Hospitalized patients with breakthrough COVID-19: Clinical features and poor outcome predictors

Retrospective Evaluation of the Efficacy of Combined Antiviral Therapy Versus Monotherapy in High-Risk Hospitalized COVID-19 Patients

The COVID-19 pandemic has led to a variety of clinical symptoms, ranging from mild respiratory problems to severe pneumonia and multi-organ failure. Remdesivir and favipiravir are approved to treat COVID-19 and are used as single agents in the Ministry of Health (MOH) protocol. However, there is limited research available on the effectiveness of their combined use. The aim of this cross-sectional study is to evaluate the efficacy and safety of remdesivir and favipiravir in reducing disease severity, hospitalization duration, and mortality rates among high-risk patients who have been hospitalized with COVID-19. A retrospective, cross-sectional study was conducted in adult patients who were treated with the MOH treatment protocol. The study period was from January 2021 to January 2022, and it included 47 patients treated with favipiravir or a combination of remdesivir and favipiravir. The study included patients with high-risk characteristics and excluded pediatric and pregnant patients. In a study of 47 hospitalized COVID-19 patients, all admitted cases presented with at least one COVID-19 symptom. The frequency of symptoms such as fever, cough, chest pain, shortness of breath, and fatigue was noted to be, respectively. The median duration of antiviral therapy was seven days (interquartile range (IQR): five to eight days), and one-third of study participants developed side effects due to antiviral administration. The proportions of renal and hepatic side effects were found to be comparable (25.5% and 21.3%, respectively). Furthermore, the frequency of overall symptom improvement on completion of antiviral therapy was found to be 70.2%. An improvement in oxygen saturation was found to be significant with combined antiviral therapy. A total of 10 death events were reported during the study period, yielding 22 poor outcomes per 1000 person-days. COVID-19 patients taking combined therapy had significantly longer survival times compared to those taking a single agent (15 and 23 days, P > 0.05, respectively). The cumulative probability of survival at the end of the study period among those receiving single and combined therapy was found to be 29% and 38%, respectively. The findings from the present study showed that combined remdesivir and favipiravir have a superior effect than single favipiravir medication in treating high-risk hospitalized COVID-19 patients. These results highlight the clinical importance of combined antiviral regimens in enhancing patient prognoses, reducing mortality rates and shortening hospital stays.

Estimating COVID-19 associated hospitalizations, ICU admissions, and in-hospital deaths averted in the United States by 2023-2024 COVID-19 vaccination: A conditional probability, causal inference, and multiplier-based approach

COVID-19-associated hospitalizations, ICU admissions, and in-hospital deaths averted from 2023 to 2024 COVID-19 vaccination from the weeks of October 1, 2023, through April 21, 2024, were estimated via a novel multiplier model that utilized causal inference, conditional probabilities of hospitalization, and correlations between data elements in Monte Carlo simulations. Median COVID-19-associated hospitalizations averted were 68,315 (95 % uncertainty interval [UI] 42,831-97,984), ICU admissions averted were 13,108 (95 % UI 4459-25,042), and in-hospital deaths averted were 5301 (95 % UI 101-14,230). Averted COVID-19-associated burden was highest in adults aged 65 years and older (hospitalizations averted 57,665, 95 % UI 35,442-84,006; ICU admissions averted 10,878, 95 % UI 3104-21,591; in-hospital deaths averted 4779, 95 % UI 0-13,132). Expanding the analytic period to comprise the weeks of September 24, 2023, through August 11, 2024, resulted in 107,197 COVID-19-associated hospitalizations averted (95 % UI 80,692-137,643), 18,292 COVID-19-associated ICU admissions averted (95 % UI 10,062-28,436), and 6749 COVID-19-associated in-hospital deaths averted (95 % UI 2077-13,557). Older adults had the highest COVID-19-associated averted burden and potential to reduce burden further through increased vaccine coverage. 2023-2024 COVID-19 vaccinations reduced the burden of COVID-19-associated severe disease.

COVID-19 infection after vaccination

Background

Although vaccination is the most effective and specific approach for prevention of infectious diseases, but in a small percentage of vaccinated person's breakthrough infections can occur. This study aimed to determine the effectiveness of different common coronavirus vaccines in this area.

