximize organ use and minimize the risk of transmission. (Table Presented).

7.
American Journal of Transplantation ; 22(Supplement 3):333, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2063353

RESUMO

Purpose: Decision to transplant organs from SARS-CoV-2 NAT+ donors(N+D) balances risk of donor-derived infection with the scarcity of available organs to meet the needs of waitlisted candidates. Method(s): OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC) reports on the use of organs from N+D from the onset of required SARS-CoV-2 lower respiratory tract(LRT) testing for lung donors (May 27, 2021) through August 31, 2021. OPTN data were analyzed for donors with a positive LRT or upper respiratory tract (URT) test reported in DonorNet discrete data fields (N+D), compared with donors who did not have positive LRT or URT in the discrete data fields (N-D). Result(s): Organs were recovered from 120 N+D (all OPTN Regions and 40/57 OPOs (70%)). Median donor age was 42 (IQR: 32-52) for N+D and 43 (30-56) for N-D. There was a greater proportion of DCD N+D than N-D (37.5% vs 28.3%, p=0.04). Underlying COD of anoxia and other were different (N+D 31.7%, 16.7% vs N-D 48%, 2.7%, respectively). Transplanted N+D and N-D did not differ by KDPI, LDRI or LVEF for kidney(KT), liver(LT) or heart(HT), respectively (Table 1). Median time from donor admission to first reported test (any result) was 0 and 4 days for URT and LRT, respectively. N+D recovery occurred a median of 2 (IQR: 1-6) days from last positive test. 246 organs (152KT, 50LT, 22HT, 22other) were transplanted from 107 N+D compared to 8969 organs from 3348 N-D. Recipients from N+D and N-D were similar in age, MELD/PELD (LT) and medical urgency status (HT). Median time from listing to transplant similar for N+D for all organs. The match run sequence number for final acceptor was higher for N+D for all organ types (Table 2). Median length of stay was similar for N+D and N-D for KT and LT (5d and 12-13d, respectively). For HT, median stay was shorter for N+D (30 vs 34d). For N+D, 3 of 50 LT died within 30d of transplant. During this timeframe, no PDDTEs were reported for any N+D at the time of transplant. Conclusion(s): N+D and N-D were similar in terms organ quality characteristics. Recipients receiving organs from N+D had higher match run sequence numbers, suggesting use of organs from N+D is not widespread across centers;however, with small numbers, this data will need to be verified. We cannot assess the relatedness of the three early mortality events in N+D recipients to donor or recipient characteristics. However, these data highlight the importance of ongoing outcome review of N+D recipients. (Figure Presented).

8.
Big Data Analytics for Healthcare: Datasets, Techniques, Life Cycles, Management, and Applications ; : 153-163, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2035590

RESUMO

Infectious diseases threaten the lives of the entire global population. Some diseases such as SARS and COVID-19 trigger pandemics, as spread from country to country, with severe adverse effects on the medical system, such as shortages in medical professionals and equipment, financial burden, and death. Therefore, it is crucial to predict and respond to the spread of infectious diseases. In this chapter, we reviewed the research related to the prediction models of the spread of infectious diseases, based on various methodologies. Studies that adopt conventional mathematical models, such SIR, SEIR, and agent-based models are considered. In addition, an analysis centered on artificial intelligence, big data, and machine learning methodologies was carried out. Decision-makers should arrive at decisions by considering limitations of modeling infectious diseases. In particular, the internal structure of deep learning is a black box;hence, it difficult to interpret the results. Modelers should transparently provide data collection, coding, and modeling processes, as well as provide information on model uncertainty to help decision-makers create policy decisions. Furthermore, to make scientific and rational decisions based on evidence, considering the geographic information system interpersonal interactions, national, and social environments, decision-makers should refer to epidemiologic data and modeling results. © 2022 Elsevier Inc. All rights reserved.

