Association of ABO blood group with in-hospital adverse outcome and long term persistent symptoms of COVID-19 infection: A single-center longitudinal observational study.

Background and Aims: There are gaps in knowledge regarding the association between the ABO blood group and coronavirus disease 2019 (COVID-19) immediate and long-term outcomes. We aimed to investigate the association of ABO blood group with COVID-19 in-hospital adverse outcomes and to determine whether ABO blood group is associated with post-COVID-19 persistent symptoms. Methods: This was a single-center longitudinal observational study that included patients who presented with symptoms suggestive of COVID-19 infection and a positive test for COVID-19 and were able to attend the out-patient clinic after 6 months following acute COVID-19. The main outcomes were intensive care unit admission, the requirement for respiratory support, in-hospital death, and persistent symptoms. χ 2 test and regression analysis were used to analyze the collected data. Results: A total of 169 patients were enrolled for the assessment of in-hospital adverse outcomes of whom 86 patients were included for the assessment of persistent symptoms after the exclusion of deceased patients or patients not attended the out-patient clinic. Patients with blood group B had higher prevalence of in-hospital death compared to blood group O (39% vs. 13%, p = 0.01) and this persisted after adjusting for sex (odds ratio, OR [confidence interval, CI] = 1.4 [1.1-2.1], p = 0.04), while patients with blood group AB had higher prevalence of requiring respiratory support than blood group O (54% vs. 10%, p = 0.02) and this persisted after adjusting for age (OR [CI] = 1.5 [1.1-2.3], p = 0.02). Concerning the association of ABO blood group and long-term symptoms, blood group AB showed a higher prevalence of palpitation (p < 0.001) and dizziness (p = 0.02) than other blood groups. Conclusions: Blood groups AB and B are significantly associated with respiratory support use and in-hospital death, respectively, compared to blood group O. Blood group AB is significantly associated with persistent palpitation and dizziness compared to other blood groups.

Long-term persistent symptoms of COVID-19 infection in patients with diabetes mellitus.

Objective: The study aimed to assess the long-term persistent symptoms of patients with diabetes mellitus (DM) and COVID-19 infection at 9 months after acute infection. Methods: This single-center cross-sectional study was conducted from May 20 to June 1, 2021. Results: A total of 112 patients were included in the present study. The most frequently reported persistent symptoms among DM group were fatigue (p = 0.01), shortness of breath (p = 0.01), and chest pain (p = 0.02) compared to non-DM group. Sulfonylurea use was associated with persistent cough (p = 0.04). Conclusion: Long-term persistent symptoms of COVID-19 infection are common among patients with DM.

Blood indices, in-hospital outcome and short-term prognosis in patients with COVID-19 pneumonia.

The predictive role of blood indices in coronavirus disease 2019 (COVID-19) related in-hospital adverse outcomes and post-recovery status is not fully defined. The main aim was to assess the association of complete blood indices measured at baseline with COVID-19 related in-hospital clinical outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury and in-hospital death, and post-recovery status. This retrospective study included patients with newly diagnosed COVID-19 infection from August 20, to September 25, 2020. The initial study cohort included 127 patients with newly diagnosed COVID-19. Of whom 26 patients were excluded, leaving 101 patients for final analysis. low lymphocytes % [Odds ratio and confidence intervals = OR (CI)] [0.2(0.0-0.2, p=0.03] increased the odds of ICU stay length while high platelet mean volume (PMV) [0.9 (1.1-5, p<0.00], high platelet distribution width (PDW) [0.3(0.4-1.9), p<0.00], and low lymphocytes % [0.2 (0.0-0.2), p=0.02] increased the odds of length of hospital stay. Decreased lymphocytes % showed significant independent association with increased risk for mechanical ventilation use [0.9 (0.9-1), p=0.04], extensive degree of lung injury [0.2 (0.1-0.7), p<0.00], and in-hospital death [0.5 (0.3-0.8), p=0.01]. High lymphocytes %[0.9 (0.9-1), p<0.00] and high PMV [0.3 (0.3-0.8), p=0.02] were significantly associated with complete recovery while increased neutrophil % [1 (1-1.1), p=0.04] was associated with increased risk for post recovery fatigue. In conclusion, low lymphocytes % and high neutrophil % are useful markers for predicting adverse in-hospital outcome and post-recovery persistent fatigue, respectively. High PMV and lymphocyte % showed significant association with favorable short-term prognosis.

