Long term follow-up of a multicentre cohort of COVID-19 patients with pulmonary embolism: Anticoagulation management and outcomes

Long COVID update: respiratory sequelae and symptoms

PURPOSE OF REVIEW

Long COVID affects approximately 6% of the population after SARS-CoV-2 infection commonly involving persistent respiratory symptoms such as breathlessness and cough. This review provides an update on the latest evidence regarding post-COVID condition/Long COVID and respiratory sequelae, focusing on persistent symptoms, respiratory complications, and therapeutic approaches to date.

RECENT FINDINGS

Post-COVID interstitial lung abnormalities are estimated to persist in approximately 11% of patients hospitalized with acute COVID-19. However, breathlessness is common in adults (non-hospitalized) with Long COVID, suggesting aetiologies beyond pneumonitis. The risk of venous thromboembolic disease in Long COVID remains uncertain and trial results of anti-coagulation in Long COVID are awaited.

SUMMARY

Long COVID presents complex respiratory challenges, and careful assessment is crucial to differentiate Long COVID symptoms from exacerbations of pre-existing respiratory conditions. Current management includes a symptom-based multidisciplinary approach, with ongoing research into effective treatments including immune modulating agents.

Prognostic factors in hospitalized patients with COVID-19 pneumonia and effectiveness of prophylactic anticoagulant therapy: a single-center retrospective study

BACKGROUND

COVID-19 pneumonia patients encounter the potential risk of venous thromboembolism (VTE) and mortality during hospitalization. This study aimed to analyzed risk factors of all-cause mortality in hospitalized patients with COVID-19 pneumonia, and investigated the effectiveness of prophylactic anticoagulation and hospital stays on the mortality in hospitalized patients with nonVTE.

METHODS

We retrospectively analyzed all COVID-19 pneumonia patients who were admitted to our medical center from December 2022 to January 2023. Clinical data and outcome events were collected from patients' electronic medical records. Cox regression was used to identify poor prognostic factors of COVID-19 pneumonia patients with VTE and nonVTE. Landmark analysis was conducted to identify time points of hospital stays between anticoagulation treatment and in-hospital survival outcomes in COVID-19 pneumonia patients with nonVTE. Binary logistic regression analysis was performed to investigate factors related to prolonged hospital stays.

RESULTS

Among 2,520 COVID-19 pneumonia patients, 1047 received prophylactic anticoagulation and 76 complicated with VTE during hospitalization. Survival curve analysis showed no statistically significant difference in mortality between COVID-19 pneumonia patients with VTE and nonVTE in prophylactic anticoagulant group (P = 0.63). Multivariate cox regression analysis revealed that male(HR = 1.398, 95%CI= [1.021,1.915]), BMI (HR = 0.935, 95%CI= [0.900,0.972]), lymphocytes (HR = 0.576, 95%CI= [0.409,0.809]), platelets (HR = 0.997, 95%CI= [0.995,0.999]), albumin (HR = 0.950, 95%CI= [0.926,0.975]), lactate dehydrogenase (HR = 1.001, 95%CI= [1.001,1.002]) were risk factors for mortality in COVID-19 pneumonia patients with nonVTE, while sCRP (HR = 1.010, 95%CI= [1.004,1.015]), anticoagulant therapy (HR = 0.247, 95%CI= [0.096,0.632]) were risk factors for mortality in COVID-19 pneumonia patients with VTE. Landmark analysis showed that for the hospital stays of 11 days, the difference in the impact of prophylactic anticoagulation on mortality was statistically significant in COVID-19 pneumonia patients with nonVTE (≤ 11days, P = 0.014; > 11days, P = 0.01). CVD (OR = 1.717, 95%CI= [1.248,2.363]), CRD (OR = 1.605, 95%CI= [1.133,2.274]), sCRP (OR = 1.003, 95%CI= [1.000,1.006]), Alb (OR = 0.959, 95%CI = [0.932,0.987]) and use of glucocorticoid (OR = 1.428, 95%CI= [1.057,1.930]) were independent factors associated with hospital stays > 11 days in anticoagulant group.