Methods

109 COVID-19 vaccinated patients were enrolled, with different types of vaccines (Sinopharm, AstraZeneca, Sputnic, Bharath, CovIran Barkat and Pasto-CoV) and time of administration in 2021 in Babol, Iran. Patients after 14 days of administration of the final dose of corona vaccines with positive COVID-19 RT-PCR test entered to study. Patients' data such as RT-PCR, type of vaccine, age, sex and outcome were collected using electronic medical records.

Results

47 patients were not fully vaccinated, 62 had two vaccine doses and 51 were fully vaccinated and considered to a breakthrough infection. Although, most of the patients with SARS-CoV-2 infection were either mild (n=18 [16.56%]), or moderate (n=86 [78.9%]), 5 (4.6%) patients had severe or critical illness, of whom 3 admitted in intensive care unit, 3 intubated, and 4 died. The average age of the participants with COVID-19 infections was 61.23 ± 19.91 years.

Conclusion

Based on our results, the COVID-19 breakthrough occurring with two doses of current vaccines were mild and moderate.

Neurological disorders throughout acute SARS-CoV2 infection: A comparative study between vaccinated and non-vaccinated patients

BACKGROUND

The role of vaccination on Covid-19 severity in neurological patients is still unknown. We aim at describing clinical characteristics and outcomes of breakthrough and unvaccinated Covid-19 patients hospitalized for neurological disorders.

METHODS

Two hundred thirty-two Covid-19 patients were admitted to a neuro-Covid Unit form March 1st 2021 to February 28th 2022. Out of the total sample, 74 (32%) were full vaccinated. The prevalence, clinical characteristics, disease severity, expressed by Brescia-COVID Respiratory Severity Scale (BCRSS) and National Early Warning Score 2 (NEWS2), and final outcomes of neurological syndromes were compared between vaccinated and unvaccinated cases. Cox regression analysis was implemented in order to investigate the combined effect of predictors of mortality.

RESULTS

Breakthrough vaccinated cases were older (years 72.4 ± 16.3 vs 67.0 ± 18.9 years, p = 0.029), showed higher pre-admission comorbidity score and Clinical Frailty scale score (4.46 ± 1.6 vs 3.75 ± 2.0, p = 0.008) with no differences in terms of disease progression or mortality rate (16.2% vs 15.2%), compared to full-dose vaccinated patients. Cox-regression analysis showed age and NEWS2 score as the variables with a significant relation to mortality between the two groups, independently from pre-morbid conditions and inflammatory response.

CONCLUSION

This study on breakthrough COVID-19 infection could help identify vulnerable neurological patients with higher risk of poor outcomes.

Vaccination Status and Outcome of Hospitalized Patients with Coronavirus Disease 2019 Before and After the Spread of Omicron Variant: An Observational Study from İzmir, Turkey

OBJECTIVE

Despite the efforts in vaccination against coronavirus disease 2019 (COVID-19), breakthrough infections occur and the need for hospitalization continues. We aimed to determine the relationship between severe acute respiratory syndrome coronavirus 2 vaccination and the severity of COVID-19 and mortality among hospitalized patients with COVID-19.

MATERIAL AND METHODS

This cross-sectional study was conducted between September 2021 and February 2022 in a university hos- pital in Turkey. Hospitalized patients with COVID-19 (both in clinics and in intensive care units), ≥18 years old, and who had no previous COVID-19 were included in the study. The demographic characteristics, clinical data, vaccination status, and outcome of the patients were analyzed retrospectively and the relationship between vaccination status and mortality was determined statistically.

RESULTS

Of the 674 patients, 180 (26.7%) had no vaccination, 282 (41.8%) had incomplete vaccination, and 212 (31.5%) were fully vaccinated according to the updated vaccination recommendations. While 44.0% of the patients were fully vaccinated before the occur- rence of omicron variant, 15.9% of the patients were fully vaccinated during the wave of the omicron variant. The patients with no vaccination were younger and had fewer comorbidities. The overall mortality was 31.8%. Under 50 years old, all the patients with fully vaccination survived and the patients with no vaccination or incomplete vaccination had higher (10.1%) mortality. During the omicron period, mortality was lower in fully vaccinated pateints.

CONCLUSION

Immunization with and booster doses of BNT162b2 should be encouraged to protect both healthy and vulnerable populations.