ECG markers of malignant arrhythmias and in-hospital outcome of COVID-19 pneumonia.

Background: ECG abnormalities associated with COVID-19 pneumonia and adverse outcome are undefined and poorly described in prior studies. Objectives: To assess the predictive role of baseline ECG markers of increased risk of malignant arrhythmias and cardiac death for adverse in-hospital outcomes. Patients and methods: A retrospective study included 93 patients of newly diagnosed COVID-19 with features consistent with pneumonia who were admitted to the hospital from August 20 to September 20, 2020. The main outcomes were defined as receiving mechanical ventilation, in-hospital cardiac arrest, length of ICU stay, and degree of lung damage according to computed tomography (CT) score. Results: Increased QTc (QT corrected) interval, Tp-e (T from peak to end) interval, and transmural dispersion of repolarization (TDR) were independent predictors of prolonged ICU stay (P < .0001) after adjustment for baseline clinical characteristics. Increasing age (P < .0001) followed by increased QTc interval (P = .02) and history of chronic lung disease (P = .04) were independent predictors of extensive lung damage. The independent predictors for in-hospital cardiac arrest were increased QTc (P = .02) followed by increasing age (P = .04) and increased Tp-e interval (P = .04). Conclusion: Repolarization abnormalities on baseline ECG may be useful prognostic markers in patients with COVID-19 pneumonia.

Electrocardiographic markers of increased risk of sudden cardiac death in patients with COVID-19 pneumonia.

BACKGROUND: Little is known about the role of ECG markers of increased risk of sudden cardiac death during the acute period of coronavirus disease 2019 ( COVID-19) pneumonia. OBJECTIVES: To evaluate ECG markers of sudden cardiac death on admission, including the index of cardiac electrophysiological balance (iCEB) (QTc/QRS) and transmural dispersion of repolarization (TDR) (T from peak to end (Tp-e) interval and Tp-e/QTc), in patients with COVID-19 pneumonia. PATIENTS AND METHODS: This cross-sectional study included 63 patients with newly diagnosed COVID-19 pneumonia who presented to the outpatient clinic or admitted to the respiratory care unit between August 20 and September 15, 2020. Forty-six persons matched for sex and age were selected from data collected before COVID-19 pandemic. RESULTS: QRS and QTc showed a significant prolongation in patients with COVID-19 pneumonia compared to the controls (87 vs. 78, p < .00, and 429 versus. 400, p < .00, respectively). After categorization of patients with COVID-19 pneumonia into 3 groups according to the severity of pneumonia as mild-moderate, severe, and critical groups, a decreased values of QRS were observed in the critical COVID-19 pneumonia group compared to severe and mild-moderate COVID-19 pneumonia groups (p = .04) while increased values of QTc and iCEB(QTc/QRS) were noted in critical COVID-19 pneumonia group compared to other 2 groups(p < .00). CONCLUSIONS: Patients with COVID-19 pneumonia showed significant changes in repolarization and conduction parameters compared to controls. Patients with mild to severe COVID-19 pneumonia may be at low risk for torsades de pointes development.

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq.

BACKGROUND AND AIMS: There is limited data about the prognosis and impact of COVID-19 pneumonia on patients with diabetes mellitus (DM). We aimed to assess blood indices, ECG markers of sudden death and malignant arrhythmias on admission, and diabetes lowering drugs as possible predictors of adverse in-hospital outcome and COVID-19 pneumonia recovery status. METHODS: A retrospective study included patients with newly diagnosed COVID-19 pneumonia from August 20, to October 5, 2020. RESULTS: A total of 192 patients with COVID-19 pneumonia were included in the present study, of whom 67 patients had DM. Low lymphocytes % [0.4(0.1-0.9), P = .011] and QTc interval prolongation [0.4(0.1-0.8), P = .022] were associated with increased length of ICU stay. On the other hand, metformin use [0.3(0.2-4), P = .032] and DPP-4 inhibitors use [0.3(0.2-3), P = .040] were associated with decreased length of ICU stay. QTc interval prolongation [0.4(0.1-0.9), P = .017] was associated with increased length of hospital stay, while using metformin [0.4(0.2-3), P = .022] was associated with decreased length of hospital stay. Low lymphocytes % [0.5(0.4-1.6), P = .001], insulin use [0.4(0.3-5), P = .003], and old age [0.5(0.1-2.3), P = .025] were associated with extensive lung injury. The risk for in-hospital death was associated with high neutrophil% [1(1-1.4), P = .045], while metformin use was associated with decreased risk for in-hospital death [0.1(0.1-0.6), P = .025]. Insulin use [0.3(0.2-4), P = .013] was associated with partial recovery following acute COVID pneumonia. CONCLUSIONS: Metformin and DPP-4 inhibitors use were associated with favorable in-hospital outcomes, while insulin use was associated with extensive lung injury and post-acute COVID-19 pneumonia partial recovery.