CONCLUSIONS

This study indicated that Male, lower BMI, peripheral blood lymphocytes, platelets, albumin and elevated lactate dehydrogenase were associated with poor hospitalisation outcomes in COVID-19 pneumonia patients with nonVTE. As for COVID-19 pneumonia patients with VTE, poor hospitalisation outcomes were associated with elevated sCRP levels and no given anticoagulant therapy. No significant difference in mortality between hospitalized COVID-19 pneumonia patients with VTE and nonVTE when receiving prophylactic anticoagulation. Prolonged hospital stays (> 11 days) may limit the effectiveness of prophylactic anticoagulation on lower in-hospital mortality for COVID-19 pneumonia patients with nonVTE.

Risk of bleeding in pulmonary embolism patients concomitant with COVID-19 undergoing extended anticoagulation: A multicenter cohort study

INTRODUCTION

The impact of Coronavirus disease 2019 (COVID-19) on clinical outcomes in pulmonary embolism (PE) patients receiving extended anticoagulation therapy is not fully understood. The study aimed to investigate the impact of the Omicron outbreak on patients with PE receiving extended anticoagulation therapy.

MATERIALS AND METHODS

This prospective multicenter cohort study was conducted during the Omicron pandemic. Patients diagnosed with PE between January 1, 2016, and September 1, 2022, who were on extended anticoagulation therapy, were recruited. The study compared VTE recurrence and bleeding events between COVID-19 and non-COVID-19 patients, using the propensity score weighting with overlap weights (PSOW) method for the final analysis.

RESULTS

A total of 521 patients with PE receiving extended anticoagulation therapy were enrolled. Patients suffering from COVID-19 had significantly higher bleeding rates (10.5 % vs 2.1 %, p = 0.001), with consistent results after PSOW (OR = 4.79, 95%CI [1.04-22.21], p = 0.045). No significant differences in VTE recurrence were observed between these two groups before and after weighting. During follow-up, 31 % of patients developed long COVID, with higher bleeding rates (14.6 % vs 3.5 %, p < 0.001). After PSOW, there was a significantly increased bleeding risk in patients with long COVID (HR = 3.29, 95%CI [1.28, 8.49]); Log-Rank test p < 0.001). Furthermore, a prior history of active malignancy (OR = 9.3; 95%CI [1.38, 59.98]), chronic kidney disease (OR = 13.98; 95%CI [1.59, 122.27]) and bleeding occurred during the acute phase of COVID-19 (OR = 23.73; 95%CI [5.20, 108.35]) were independent predictors of bleeding in patients with long COVID.

CONCLUSIONS

COVID-19 and long COVID are associated with an increased bleeding risk in PE patients undergoing extended anticoagulation therapy. This study emphasizes the need for close monitoring and optimization of anticoagulation strategies in PE patients.

Treatment and long term follow-up results in patients with pulmonary vascular thrombosis related to COVID-19

Pulmonary embolism is a complication of COVID-19 infection. The aim of this study is to assess prognosis and treatment response, including incidences of chronicity, relapse, and mortality among outpatients diagnosed with COVID-19-related pulmonary embolism between 2020 and 2022. A total of 101 patients with pulmonary embolism, started on anticoagulation during or within a month of COVID-19 infection, were included after testing positive by PCR. Data about comorbidities, Pulmonary Embolism Severity Index scores, PE diagnostic modalities, biochemical parameters, and transthoracic echocardiographic findings at diagnosis and at 24-month follow-up were collected. Cardiac catheterization parameters were recorded and compared between groups at diagnosis and at the 24-month follow-up. Groups were comparable with respect to gender, age, body mass index, and comorbidity score. Use of Q-SPECT for diagnosis was found significantly higher in patients with COVID-19-related pulmonary embolism (P < .001). The incidence of deep vein thrombosis was similar. In the study group, 43.6% of patients received anticoagulants for 3 months, with 49.1% using low molecular weight heparin and 50.9% using direct oral anticoagulants. At 24 months, rate of patients continuing treatment was comparable between groups. Specific pulmonary artery blockage value was found to be higher in patients with chronic thromboembolic pulmonary hypertension compared to those who demonstrated a response to pulmonary embolism treatment (P = .009). No adverse effects of anticoagulant therapy were observed during course of treatment. Over 24-month follow-up period, mortality, relapse, chronic thromboembolic hypertension and thromboembolic disease was observed in 2%, 2.2%, 4.9%, and 9.9% of patients, respectively.

