ABSTRACT
IMPORTANCE: The actual risk of thrombotic events after Covid-19 vaccination is unknown. OBJECTIVE: To evaluate the risk of thrombotic events after Covid-19 vaccination. DESIGN: Retrospective cohort study which included consecutive adult patients vaccinated with the first dose of Covid-19 vaccine between January 1 and May 30, 2021, and a historic control group, defined as consecutive patients vaccinated with influenza vaccine between March 1 and July 30, 2019. SETTING: Hospital Italiano de Buenos Aires, a tertiary hospital in Argentina. PARTICIPANTS: Non-Hospitalized Adults vaccinated with the first dose of a Covid-19 vaccine. EXPOSURE: Vaccination with Covid-19 vaccines available during the study period: Gam-COVID-Vac (Sputnik), ChAdOx1 nCoV-19 (AstraZeneca/Oxford or Covishield), BBIBP-CorV (Beijing Institute of Biological Products) (Sinopharm). Active comparator group exposure was Influenza vaccine. MAIN OUTCOME: Primary endpoint was cumulative incidence of any symptomatic thrombotic event at 30 days, defined as the occurrence of at least one of the following: symptomatic acute deep venous thrombosis (DVT); symptomatic acute pulmonary embolism (PE); acute ischemic stroke (AIS); acute coronary syndrome (ACS) or arterial thrombosis. RESULTS: From a total of 29,985 adult patients who received at least a first dose of Covid-19 vaccine during study period and 24,777 who received Influenza vaccine in 2019, we excluded those who were vaccinated during hospitalization. We finally included 29,918 and 24,753 patients respectively. Median age was 73 years old (IQR 75-81) and 67% were females in both groups. Thirty six subjects in the Covid-19 vaccination group (36/29,918) and 15 patients in the Influenza vaccination group (15/24,753) presented at least one thrombotic event. The cumulative incidence of any thrombotic event at 30 days was 12 per 10,000 (95%CI 9-17) for Covid-19 group and 6 per 10,000 (95%CI 4-10) for Influenza group (p-value=0.022). CONCLUSIONS AND RELEVANCE: This study shows a significant increase in thrombotic events in subjects vaccinated with Covid-19 vaccines in comparison to a control group. The clinical implication of these findings should be interpreted with caution, in light of the high effectiveness of vaccination and the inherent risk of thrombosis from Covid-19 infection itself.
Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Ischemic Stroke , Thrombosis , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Female , Humans , Influenza Vaccines/adverse effects , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Male , Retrospective Studies , Thrombosis/epidemiology , Thrombosis/etiologyABSTRACT
Hypertension (HTN) is a prevalent disease. A 30% of the population is unaware of having HTN and 65% of patients with HTN have a poor control. There is no standardized way to diagnose HTN in the inpatient setting. This is why the focus on this population, both for the diagnosis of HT and for the detection of poor control, is relevant. It was a cross sectional study of hospitalized adult patients (>18 years old) for clinical causes, in 2017. Hypertensive emergencies were excluded. Elevated blood pressure (EBP) was defined as the registry of SBP = 140 and / or DBP = 90 mmHg on two or more occasions, on two different days, measured through a sphygmomanometer, and/or one-time indication of antihypertensive medication. A total of 2203 patients were included. Median age: 73 years (IIQ 25-75%: 56-86). Women: 55% (1203). Median days of hospitalization: 5 (IIQ 25-75% 4-9). A 58% of them were known hypertensive. The prevalence of EBP was 7.6% [168, 95% CI 6.6-8.8], of which 12.5% (21) were unaware of having HTN. Compared to patients without EBP, the mean SBP and DBP were higher, they were older (77 vs. 73 years, p < 0.001), had higher rates of chronic kidney disease (21% vs. 12% p < 0.001), stroke (15% vs. 10% p = 0.035) and HTN (87% vs. 56% p < 0.001). They had more events of heart failure (8% vs. 3%, p <0.001) and stroke (3.6% vs. 1.2%, p = 0.02) during hospitalization. The prevalence of EBP was lower compared to previous studies. We observed an association between cardiovascular events and EBP.