Evaluation of the Effects of Coronavirus Vaccination Status on Inpatient Demographics and Clinical and Laboratory Data

Background The coronavirus disease 2019 (COVID-19) pandemic has been largely controlled by vaccines. However, a notable increase in COVID-19 infections has been observed among vaccinated individuals. The protection conferred by vaccination remains a topic of ongoing discussion and research. Our study aims to assess the impact of vaccination status on the demographics, clinical presentations, and laboratory characteristics of patients who were admitted to the hospital and subsequently hospitalized for further evaluation and treatment. Methods We examined hospitalized COVID-19 patients in terms of demographics, immunization status, clinical and laboratory findings, and outcomes over a seven-month period during which the delta variant was prevalent. Patients were categorized into three groups based on their vaccination status: unvaccinated (n=1,321, 53.3%), partially vaccinated (n=214, 8.6%), and fully vaccinated (n=944, 38.1%). Data from these patients were compared across groups. Results The study included 2,479 polymerase chain reaction (PCR)-confirmed hospitalized COVID-19 patients. The median ages (range) for the unvaccinated, partially vaccinated, and fully vaccinated patients who required hospitalization due to COVID-19 infection were 51 (18-98), 61 (21-91), and 71 (23-99), respectively (p<0.001). White blood cell count, neutrophils, monocytes, platelet count, and inflammatory markers such as erythrocyte sedimentation rate, C-reactive protein, procalcitonin, and IL-6, as well as fibrinogen and troponin T levels, were observed to be higher in the fully vaccinated patients compared to the unvaccinated and partially vaccinated patients. Clinical follow-ups showed that the intensive care unit (ICU) admission rates, length of hospital stay, and mortality rates were also higher in the fully vaccinated group compared to the other groups. Conclusion Our findings indicate that full vaccination significantly reduces hospitalization rates in younger individuals with average risk. However, patients with high-risk factors, such as advanced age and multiple comorbidities, exhibited higher hospitalization rates, increased need for intensive care, longer hospital stays, elevated inflammatory markers, and higher mortality even when fully vaccinated. It is crucial for elderly patients to receive thorough evaluations during emergency visits and to be provided with early treatment to reduce potential morbidity and mortality.

SARS-CoV-2 vaccine breakthrough infection in the older adults: a meta-analysis and systematic review

BACKGROUND

Corona Virus Disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) has recently declined, and reports about COVID-19 breakthrough infection have increased. We aimed to conduct a meta-analysis on population-based studies of the prevalence and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection amongst older adults worldwide.

METHODS

Studies from PubMed, Embase, Cochrane Library, and Web of Science were systematically screened to determine the prevalence and incidence of SARS-CoV-2 breakthrough infection in older adults from inception to November 2, 2022. Our meta-analysis included 30 studies, all published in English. Pooled estimates were calculated using a random-effect model through the inverse variance method. Publication bias was tested through funnel plots and Egger's regression test, and sensitivity analyses were performed to confirm the robustness of the results. This research was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Thirty publications were included in this meta-analysis (17 on prevalence, 17 on incidence, and 4 on both). The pooled prevalence of COVID-19 breakthrough infection among older adults was 7.7 per 1,000 persons (95% confidence interval [95%CI] 4.0-15.0). At the same time, the pooled incidence was 29.1 per 1000 person-years (95%CI 15.2-55.7).

CONCLUSIONS

This meta-analysis provides estimates of prevalence and incidence in older adults. We concluded that the prevalence and incidence of SARS-CoV-19 breakthrough infection in older people was low. The prevalence and incidence of breakthrough infection admitted to hospital, severe-critical, and deathly was significantly lower. Otherwise, there was considerable heterogeneity among estimates in this study, which should be considered when interpreting the results.

Short-term exposure to ambient air pollution and COVID-19 severity during SARS-CoV-2 Delta and Omicron waves: A multicenter study