9.
20th International Conference on e-Society, ES 2022 and 18th International Conference on Mobile Learning, ML 2022 ; : 170-178, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2034082

RESUMO

Due to COVID-19, all classes in schools have been converted to distance learning using online platforms. However, various problems were raised when converting face-to-face classes to online distance learning. In particular, the difficulties were more pronounced for practical design courses because they include practical experience. In this context, this study focused on actual online distance learning classroom cases in design education. Based on the qualitative case study methodology, four instructors were interviewed about their experience with distance learning courses that actively utilized online platforms for college design courses as research cases. In design education, which aims at interdisciplinary and convergence thinking, online distance learning is meaningful in that it can expand experience and opportunities for the overall formative design through the development of technology. On the other hand, there are clear limitations in terms of practical production activities for existing online distance learning methods. Therefore, it is necessary to explore whether to develop classes based on the recently used effective activities or whether to find new strategies in the case that these limitations are fundamental to online distance learning. © 2022 IADIS Press. All rights reserved.

10.
Emerging Science Journal ; 6(5):1153-1166, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2026409

RESUMO

Technological advancements in virtual reality have influenced festivalgoers, performers, and festival organizers. Due to the COVID-19 pandemic, organizers of cultural and tourism festivals have sought to deliver festivals online using virtual reality to provide an immersive experience from home. However, despite growing interest in virtual reality for festivals, there is no current systematic review to synthesize knowledge from academic papers within the festival context. This paper aims to provide a structured understanding of extant virtual reality research regarding festivals by using a systematic literature review. After a comprehensive review of extant literature from major databases, 19 relevant articles were extracted and synthesized according to the types, venues, roles, and objectives of the virtual reality applications. This study is the first systematic literature review to examine the current landscape of consumer research on virtual reality in festivals. Our results show that the limited numbers of extant literature concerning virtual reality in festivals indicates that this is an important yet significantly under-researched topic for future research. Current literature on virtual reality in festival contexts also lacks an in-depth understanding of consumer engagement and experiences. This paper recommends incorporating the application of theory and robust consumer research methods into future virtual festival research. © 2022 by the authors. Licensee ESJ, Italy.

11.
Proceedings of the Second Workshop on Combating Online Hostile Posts in Regional Languages during Emergency Situations (Constraint 2022) ; : 95-102, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2011902

RESUMO

The COVID-19 pandemic has created severe threats to global health control. In particular, misinformation circulated on social media and news outlets has undermined public trust in government and health agencies. This problem is further exacerbated in developing countries or low-resource regions where the news may not be equipped with abundant English fact-checking information. This poses a question: "are existing computational solutions toward misinformation also effective in low-resource regions?" In this paper, to answer this question, we make the first attempt to detect COVID 19 misinformation in English, Spanish, and Haitian French populated in the Caribbean region, using the fact-checked claims in US-English. We started by collecting a dataset of real & false claims in the Caribbean region. Then we trained several classification and language models on COVID-19 from high-resource language regions and transferred this knowledge to the Caribbean claim dataset. The experimental results show the limitations of current false claim detection in low-resource regions and encourage further research toward the detection of multi-lingual false claims in long tail.

12.
Innovation in Aging ; 5:717-718, 2021.
Artigo em Inglês | Web of Science | ID: covidwho-2011797
13.
Innovation in Aging ; 5:130-130, 2021.
Artigo em Inglês | Web of Science | ID: covidwho-2011110
14.
Innovation in Aging ; 5:130-131, 2021.
Artigo em Inglês | Web of Science | ID: covidwho-2010762
15.
Child Care Health Dev ; 48(6): 1122-1133, 2022 11.
Artigo em Inglês | MEDLINE | ID: covidwho-2001618