La hipertensión arterial (HTA) es una enfermedad prevalente. El 30% de la población desconoce su diagnóstico y el 65% tiene un mal control. No existe actualmente una forma estandarizada de diagnosticar HTA en internados. Es por esto que el enfoque en poblaciones tales como pacientes internados, tanto para el diagnóstico de HTA como para la detección de un pobre control, resulta relevante. Se trata de un estudio de corte transversal de pacientes adultos internados (> 18 años) por diversas causas clínicas, en 2017. Se excluyeron emergencias hipertensivas. Se definió presión arterial elevada (PAe) al registro de presión sistólica = 140 y/o diastólica = 90 mmHg en dos o más oportunidades, en días de internación distintos, medidas a través de un esfingomanómetro, y/o por indicación de rescate de antihipertensivos. Se incluyeron 2203 pacientes. Mediana de edad: 73 años (IIQ 25-75%: 56-86). Mujeres: 55% (1203). Mediana de días de internación: 5 (IIQ 25-75% 4-9). El 58% era hipertenso conocido. La prevalencia de PAe fue del 7.6% [168, IC 95% 6.6-8.8], del que 12.5%(21) no se conocían hipertensos. Comparado con los pacientes sin PAe, la media de presión sistólica y diastólica fue mayor, tenían mayor edad en años (77 vs. 73, p < 0.001), más antecedente de enfermedad renal crónica (21% vs. 12% p < 0,001), ACV (15% vs. 10% p = 0.035) y HTA (87% vs. 56% p < 0.001). También presentaron más eventos de insuficiencia cardíaca (8% vs. 3%, p <0.001) y ACV (3.6% vs. 1.2%, p = 0.02) en internación. La prevalencia de PAe fue menor respecto a estudios previos. Observamos una asociación entre eventos cardiovasculares y presión arterial elevada.
Subject(s)
Hypertension , Adolescent , Adult , Aged , Antihypertensive Agents , Blood Pressure , Cross-Sectional Studies , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , PrevalenceABSTRACT
Resumen La hipertensión arterial (HTA) es una enfermedad prevalente. El 30% de la población desconoce su diagnóstico y el 65% tiene un mal control. No existe actualmente una forma estandarizada de diagnosticar HTA en internados. Es por esto que el enfoque en poblaciones tales como pacientes internados, tanto para el diagnóstico de HTA como para la detección de un pobre control, resulta relevante. Se trata de un estudio de corte transversal de pacientes adultos internados (> 18 años) por diversas causas clínicas, en 2017. Se excluyeron emergencias hipertensivas. Se definió presión arterial elevada (PAe) al registro de presión sistólica ≥ 140 y/o diastólica ≥ 90 mmHg en dos o más oportunidades, en días de internación distintos, medidas a través de un esfingomanómetro, y/o por indicación de rescate de antihipertensivos. Se incluyeron 2203 pacientes. Mediana de edad: 73 años (IIQ 25-75%: 56-86). Mujeres: 55% (1203). Mediana de días de internación: 5 (IIQ 25-75% 4-9). El 58% era hipertenso conocido. La prevalencia de PAe fue del 7.6% [168, IC 95% 6.6-8.8], del que 12.5%(21) no se conocían hipertensos. Comparado con los pacientes sin PAe, la media de presión sistólica y diastólica fue mayor, tenían mayor edad en años (77 vs. 73, p < 0.001), más antecedente de enfermedad renal crónica (21% vs. 12% p < 0,001), ACV (15% vs. 10% p = 0.035) y HTA (87% vs. 56% p < 0.001). También presentaron más eventos de insuficiencia cardíaca (8% vs. 3%, p<0.001) y ACV (3.6% vs. 1.2%, p = 0.02) en internación. La prevalencia de PAe fue menor respecto a estudios previos. Observamos una asociación entre eventos cardiovasculares y presión arterial elevada.
Abstract Hypertension (HTN) is a prevalent disease. A 30% of the population is unaware of having HTN and 65% of patients with HTN have a poor control. There is no standardized way to diagnose HTN in the inpatient set ting. This is why the focus on this population, both for the diagnosis of HT and for the detection of poor control, is relevant. It was a cross sectional study of hospitalized adult patients (>18 years old) for clinical causes, in 2017. Hypertensive emergencies were excluded. Elevated blood pressure (EBP) was defined as the registry of SBP ≥ 140 and / or DBP ≥ 90 mmHg on two or more occasions, on two different days, measured through a sphygmomanometer, and/or one-time indication of antihypertensive medication. A total of 2203 patients were included. Median age: 73 years (IIQ 25-75%: 56-86). Women: 55% (1203). Median days of hospitalization: 5 (IIQ 25-75% 4-9). A 58% of them were known hypertensive. The prevalence of EBP was 7.6% [168, 95% CI 6.6-8.8], of which 12.5% (21) were unaware of having HTN. Compared to patients without EBP, the mean SBP and DBP were higher, they were older (77 vs. 73 years, p < 0.001), had higher rates of chronic kidney disease (21% vs. 12% p < 0.001), stroke (15% vs. 10% p = 0.035) and HTN (87% vs. 56% p < 0.001). They had more events of heart failure (8% vs. 3%, p <0.001) and stroke (3.6% vs. 1.2%, p = 0.02) during hospitalization. The prevalence of EBP was lower compared to previous studies. We observed an association between cardiovascular events and EBP.
