Demographics, clinical characteristics and outcomes among 197 patients with COVID-19 in the Gold Coast area.

BACKGROUND: Clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients have been varied internationally but have not been studied in an Australian cohort. AIM: To describe characteristics and outcomes of approximately the first 200 documented COVID-19 cases during the first outbreak in the Gold Coast. METHODS: Retrospective observational cohort study of COVID-19 patients managed by Gold Coast Hospital and Health Service (GCHHS). Demographics, clinical characteristics and outcomes data were collected. RESULTS: One hundred and ninety-seven patients were included (mean age 45 years); 52.3% were female and 9.1% were healthcare workers. Most were overseas travellers (53.8%), contacts of a local confirmed case (25.4%) or cruise ship passengers (17.3%). The commonest comorbidities were hypertension (14.2%) and asthma (11.2%). The commonest symptoms were cough (74.1%), fever (58.9%), sore throat (48.7%), headache (48.7%) and rhinorrhoea (46.2%). Sixty-three patients were hospitalised and the rest admitted to a 'virtual ward'. Of 63 hospitalised patients, 5 (7.9%) required intensive care unit (ICU) admission and 3 (4.8%) required intubation. No patients died. Due to low numbers of accurate exposure dates, the incubation period could not be reliably calculated for a significant proportion of the cohort. Average duration of symptoms was 14 days, time from first symptom to hospitalisation was 5.3 days and time from first symptom to ICU admission was 11.6 days. The majority (88%) experienced mild disease and achieved complete symptom resolution (97%). Nasopharyngeal swab polymerase chain reaction was the main diagnostic method (99%). Twenty-four patients received anti-viral pharmacotherapy, with 87.5% getting hydroxychloroquine. CONCLUSIONS: The present study provides characteristics and outcomes of the first 197 patients with COVID-19 in the Gold Coast.

Association of renin angiotensin antagonists with adverse perioperative events in patients undergoing elective orthopaedic surgery: a case-control study.

BACKGROUND: Renin angiotensin antagonists (RAA) may block protective vasopressor responses during surgery. Evidence linking RAA with intraoperative hypotension and perioperative adverse events is conflicting. AIM: To compare the incidence of intraoperative hypotension and adverse events between patients receiving or not receiving RAA. METHODS: This is a retrospective case-control study of 258 consecutive patients who underwent elective total knee or hip replacement between 1 January 2013 and 31 August 2016 and who were chronically prescribed a single blood pressure-lowering agent up to the time of surgery. Primary outcome measures were differences between patients receiving RAA (cases; n = 129) and patients receiving non-RAA medications (controls; n = 129) in incidence of intraoperative hypotension (systolic blood pressure <90 mmHg), perioperative acute kidney injury (AKI, >30% increase in serum creatinine from baseline on Day 1 post-operatively) and new onset major adverse cardiac or cerebrovascular events (MACCE) or in-hospital death over 72 h post-operatively. RESULTS: Patients receiving RAA had significantly higher preoperative systolic blood pressure, greater prevalence of hypertension and chronic kidney disease, lower prevalence of ischaemic heart disease and lower cardiac risk compared to controls. Age, gender, type of operation, operative fitness, mode and duration of anaesthesia and prevalence of other types of cardiovascular disease, dyslipidaemia and diabetes were similar between groups. Compared to controls, patients receiving RAA had higher incidence of intraoperative hypotension (76.0 vs 45.9%, P < 0.001), AKI (11.6 vs 1.6%, P = 0.002) and MACCE (6.2 vs 0%, P = 0.007), with all adverse events associated with intraoperative hypotension. CONCLUSION: This study provides further observational evidence of RAA-induced harm in patients undergoing elective surgery, although determining benefits and harms of preoperative withdrawal of RRA requires prospective randomised trials.