RESUMO

OBJECTIVES: Changes to income and employment are key social determinants of health that have impacted many families during the COVID-19 pandemic. This research aimed to understand how changes to employment and income influenced family environments that contribute to early childhood development and health. METHODS: A concurrent triangulation mixed method design was used through a cross-sectional survey on early impacts of the COVID-19 pandemic involving families with young children in the Canadian Maritime provinces (n = 2158). Analyses included multivariate regression models to examine whether changes to employment and income predicted changes to Family access to resources and social support, parenting Abilities and self-care at home, and home Routines and Environments (FARE Change Scale). Content analysis was used to identify themes from the open-ended questions. RESULTS: Changes to employment and income early in the pandemic like no longer working but continued to receive salary, working fewer hours for the same salary earned before the pandemic, no longer working nor receiving salary, working fewer hours resulting in salary reduction, essential worker status and household income were significant predictors of FARE Change Scale when ethnicity/cultural background and province of residence are controlled (P < .05). Themes provided a description of family impacts, including shifting employment and income, finding time and capacity, feelings of guilt and the creation of new routines. CONCLUSION: Our study provides insight on the implications of public health restrictions, such as the importance of increased time for parents (through reduced work hours) and access to resources and social support to support child development and health.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Canadá/epidemiologia , Criança , Desenvolvimento Infantil , Pré-Escolar , Estudos Transversais , Humanos
16.
Cytotherapy ; 24(5):S109-S110, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996725

RESUMO

Background & Aim: Background. Immunological characteristics of COVID-19 show pathological hyperinflammation associated with lymphopenia and dysfunctional T cell responses. These features provide a rationale for restoring functional T cell immunity in COVID-19 patients by adoptive transfer of SARS-CoV-2 specific T cells. Methods, Results & Conclusion: Methods. To generate SARS-CoV-2 specific T cells, we isolated peripheral blood mononuclear cells from 7 COVID-19 recovered and 13 unexposed donors. Consequently, we stimulated cells with SARS-CoV-2 peptide mixtures covering spike, membrane and nucleocapsid proteins. Then, we culture expanded cells with IL-2 for 21 days. We assessed immunophenotypes, cytokine profiles, antigen specificity of the final cell products. Results. Our results show that SARS-CoV-2 specific T cells could be expanded in both COVID-19 recovered and unexposed groups. Immunophenotypes were similar in both groups showing CD4+ T cell dominance, but CD8+ and CD3+CD56+ T cells were also present. Antigen specificity was determined by ELISPOT, intracellular cytokine assay, and cytotoxicity assays. One out of 14 individuals who were previously unexposed to SARS-CoV-2 failed to show antigen specificity. Moreover, ex-vivo expanded SARS-CoV-2 specific T cells mainly consisted of central and effector memory subsets with reduced alloreactivity against HLA-unmatched cells suggesting the possibility for the development of third-party partial HLA-matching products. Conclusion. In conclusion, our findings show that SARS-CoV-2 specific T cell can be readily expanded from both COVID-19 and unexposed individuals and can therefore be manufactured as a biopharmaceutical product to treat severe COVID-19 patients.

17.
Journal of General Internal Medicine ; 37:S392, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995749

RESUMO

CASE: We report a 50-year-old Caucasian female with a history of systemic lupus erythematosus (SLE) in remission and chronic kidney disease (CKD) stage 5. The patient presented with dyspnea on exertion and orthopnea for two weeks. Six weeks ago, she was diagnosed with COVID-19 after presenting to the ED for substernal chest pain, myalgias, and fatigue. During this admission, she denied any current joint pain, chest pain, or rashes. She denies a history of alcohol or illicit drug use. EKG in the ED showed T-wave inversions in lead I and aVL, stable from prior EKG. The brain natriuretic peptide level was elevated at 3,500 pg/ml. There was no transaminitis, and kidney function was at baseline. Chest x-ray showed pulmonary vascular congestion and cardiomegaly. A transthoracic echocardiogram showed a left ventricular ejection fraction of 15-20% with severe global hypokinesis. The patient had a full cardiomyopathy workup. We ruled out ischemic cardiomyopathy with a negative coronary angiogram. Non-ischemic cardiomyopathy (NICMO) workup was initiated, with a focus on viral or autoimmune myocarditis. While a cardiac MRI would have been the gold standard to assess for myocardial scarring, the patient's CKD status prohibited this possibility. Similarly, an endomyocardial biopsy was not performed due to its low sensitivity for diagnosing viral or autoimmune myocarditis. Without evidence of infiltrative disease, or other exposures, it was deemed that the patient's recent history of COVID-19 infection, in conjunction with underlying SLE, were the causes of her new-onset NICMO. The patient's dyspnea responded to intravenous bumetanide. We initiated guideline-directed medical therapy with carvedilol and isosorbide-dinitrate. She continues regular follow-up in the outpatient heart failure clinic. IMPACT/DISCUSSION: Classification and evaluation of NICMO can be broad, and thus the clinical picture plays an essential role in the workup. Acquired cardiomyopathy from prior myocarditis was the most likely etiology of our patient's new-onset NICMO. Our patient had no clinical symptoms of myocarditis prior to her exposure to COVID-19, making it unlikely that SLE was the sole driving factor. There is a known association between COVID-19 and myocarditis. A few proposed mechanisms for COVID-19 induced myocarditis include upregulation of cytokines, particularly interleukin-6, and downregulation of ACE2, leading to microvascular and cardiac pericyte dysfunction. Cytokine release from COVID-19 coupled with subclinical SLE could have acted synergistically to cause this patient's condition. Given the increasing incidence of COVID-19 infections, internists must consider COVID-19 exposures during the workup of new-onset heart failure. CONCLUSION: The workup for NICMO in the COVID-19 era must include detailed history taking for sick contacts and prior history of COVID-19 diagnosis. More research is needed to determine if COVID-19 infection can increase the risk of NICMO in patients with a known history of SLE.

