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Machowski M, Ou-Pokrzewińska A, Perzanowska-Brzeszkiewicz K, Gałecka-Nowak M, Pacho S, Jermakow M, Wójcik A, Zoruk M, Pruszczyk A, Deutsch K, Roik M, Łabyk A, Palczewski P, Pruszczyk P. Predicting Acute Cardiovascular Complications in COVID-19: Insights from a Specialized Cardiac Referral Department. Med Sci Monit 2024; 30:e942612. [PMID: 38644597 PMCID: PMC11047208 DOI: 10.12659/msm.942612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND COVID-19 increases the risk of acute cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), acute pulmonary embolism (APE), and acute myocarditis (AMyo). The actual impact of CVDs on mortality of patients with COVID-19 remains unknown. This study aimed to determine whether CVDs influence the course of COVID-19 pneumonia and if they can be easily detected by using common tests and examinations. MATERIAL AND METHODS Data of 249 consecutive patients with COVID-19 hospitalized in a dedicated cardiology department were analyzed. On admission, clinical status, biomarkers, computed tomography, and bedside echocardiography were performed. RESULTS D-dimer level predicted APE (AUC=0.850 95% CI [0.765; 0.935], P<0.001) with sensitivity of 69.4% and specificity of 96.2% for a level of 4968.0 ng/mL, and NT-proBNP predicted AMyo (AUC=0.692 95% CI [0.502; 0.883], P=0.004) and showed sensitivity of 54.5%, with specificity of 86.5% for the cut-off point of 8970 pg/mL. Troponin T levels were not useful for diagnostic differentiation between CVDs. An extent of lung involvement predicted mortality (OR=1.03 95% CI [1.01;1.04] for 1% increase, P<0.001). After adjusting for lung involvement, ACS increased mortality, compared with COVID-19 pneumonia only (OR=5.27 95% CI [1.76; 16.38] P=0.003), while APE and AMyo did not affect risk for death. CONCLUSIONS D-dimer and NT-proBNP, but not troponin T, are useful in differentiating CVDs in patients with COVID-19. ACS with COVID-19 increased in-hospital mortality independently from extent of lung involvement, while coexisting APE or AMyo did not.
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Affiliation(s)
- Michał Machowski
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Aisha Ou-Pokrzewińska
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Perzanowska-Brzeszkiewicz
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Gałecka-Nowak
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Pacho
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Jermakow
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Wójcik
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Milena Zoruk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Karol Deutsch
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Łabyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
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Bomfim LN, de Barros CRA, Veloso FCS, Micheleto JPC, Melo KA, Gonçalves IS, Kassar SB, Oliveira MJC. Chest computed tomography findings of patients infected with Covid-19 and their association with disease evolution stages. Radiography (Lond) 2023; 29:1093-1099. [PMID: 37757676 DOI: 10.1016/j.radi.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION To describe CT findings in patients with confirmed Covid-19 infection and correlate them with the disease evolution stages. METHODS This is a historical cohort observational analytical study carried out with outpatients, inpatients, and emergency patients from a private hospital in Maceió/AL, Brazil. The final sample consisted of 390 patients with positive RT-PCR for Covid-19 with available laboratory tests and chest CT results. RESULTS The most frequent initial symptoms were cough, fever, dyspnea and headache. The most commonly found comorbidities were hypertension, diabetes mellitus and obesity. A total of 22% of the CT scans showed no alterations; ground-glass opacity was the most frequently found one. There was a significant association between age, comorbidities, pulmonary involvement, ground-glass opacity, mosaic attenuation and percentage of pulmonary involvement with death. The analysis of the disease stages showed a significant association with laboratory data (CRP and platelet levels), ground-glass opacity and mosaic attenuation with the disease evolution stages in relation to the days since symptom onset. CONCLUSION The disease evolution of Covid-19 occurs in stages, and this study describes tomographic findings in patients with confirmed Covid-19 infection and shows they vary depending on the disease evolution stages. IMPLICATIONS FOR PRACTICE This paper provides important addition to the various records that have been accumulated through the Covid-19 pandemic.
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Affiliation(s)
- L N Bomfim
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - C R A de Barros
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - F C S Veloso
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - J P C Micheleto
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - K A Melo
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - I S Gonçalves
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - S B Kassar
- Av. Comendador Gustavo Paiva, 5017, Cruz das Almas, Maceió, AL, Cep 57038-000, Brazil.