ABSTRACT
Resumen Introducción: Los abscesos hepáticos primarios producidos por Klebsiella pneumoniae y las implicancias sistémicas relacionadas constituyen el síndrome de absceso hepático invasor por Klebsiella pneumoniae. Objetivo: Describir las características clínicas, epidemiológicas y la evolución de esta entidad en nuestro centro. Pacientes y Métodos: Cohorte retrospectiva de pacientes adultos internados en el Hospital Italiano de Buenos aires entre el 1 de enero de 2001 y el 1 de mayo de 2020. Se incluyeron pacientes con diagnóstico de absceso en cualquier órgano con aislamiento en cultivo de absceso o hemocultivo positivo para Klebsiella pneumoniae para ser analizadas las características epidemiológicas, clínicas y la evolución de aquellos con localización primaria hepática. Resultados: 10 pacientes fueron incluidos. Dos (20%) pacientes fueron orientales. La mediana de edad fue 69 años (IIC 64-79), nueve (90%) fueron hombres. La co-morbilidad más frecuente fue diabetes mellitus tipo 2 (40%). Cuatro (40%) pacientes tuvieron diseminación a otros órganos. La mediana de internación fue 21,5 días (IIC 15-43), 60% (n: 6) requirió internación en unidad de cuidados intensivos y 30% (n: 3) de los pacientes falleció. Conclusión: El síndrome de absceso hepático invasor por Klebsiella pneumoniae es una enfermedad infrecuente, potencialmente mortal. Este estudio intenta reportar las características de los pacientes con esta patología en nuestra población.
Abstract Background: Primary liver abscesses caused by Klebsiella pneumoniae and their related systemic complications produce the invasive liver abscess syndrome due to Klebsiella pneumoniae. Aim: To describe the clinical, epidemiological and evolution characteristics in our center. Methods: A retrospective cohort of hospitalized adults in Hospital Italiano de Buenos Aires between January 1st, 2001 and May 1st, 2020. We included patients with diagnosis of abscess in any organ with rescue in culture or positive blood culture for Klebsiella pneumoniae. Epidemiological, clinical characteristics and prognosis of those with hepatic primary localization were analyzed. Results: 10 patients were included. Two (20%) patients were Oriental. Median age was 69 years (interquartile range 64-79), nine (90%) were men. The most frequent comorbidity was type 2 diabetes (40%). Four (40%) patients had spread to other organs. The median hospitalization was 21.5 days (IIC 15-43), 60% (n: 6) were hospitalized in the intensive care unit and 30% (n: 3) died. Conclusions: The invasive liver abscess syndrome due to Klebsiella pneumoniae is a rare life-threatening disease. Our study reports the characteristics of patients with this syndrome in our population.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Klebsiella Infections/diagnosis , Klebsiella Infections/epidemiology , Liver Abscess/epidemiology , Retrospective Studies , Diabetes Mellitus, Type 2 , Klebsiella pneumoniaeABSTRACT
BACKGROUND: Primary liver abscesses caused by Klebsiella pneumoniae and their related systemic complications produce the invasive liver abscess syndrome due to Klebsiella pneumoniae. AIM: To describe the clinical, epidemiological and evolution characteristics in our center. METHODS: A retrospective cohort of hospitalized adults in Hospital Italiano de Buenos Aires between January 1st, 2001 and May 1st, 2020. We included patients with diagnosis of abscess in any organ with rescue in culture or positive blood culture for Klebsiella pneumoniae. Epidemiological, clinical characteristics and prognosis of those with hepatic primary localization were analyzed. RESULTS: 10 patients were included. Two (20%) patients were Oriental. Median age was 69 years (interquartile range 64-79), nine (90%) were men. The most frequent comorbidity was type 2 diabetes (40%). Four (40%) patients had spread to other organs. The median hospitalization was 21.5 days (IIC 15-43), 60% (n: 6) were hospitalized in the intensive care unit and 30% (n: 3) died. CONCLUSIONS: The invasive liver abscess syndrome due to Klebsiella pneumoniae is a rare life-threatening disease. Our study reports the characteristics of patients with this syndrome in our population.