18.
IEEE Frontiers in Education Conference (FIE) ; 2021.
Artigo em Inglês | Web of Science | ID: covidwho-1978382

RESUMO

This article represents a Work in Progress. COVID-19 pandemic has affected the way we conduct our lives across different segments of society. Higher education's organizational activities were rearranged as instructors and students were forced to switch from in-person to online and hybrid class activities. We examine how COVID-19 reshaped teaching at an engineering school in a large, public research university in the U.S. Midwest. In our earlier studies (during the pre-COVID-19 era) we found that faculty culture prioritized research over teaching. We also discovered that students avoided interactions with their instructors for several reasons, including the perception that their professors were too busy. Still, a professor's role at a research university involves teaching one to two courses per semester. With the advent of COVID-19, one of the many emerging crises in higher education was that instructors were largely unprepared to teach online and were left scrambling to adjust. Our most current research revealed that instructors had to develop proficiency quickly in various technologies to enable them to pre-record lectures, offer help sessions remotely, and design and administer exams. The learning curve was steep and led to a significant increase in instructor preparation time. This rearrangement of activities seems to have influenced professors' attitudes since they placed higher emphasis on quality of teaching, devoted more time to interacting with students outside class sessions and were more flexible in terms of students' academic challenges.

19.
Gastroenterology ; 162(7):S-1280, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1967446

RESUMO

Background & Aims: Prior studies have indicated the presence of hepatic inflammation (as signified by elevated liver function test (LFT) values), as conferring an escalated risk toward adverse outcomes in patients admitted with COVID-19. In line with this hypothesis, we study the various thresholds of LFTs and its associated prognostic risks toward COVID- 19 related hospital deaths Method: This was a single-center retrospective study involving patients admitted with COVID-19. Univariate Cox regression analysis identified the LFT variables significantly associated with our primary endpoint, in-hospital death. Subsequently, 500 iterations of thresholds were generated for each biomarker to estimate the prognostic relationship between biomarker and endpoint. Multivariate Cox regression and event-analyses were performed for each threshold to identify the minimal cutoffs at which the prognostic relationship was significant. Event curves were drawn for each significant relationship. Results: A total of 858 patients with COVID-19 were included with a median follow-up time of 5 days from admission. From the total, 90 patients passed away during admission (10.5%). The deceased cases were more likely to be older (66.2 vs 55.3y p<0.001);however, there was no difference in gender (male: 66 vs 56.2% p=0.11). Between the cases and controls (no-death), deceased cases had higher incidence of nonalcoholic fatty liver disease (7.78 vs 2.99% p=0.042), COPD (18.9 vs 7.80% p=0.001), lung cancer (4.44 vs 0.65% p= 0.009), ICU admissions (81.1 vs 26% p<0.001), and intubation events (84.4 vs 19.5% p<0.001), however there was no difference in alcohol use (21.1 vs 30.6% p=0.083) and alcoholic liver disease (5.56 vs 2.08% p=0.097). Upon univariate Cox analysis, the following LFT parameters were associated with in-hospital death: Bilirubin (p<0.001), AST (p<0.001), ALT (p<0.001). However, alkaline phosphatase (p=0.449) was not associated with the primary endpoint. The iterations of event regression analyses using 500 sequences of LFT thresholds showed the following cutoffs to be significantly associated with in-hospital death (minimally significant values): ALT (281.71 IU/L), AST (120.94 IU/L), bilirubin (2.615 mg/ dL). On the multivariate analysis, while controlling for demographics and cardiopulmonary/ medical comorbidities, the following adjusted hazard ratios were derived for each cutoff: ALT (aHR: 6.43 95%CI 1.85-22.40), AST (aHR: 3.35 95%CI 1.84-6.11), and bilirubin (aHR: 2.77 95%CI 1.15-6.65). Conclusion: The delineated cutoffs for AST, ALT, and bilirubin levels can serve as clinical benchmarks to help determine when a COVID-19 infection poses significant risk. Given this finding, the cutoffs can be used as part of a risk assessment for patients to support early preventative therapies and medical management. (Table Presented)