Genetic correlations, shared risk genes and immunity landscapes between COVID-19 and venous thromboembolism: evidence from GWAS and bulk transcriptome data

BACKGROUND

Patients with coronavirus disease 2019 (COVID-19) were vulnerable to venous thromboembolism (VTE), which further increases the risk of unfavorable outcomes. However, neither genetic correlations nor shared genes underlying COVID-19 and VTE are well understood.

OBJECTIVE

This study aimed to characterize genetic correlations and common pathogenic mechanisms between COVID-19 and VTE.

METHODS

We used linkage disequilibrium score (LDSC) regression and Mendelian Randomization (MR) analysis to investigate the genetic associations and causal effects between COVID-19 and VTE, respectively. Then, the COVID-19 and VTE-related datasets were obtained from the Gene Expression Omnibus (GEO) database and analyzed by bioinformatics and systems biology approaches with R software, including weighted gene co-expression network analysis (WGCNA), enrichment analysis, and single-cell transcriptome sequencing analysis. The miRNA-genes and transcription factor (TF)-genes interaction networks were conducted by NetworkAnalyst. We performed the secondary analysis of the ATAC-seq and Chip-seq datasets to address the epigenetic-regulating relationship of the shared genes.

RESULTS

This study demonstrated positive correlations between VTE and COVID-19 by LDSC and bidirectional MR analysis. A total of 26 potential shared genes were discovered from the COVID-19 dataset (GSE196822) and the VTE dataset (GSE19151), with 19 genes showing positive associations and 7 genes exhibiting negative associations with these diseases. After incorporating two additional datasets, GSE164805 (COVID-19) and GSE48000 (VTE), two hub genes TP53I3 and SLPI were identified and showed up-regulation and diagnostic capabilities in both illnesses. Furthermore, this study illustrated the landscapes of immune processes in COVID-19 and VTE, revealing the downregulation in effector memory CD8+ T cells and activated B cells. The single-cell sequencing analysis suggested that the hub genes were predominantly expressed in the monocytes of COVID-19 patients at high levels. Additionally, we identified common regulators of hub genes, including five miRNAs (miR-1-3p, miR-203a-3p, miR-210-3p, miR-603, and miR-124-3p) and one transcription factor (RELA).

CONCLUSIONS

Collectively, our results highlighted the significant correlations between COVID-19 and VTE and pinpointed TP53I3 and SLPI as hub genes that potentially link the severity of both conditions. The hub genes and their common regulators might present an opportunity for the simultaneous treatment of these two diseases.

Investigation of the electrochemical properties of edoxaban using glassy carbon and boron-doped diamond electrodes and development of an eco-friendly and cost effective voltammetric method for its determination

In this study, the highly risky drug Edoxaban (EDX), which can threaten life and cause bleeding, was electro analytically evaluated. The electrochemical behavior of EDX was investigated using glassy carbon electrode (GCE) and boron-doped diamond electrode (BDDE). In this study, for the first time, a simple, rapid, sensitive, and selective voltammetric technique was developed by using different electrodes for the electrochemical characterization and detection of EDX. The optimized voltammetric technique showed anodic signals of EDX at +1.09 V and +1.08 V on GCE and BDDE, respectively, in BR (pH 5.0) solution. The developed voltammetric method provided a very good analytical working range for EDX in BR (pH 5.0) solution on GCE and BDDE, covering concentration ranges from 1.84 μM to 12.88 μM and from 3.68 μM to 14.72 μM, respectively. The limits of detection for EDX on GCE and BDDE under these experimental conditions were calculated as 0.24 μM and 0.57 μM, respectively. The developed voltammetric methods on both electrodes were successfully applied to urine and tablet samples. Additionally, the obtained voltammetric results were compared with UV-Vis spectroscopy results.