| | - M J C Oliveira
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
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Peixoto D, Neves Y, Generoso G, Loureiro B, Callia J, Anastácio V, Alves J, Oshiro E, Lima L, Sawamura M, Auad R, Bittencourt M, Abdala E, Ibrahim K. Validation of the North America expert consensus statement on reporting CT findings for COVID-19 in individuals with lung cancer. Braz J Med Biol Res 2023; 55:e12376. [PMID: 36629525 PMCID: PMC9828872 DOI: 10.1590/1414-431x2022e12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/03/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of our study was to validate the use of the standardized Radiological Society of North America (RSNA) reporting system in individuals with known lung cancer who presented to the emergency department with suspected COVID-19. We included patients aged 18 years or older from the Cancer Institute of the State of São Paulo (ICESP) with a confirmed diagnosis of lung cancer, admitted to the emergency department and undergoing chest computed tomography (CT) for suspicion of COVID-19. Comparison between SARS-CoV2 RT-PCR across RSNA categories was performed in all patients and further stratified by diagnosis of lung cancer progression. Among 58 individuals included in the analysis (65±9 years, 43% men), 20 had positive RT-PCR. Less than a half (43%) had no new lung findings in the CT. Positive RT-PCR was present in 75% of those with typical findings according to RSNA and in only 9% when these findings were classified as atypical or negative (P<0.001). Diagnostic accuracy was even higher when stratified by the presence or absence of progressive disease (PD). Extent of pulmonary inflammatory changes was strongly associated with higher mortality, reaching a lethality of 83% in patients with >25% of lung involvement and 100% when there was >50% of lung involvement. The lung involvement score was also highly predictive of prognosis in this population as was reported for non-lung cancer individuals. Collectively, our results demonstrated that diagnostic and prognostic values of chest CT findings in COVID-19 are robust to the presence of lung abnormalities related to lung cancer.
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Affiliation(s)
- D. Peixoto
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Y.C.S. Neves
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - G. Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B.M.C. Loureiro
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J.P.B. Callia
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V.M. Anastácio
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J.L. Alves
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E.M. Oshiro
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.R. Lima
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M.V.Y. Sawamura
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R.V. Auad
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M.S. Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E. Abdala
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K.Y. Ibrahim
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Wada N, Li Y, Hino T, Gagne S, Valtchinov VI, Gay E, Nishino M, Madore B, Guttmann CRG, Bond S, Ishigami K, Hunninghake GM, Levy BD, Kaye KM, Christiani DC, Hatabu H. COVID-19 Vaccination reduced pneumonia severity. Eur J Radiol Open 2022; 9:100456. [PMID: 36386765 DOI: 10.1016/j.ejro.2022.100456] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the effect of vaccinations and boosters on the severity of COVID-19 pneumonia on CT scans during the period of Delta and Omicron variants. Methods Retrospectively studied were 303 patients diagnosed with COVID-19 between July 2021 and February 2022, who had obtained at least one CT scan within 6 weeks around the COVID-19 diagnosis (-2 to +4 weeks). The severity of pneumonia was evaluated with a 6-point scale Pneumonia Score. The association between demographic and clinical data and vaccination status (booster/additional vaccination, complete vaccination and un-vaccination) and the difference between Pneumonia Scores by vaccination status were investigated. Results Of 303 patients (59.4 ± 16.3 years; 178 females), 62 (20 %) were in the booster/additional vaccination group, 117 (39 %) in the complete vaccination group, and 124 (41 %) in the unvaccinated group. Interobserver agreement of the Pneumonia Score was high (weighted kappa score = 0.875). Patients in the booster/additionally vaccinated group tended to be older (P = 0.0085) and have more underlying comorbidities (P < 0.0001), and the Pneumonia Scores were lower in the booster/additionally vaccinated [median 2 (IQR 0-4)] and completely vaccinated groups [median 3 (IQR 1-4)] than those in the unvaccinated group [median 4 (IQR 2-4)], respectively (P < 0.0001 and P < 0.0001, respectively). A multivariable linear analysis adjusted for confounding factors confirmed the difference. Conclusion Vaccinated patients, with or without booster/additional vaccination, had milder COVID-19 pneumonia on CT scans than unvaccinated patients during the period of Delta and Omicron variants. This study supports the efficacy of the vaccine against COVID-19 from a radiological perspective.
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Castro MA, Reza S, Chu WT, Bradley D, Lee JH, Crozier I, Sayre PJ, Lee BY, Mani V, Friedrich TC, O’Connor DH, Finch CL, Worwa G, Feuerstein IM, Kuhn JH, Solomon J. Toward the determination of sensitive and reliable whole-lung computed tomography features for robust standard radiomics and delta-radiomics analysis in a nonhuman primate model of coronavirus disease 2019. J Med Imaging (Bellingham) 2022; 9:066003. [PMID: 36506838 PMCID: PMC9731356 DOI: 10.1117/1.jmi.9.6.066003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose We propose a method to identify sensitive and reliable whole-lung radiomic features from computed tomography (CT) images in a nonhuman primate model of coronavirus disease 2019 (COVID-19). Criteria used for feature selection in this method may improve the performance and robustness of predictive models. Approach Fourteen crab-eating macaques were assigned to two experimental groups and exposed to either severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or a mock inoculum. High-resolution CT scans were acquired before exposure and on several post-exposure days. Lung volumes were segmented using a deep-learning methodology, and radiomic features were extracted from the original image. The reliability of each feature was assessed by the intraclass correlation coefficient (ICC) using the mock-exposed group data. The sensitivity of each feature was assessed using the virus-exposed group data by defining a factor R that estimates the excess of variation above the maximum normal variation computed in the mock-exposed group. R and ICC were used to rank features and identify non-sensitive and unstable features. Results Out of 111 radiomic features, 43% had excellent reliability ( ICC > 0.90 ), and 55% had either good ( ICC > 0.75 ) or moderate ( ICC > 0.50 ) reliability. Nineteen features were not sensitive to the radiological manifestations of SARS-CoV-2 exposure. The sensitivity of features showed patterns that suggested a correlation with the radiological manifestations. Conclusions Features were quantified and ranked based on their sensitivity and reliability. Features to be excluded to create more robust models were identified. Applicability to similar viral pneumonia studies is also possible.