20.
Gastroenterology ; 162(7):S-1279-S-1280, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1967445

RESUMO

Background and Aims: While the relationship between elevated liver enzymes and COVID- 19 related adverse events is well-established, a liver-dependent prognostic model that predicts the risk of death is helpful to accurately stratify admitted patients. In this study, we use a bootstrapping-enhanced method of regression modeling to predict COVID-19 related deaths in admitted patients. Method: This was a single-center, retrospective study. Univariate and multivariate Cox regression analyses were performed using 30-day mortality as the primary endpoint to establish associated hepatic risk factors. Regression-based prediction models were constructed using a series of modeling iterations with an escalating number of categorical terms. Model performance was evaluated using receiver operating characteristic (ROC) curves. Model accuracy was internally validated using bootstrapping-enhanced iterations. Results: 858 patients admitted to hospital with COVID-19 were included. 78 were deceased by 30 days (9.09%). Cox regression (greater than 20 variables) showed the following core variables to be significant: INR (aHR 1.26 95%CI 1.06-1.49), AST (aHR 1.00 95%CI 1.00- 1.00), age (aHR 1.05 95%CI 1.02-1.08), WBC (aHR 1.07 95%CI 1.03-1.11), lung cancer (aHR 3.38 95%CI 1.15-9.90), COPD (aHR 2.26 95%CI 1.21-4.22). Using these core variables and additional categorical terms, the following model iterations were constructed with their respective AUC;model 1 (core only): 0.82 95%CI 0.776-0.82, model 2 (core + demographics): 0.828 95%CI 0.785-0.828, model 3 (prior terms + additional biomarkers): 0.842 95%CI 0.799-0.842, model 4 (prior terms + comorbidities): 0.851 95%CI 0.809-0.851, model 5 (prior terms + life-sustaining therapies): 0.933 95%CI 0.91-0.933, model 6 (prior terms + COVID-19 medications): 0.934 95%CI 0.91-0.934. Model 1 demonstrated the following parameters at 0.91 TPR: 0.54 specificity, 0.17 PPV, 0.98 NPV. Bootstrapped iterations showed the following AUC for the respective models: model 1: 0.82 95%CI 0.765-0.882, model 2 0.828 95%CI 0.764-0.885, model 3 0.842 95%CI 0.779-0.883, model 4: 0.851 95%CI 0.808-0.914, model 5: 0.933 95%CI 0.901-0.957, model 6: 0.934 95%CI 0.901- 0.961. Conclusion: Model 1 displays high prediction performance (AUC >0.8) in both regression-based and bootstrapping-enhanced modeling iterations. Therefore, this model can be adopted for clinical use as a calculator to evaluate the risk of 30-day mortality in patients admitted with COVID-19. (Table Presented)

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