Air pollution may affect the clinical course of respiratory diseases, including COVID-19. This study aimed to evaluate the relationship between exposure of adult patients to mean 24 h levels of particulate matter sized <10 μm (PM₁₀ ) and <2.5 μm (PM_2.5 ) and benzo(a)pyrene (B(a)P) during a week before their hospitalization due to SARS-CoV-2 infection and symptomatology, hyperinflammation, coagulopathy, the clinical course of disease, and outcome. The analyses were conducted during two pandemic waves: (i) dominated by highly pathogenic Delta variant (n = 1440) and (ii) clinically less-severe Omicron (n = 785), while the analyzed associations were adjusted for patient's age, BMI, gender, and comorbidities. The exposure to mean 24 h B(a)P exceeding the limits was associated with increased odds of fever and fatigue as early COVID-19 symptoms, hyperinflammation due to serum C-reactive protein >200 mg/L and interleukin-6 >100 pg/mL, coagulopathy due to  d-dimer >2 mg/L and fatal outcome. Elevated PM₁₀ and PM_{2. 5} levels were associated with higher odds of respiratory symptoms, procalcitonin >0.25 ng/mL and interleukin >100 pg/mL, lower oxygen saturation, need for oxygen support, and death. The significant relationships between exposure to air pollutants and the course and outcomes of COVID-19 were observed during both pandemic waves. Short-term exposure to elevated PM and B(a)P levels can be associated with a worse clinical course of COVID-19 in patients requiring hospitalization and, ultimately, contribute to the health burden caused by SARS-CoV-2 variants of higher and lower clinical significance.

Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2

The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm³; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm³ or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.

Associations between underlying diseases with COVID-19 and its symptoms among adults: a cross-sectional study

Background

Specific underlying diseases were reported to be associated with severe COVID-19 outcomes, but little is known about their combined associations. The study was aimed to assess the relations of number of and specific underlying diseases to COVID-19, severe symptoms, loss of smell, and loss of taste.

Methods

A total of 28,204 adult participants in the National Health Interview Survey 2021 were included. Underlying diseases (including cardiovascular diseases, cancer, endocrine diseases, respiratory diseases, neuropsychiatric diseases, liver and kidney diseases, fatigue syndrome, and sensory impairments), the history of COVID-19, and its symptoms were self-reported by structured questionnaires. Multivariable logistic regression models were used to assess the combined relation of total number of underlying diseases to COVID-19 and its symptoms, while mutually adjusted logistic models were used to examine their independent associations.

Results

Among the 28,204 participants (mean ± standard deviation: 48.2 ± 18.5 years), each additional underlying disease was related to 33, 20, 37, and 39% higher odds of COVID-19 (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.29-1.37), severe symptoms (OR: 1.20, 95% CI: 1.12-1.29), loss of smell (OR: 1.37, 95% CI: 1.29-1.46), and loss of taste (OR: 1.39, 95% CI: 1.31-1.49). In addition, independent associations of sensory impairments with COVID-19 (OR: 3.73, 95% CI: 3.44-4.05), severe symptoms (OR: 1.37, 95% CI: 1.13-1.67), loss of smell (OR: 8.17, 95% CI: 6.86-9.76), and loss of taste (OR: 6.13, 95% CI: 5.19-7.25), cardiovascular diseases with COVID-19 (OR: 1.13, 95% CI: 1.03-1.24), neuropsychiatric diseases with severe symptoms (OR: 1.41, 95% CI: 1.15-1.74), and endocrine diseases with loss of taste (OR: 1.28, 95% CI: 1.05-1.56) were observed.

Conclusion

A larger number of underlying diseases were related to higher odds of COVID-19, severe symptoms, loss of smell, and loss of taste in a dose-response manner. Specific underlying diseases might be individually associated with COVID-19 and its symptoms.

Clinical features and severe outcome predictors of COVID-19 vaccine breakthrough infection among hospitalized patients: results from Egypt severe acute respiratory infections sentinel surveillance, 2021-2022

BACKGROUND

COVID-19 vaccines are effective against infections and outcomes; however, breakthrough infections (VBT) are increasingly reported, possibly due to waning of vaccine-induced immunity or emerging variants. Most studies have focused on determining VBT rate based on antibody levels. This study aims at describing clinical features, risks, time trends, and outcomes of COVID-19 VBT among hospitalized patients in Egypt.

METHODS

Data of SARS-CoV-2 confirmed patients hospitalized in 16 hospitals was obtained from the severe acute respiratory infections surveillance database, September 2021-April 2022. Data includes patients' demographics, clinical picture, and outcomes. Descriptive analysis was performed and patients with VBT were compared to not fully vaccinated (UPV). Bivariate and multivariate analyses were performed using Epi Info7 with a significance level < 0.05 to identify VBT risk factors.