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Affiliation(s)
- Marcelo A. Castro
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States,Address all correspondence to Marcelo A. Castro,
| | - Syed Reza
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Center for Infectious Disease Imaging, Bethesda, Maryland, United States
| | - Winston T. Chu
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Center for Infectious Disease Imaging, Bethesda, Maryland, United States
| | - Dara Bradley
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Center for Infectious Disease Imaging, Bethesda, Maryland, United States
| | - Ji Hyun Lee
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Ian Crozier
- Frederick National Laboratory for Cancer Research, Clinical Monitoring Research Program Directorate, Frederick, Maryland, United States
| | - Philip J. Sayre
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Byeong Y. Lee
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Venkatesh Mani
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Thomas C. Friedrich
- University of Wisconsin–Madison, School of Veterinary Medicine, Department of Pathobiological Sciences, Madison, Wisconsin, United States
| | - David H. O’Connor
- University of Wisconsin–Madison, Department of Pathology and Laboratory Medicine, Madison, Wisconsin, United States
| | - Courtney L. Finch
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Gabriella Worwa
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Irwin M. Feuerstein
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Jens H. Kuhn
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Integrated Research Facility at Fort Detrick, Frederick, Maryland, United States
| | - Jeffrey Solomon
- Frederick National Laboratory for Cancer Research, Clinical Monitoring Research Program Directorate, Frederick, Maryland, United States
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Baker J, Krishnan N, Abroms LC, Berg CJ, Bittoun R. The Impact of Tobacco Use on COVID-19 Outcomes: A Systematic Review. J Smok Cessat 2022; 2022:1-11. [PMID: 35126740 PMCID: PMC8777389 DOI: 10.1155/2022/5474397] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/24/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Tobacco use increases risks for numerous diseases, including respiratory illnesses. We examined the literature to determine whether a history of tobacco use increases risks for adverse outcomes among COVID-19 patients. Methods We conducted a systematic search of PubMed, LitCovid, Scopus, and Europe PMC (for preprints) using COVID-19 and tobacco-related terms. We included studies of human subjects with lab-confirmed COVID-19 infections that examined tobacco use history as an exposure and used multivariable analyses. The data was collected between March 31st, 2020, and February 20th, 2021. Outcomes included mortality, hospitalization, ICU admission, mechanical ventilation, and illness severity. Results Among the 39 studies (33 peer-reviewed, 6 preprints) included, the most common outcome assessed was mortality (n = 32). The majority of these studies (17/32) found that tobacco use increased risk, one found decreased risk, and 14 found no association. Tobacco use was associated with increased risk of hospitalization in 7 of 10 studies, ICU admission in 6 of 9 studies, mechanical ventilation in 2 of 6 studies, and illness severity in 3 of 9 studies. One study found that tobacco use history increased risk of pulmonary embolism in COVID-19 patients. Tobacco use was found to compound risks associated with diabetes (n = 1), cancer (n = 2), and chronic liver disease (n = 1). Conclusion There is strong evidence that tobacco use increases risks of mortality and disease severity/progression among COVID-19 patients. Public health efforts during the pandemic should encourage tobacco users to quit use and seek care early and promote vaccination and other preventive behaviors among those with a history of tobacco use.
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Marziliano A, Burns E, Chauhan L, Liu Y, Makhnevich A, Zhang M, Carney MT, Dbeis Y, Lindvall C, Qiu M, Diefenbach MA, Sinvani L. Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic. J Gerontol A Biol Sci Med Sci 2021; 77:e124-e132. [PMID: 34279628 PMCID: PMC8344548 DOI: 10.1093/gerona/glab171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. Methods Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. Results Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. Conclusion Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.
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Affiliation(s)
- Allison Marziliano
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Edith Burns
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Lakshpaul Chauhan
- Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yan Liu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Alex Makhnevich
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Meng Zhang
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Maria T Carney
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yasser Dbeis
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael A Diefenbach
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Liron Sinvani
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
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