ECG changes and markers of increased risk of arrhythmia in patients with myocardial bridge.

BACKGROUND: The clinical significance and prognosis of myocardial bridge (MB) is still a matter of debate. OBJECTIVES: To assess the novel ECG markers of T peak-to-end (Tp-e) interval, transmural dispersion of repolarization (TDR), is assessed by Tp-e/QT ratio, and index of electrophysiogical index(iCEB),is defined by QT/QRS ratio and changes (ST-T changes) in MB patients. PATIENTS AND METHODS: Forty one patients who were diagnosed as having MB (MB group) and other 41 patients without MB (non-MB group) at multi-detector CT (MDCT) exam matched by age, sex were enrolled in the study. RESULTS: iCEB was significantly increased in MB group in comparison to non-MB group particularly in patients with no coronary atherosclerosis (5.3 Vs 4.5, p = 0.04). Tp-e and TDR values were decreased in MB in comparison to non-MB patients particularly in patients with coronary atherosclerosis (69 Vs 80, p = 0.003 and 0.18 Vs 0.2, p = 0.01 respectively). Isolated T inversion in V1 was observed more in MB compared to non-MB patients (58% Vs 5%, p ≤ 0.0001) particularly in patients without coronary atherosclerosis. CONCLUSION: MB patients have shown decreased Tp-e and TDR markers particularly in MB patients with coronary atherosclerosis.

ECG markers of arrythmogenic risk relationships with pericardial fat volume and BMI in patients with coronary atherosclerosis.

BACKGROUND: Several novel ECG markers are proposed to predict the risk of sudden cardiac death in several clinical conditions in the recent years. However, little is known about the association of pericardial fat or obesity with these markers. OBJECTIVES: To assess the possible relationship between pericardial fat volume (PFV) and body mass index (BMI) with novel ECG markers (Tp-e, Tp-e/QT, Tp-e/QTc*QRS and QTc/QRS) in patients with coronary atherosclerosis. PATIENTS AND METHODS: We enrolled 100 patients with suspected coronary artery disease who underwent 64-slice multi-detector CT angiography. RESULTS: Higher values of Tp-e/QTc*QRS and QTc/QRS were observed among high PFV group in comparison to low PFV group particularly in patient with coronary atherosclerosis and these relationships persisted after adjustment for cardiac risk factors and coronary calcium score (CAC) while no significant differences in QTc, Tp-e, Tp-e/QTc and Tp-e/QRS values were observed between the PFV groups in patients without coronary atherosclerosis. There was no significant difference in QTc, Tp-e/QTc, Tp-e/QRS, Tp-e/QTc*QRS and QTc/QRS observed between the BMI groups either in patients with and without coronary atherosclerosis. CONCLUSION: PFV and not obesity measured by BMI is significantly associated with novel ECG markers of arrhythmia risk in patients with coronary atherosclerosis. These results could suggest the potential role of PFV in cardiac arrhythmogenesis through depolarization-repolarization conduction abnormalities.

Index of cardiac electrophysiological balance and transmural dispersion of the repolarization index relationships with pericardial fat volume and coronary calcification.

AIM: To assess the possible relationship between coronary atherosclerosis markers, pericardial fat volume (PFV) and coronary artery calcification, with ECG markers of index of the cardiac electrophysiological balance (iCEB) and transmural dispersion of the repolarization in patients with suspected coronary artery disease. METHODOLOGY: One hundred patients who underwent 64-slice multidetector computed tomography angiography were found to be eligible and were enrolled in the study. RESULTS: Patients with high iCEB levels tended to have a higher PFV values compared with patients with low iCEB levels (median [interquartile range]) (152 [29-206] vs 96 [14-177]; p = 0.03). No significant differences in coronary artery calcification values were observed between iCEB and transmural dispersion of the repolarization groups. CONCLUSION: A higher PFV value was observed in patients with high iCEB. Larger prospective studies are required to confirm the results.