RESULTS

Overall, 1,297 patients enrolled, their mean age 56.7 ± 17.0 years, 41.5% were males, 64.7% received inactivated, 25.% viral vector, and 7.7% mRNA vaccine. VBT was identified in 156(12.0%) patients with an increasing trend over time. VBT significantly was higher in (16-35 years) age, males, in those who received inactivated vaccine compared to corresponding groups of UPV (14.1 vs. 9.0%, p < 0.05 and 57.1 vs. 39.4%, p < 0.001 and 64.7 vs. 45.1, p < 0.01 respectively). Whereas receiving mRNA vaccine was significantly protective against VBT (7.7 vs. 21.6%, p < 001). VBT patients tend to have shorter hospital stays and lower case fatality (mean hospital days = 6.6 ± 5.5 vs. 7.9 ± 5.9, p < 0.01 and CFR = 28.2 vs. 33.1, p < 0.01 respectively). MVA identified younger ages, male gender, and inactivated vaccines as risks for VBT.

CONCLUSION

The study indicated that COVID-19 vaccines significantly reduce hospital days and fatality. VBT trend is on the rise and males, young ages, and inactivated vaccine receivers are at higher risk. Caution regarding relaxation of personal preventive measures in areas with higher or increasing incidences of COVID-19, particularly for the at-risk group even if they are vaccinated. The vaccination strategy should be revised to reduce VBT rate and increase vaccine effectiveness.

Validation of the RIM Score-COVID in the Spanish SEMI-COVID-19 Registry

The significant impact of COVID-19 worldwide has made it necessary to develop tools to identify patients at high risk of severe disease and death. This work aims to validate the RIM Score-COVID in the SEMI-COVID-19 Registry. The RIM Score-COVID is a simple nomogram with high predictive capacity for in-hospital death due to COVID-19 designed using clinical and analytical parameters of patients diagnosed in the first wave of the pandemic. The nomogram uses five variables measured on arrival to the emergency department (ED): age, sex, oxygen saturation, C-reactive protein level, and neutrophil-to-platelet ratio. Validation was performed in the Spanish SEMI-COVID-19 Registry, which included consecutive patients hospitalized with confirmed COVID-19 in Spain. The cohort was divided into three time periods: T1 from February 1 to June 10, 2020 (first wave), T2 from June 11 to December 31, 2020 (second wave, pre-vaccination period), and T3 from January 1 to December 5, 2021 (vaccination period). The model's accuracy in predicting in-hospital COVID-19 mortality was assessed using the area under the receiver operating characteristics curve (AUROC). Clinical and laboratory data from 22,566 patients were analyzed: 15,976 (70.7%) from T1, 4,233 (18.7%) from T2, and 2,357 from T3 (10.4%). AUROC of the RIM Score-COVID in the entire SEMI-COVID-19 Registry was 0.823 (95%CI 0.819-0.827) and was 0.834 (95%CI 0.830-0.839) in T1, 0.792 (95%CI 0.781-0.803) in T2, and 0.799 (95%CI 0.785-0.813) in T3. The RIM Score-COVID is a simple, easy-to-use method for predicting in-hospital COVID-19 mortality that uses parameters measured in most EDs. This tool showed good predictive ability in successive disease waves.

Sustained Cytotoxic Response of Peripheral Blood Mononuclear Cells from Unvaccinated Individuals Admitted to the ICU Due to Critical COVID-19 Is Essential to Avoid a Fatal Outcome

The main objective of this study was to determine the influence of the cytotoxic activity of peripheral blood mononuclear cells (PBMCs) on the outcome of unvaccinated individuals with critical COVID-19 admitted to the ICU. Blood samples from 23 individuals were collected upon admission and then every 2 weeks for 13 weeks until death (Exitus group) (n = 13) or discharge (Survival group) (n = 10). We did not find significant differences between groups in sociodemographic, clinical, or biochemical data that may influence the fatal outcome. However, direct cellular cytotoxicity of PBMCs from individuals of the Exitus group against pseudotyped SARS-CoV-2-infected Vero E6 cells was significantly reduced upon admission (-2.69-fold; p = 0.0234) and after 4 weeks at the ICU (-5.58-fold; p = 0.0290), in comparison with individuals who survived, and it did not improve during hospitalization. In vitro treatment with IL-15 of these cells did not restore an effective cytotoxicity at any time point until the fatal outcome, and an increased expression of immune exhaustion markers was observed in NKT, CD4+, and CD8+ T cells. However, IL-15 treatment of PBMCs from individuals of the Survival group significantly increased cytotoxicity at Week 4 (6.18-fold; p = 0.0303). Consequently, immunomodulatory treatments that may overcome immune exhaustion and induce sustained, efficient cytotoxic activity could be essential for survival during hospitalization due to critical COVID-19.

Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment

BACKGROUND

COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures.

METHODS

The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay.

RESULTS

The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death.

CONCLUSIONS

In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.

COVID-19 Breakthrough Infections among Patients Aged ≥65 Years in Serbia: Morbidity and Mortality Overview

BACKGROUND: Vaccines against severe acute respiratory syndrome coronavirus 2 have shown effectiveness in the prevention of COVID-19. Breakthrough infections occur, and age has been shown to be one of the dominant risk factors for poorer outcome. This research focuses on characteristics of breakthrough infections in older adults. METHODS: This retrospective study was conducted for four months (March−June 2021) in the autonomous province of Vojvodina in Serbia on 11,372 patients using reverse-transcription polymerase chain reaction or antigen-detection rapid diagnostic tests verifying COVID-19 in those aged ≥65 years. Demographics, comorbidities, disease severity, and final outcomes were evaluated in fully vaccinated compared to unvaccinated individuals. Individuals were divided into younger-old (65−74 years) and older-old (≥75 years) age groups and differences between those groups were further evaluated. Binary logistic regression was performed to identify independent predictors of poor outcome. RESULTS: By the end of the research, 51.3% of the population of APV 65−74 years, as well as 46.2% of those older than 74 years, were vaccinated. From the acquired sample, 17.4% had breakthrough infection. Asymptomatic forms were higher in both age groups of vaccinated vs. unvaccinated (3.9%—younger-old, 6.3%—older-old vs. 2.9%—younger-old, 3.9%—older-old). The same results were registered with mild symptoms (82.1%—younger-old, 68.1%—older-old vs. 76.3%—younger-old, 57.5%—older-old) (p < 0.001). The case fatality ratio of the vaccinated population was smaller than the unvaccinated population in both groups (3.1% vs. 7.9%—younger-old; 11.4% vs. 22.5%—older-old) (p < 0.001). The odds ratio for poor outcome in unvaccinated individuals was 2.3 (95% confidence interval, p < 0.001) for the total sample. CONCLUSIONS: An increase in asymptomatic and mild forms, as well as decrease in severe or critical forms and poor outcomes, were noted in the vaccinated population. Choosing to avoid vaccination against SARS-CoV-2 may increase the chance of poor outcome in older individuals.

Expanding the spectrum of the hyperferritinemic syndrome, from pathogenic mechanisms to clinical observations, and therapeutic implications

From the introduction of hyperferritinemic syndrome concept, a growing body of evidence has suggested the role of ferritin as a pathogenic mediator and a relevant clinical feature in the management of patients with inflammatory diseases. From a pathogenic point of view, ferritin may directly stimulate the aberrant immune response by triggering the production of pro-inflammatory mediators in inducing a vicious pathogenic loop and contributing to the occurrence of cytokine storm syndrome. The latter has been recently defined as a clinical picture characterised by elevated circulating cytokine levels, acute systemic inflammatory symptoms, and secondary organ dysfunction beyond that which could be attributed to a normal response to a pathogen It is noteworthy that the occurrence of hyperferritinemia may be correlated with the development of the cytokine storm syndrome in the context of an inflammatory disease. In addition to adult onset Still's disease, macrophage activation syndrome, catastrophic anti-phospholipids syndrome, and septic shock, recent evidence has suggested this association between ferritin and life-threatening evolution in patients with systemic lupus erythematosus, with anti-MDA5 antibodies in the context of poly-dermatomyositis, with severe COVID-19, and with multisystem inflammatory syndrome. The possible underlying common inflammatory mechanisms, associated with hyperferritinemia, may led to the similar clinical picture observed in these patients. Furthermore, similar therapeutic strategies could be suggested inhibiting pro-inflammatory cytokines and improving long-term outcomes in these disorders. Thus, it could be possible to expand the spectrum of the hyperferritinemic syndrome to those diseases burdened by a dreadful clinical picture correlated with hyperferritinemia and the occurrence of the cytokine storm syndrome. In addition, the assessment of ferritin may provide useful information to the physicians in clinical practice to manage these patients. Therefore, ferritin may be considered a relevant clinical feature to be used as biomarker in dissecting the unmet needs in the management of these disorders. Novel evidence may thus support an expansion of the spectrum of the hyperferritinemic syndrome to these diseases burdened by a life-threatening clinical picture correlated with hyperferritinemia and the occurrence of the cytokine storm syndrome.