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Feeney L, Hamilton A, Lavery A, O’Neill C, Walls G, Taylor K, Turkington RC. Real world outcomes in cancer patients with COVID-19 infection: Northern Ireland experience. THE ULSTER MEDICAL JOURNAL 2023; 92:29-37. [PMID: 36762131 PMCID: PMC9899036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background Cancer has been assumed to be associated with a high-risk of morbidity and mortality from COVID-19. Protective measures have incorporated modifications in cancer treatments. There are conflicting data about the impact of COVID-19 infection and outcomes in cancer patients. We aim to describe the impact of demographic and clinical characteristics on COVID-19 outcomes in patients with cancer in Northern Ireland reported within the UK Coronavirus Cancer Monitoring Project (UKCCMP). Method Prospective data collection including demographics, cancer stage and type, treatment and outcomes occurred for all Northern Irish patients enrolled in the UKCCMP. The primary endpoint was all-cause mortality. Descriptive statistics and logistic regression analysis were performed using SPSSv25. Results Between March 2020 and March 2021, 110 cases were registered. Median age was 63 years (range 27 to 87). Seventy patients (63.6%) were >60 years and 59 (53.8%) were females. Co-morbidities were reported in 83 patients (72.7%). Most patients had metastatic disease (64, 58.2%). Sixty-seven patients (60.9%) received anticancer treatment in the 4 weeks prior to COVID-19 infection. Of those patients, 35 (52.2%) received chemotherapy. Thirty-nine patients (58.2%) continued treatment as planned; 24 (36.9%) stopped treatment due to SARS-CoV-2 infection. The majority of patients were asymptomatic or experienced mild symptoms (67, 60.9%). Fifty-one (46.3%%) were admitted to hospital for COVID-19. Risk of severe/critical COVID-19 disease was significantly associated with age (OR 1.07 [95% CI 1.03-1.11); p=0.004), pre-existing hypertension (OR 3.29 [95% CI 1.42-7.62]; p=0.02) and thoracic primary malignancy (OR 4.41 [95% CI 1.52-12.74]; p=0.042). Twenty-nine patients (26.3%) died of whom 15 (57.7%) died of COVID-19 and 13 (44.8%) died due to cancer. Risk of death was significantly associated with age (OR 1.05 [95% CI 1.01-1.09]; p=0.014), male sex (OR 3.76 [95% CI 1.51-9.34]; p=0.008) and thoracic primary malignancy (OR 5.35 [95% CI 1.88-15.25]; p=0.014). When corrected for age, gender and co-morbidities, chemotherapy within the past 4 weeks was not significantly associated with mortality (OR 0.65 [95% CI 0.20-2.11]; p=0.476). Conclusion Age and thoracic cancer diagnosis correlated with survival. Comparison of performance during the pandemic with national benchmarks can inform how regional services should be adapted in preparation for future healthcare crises.
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Affiliation(s)
- Laura Feeney
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK,Northern Ireland Cancer Centre, Belfast, UK,Correspondence to: Laura Feeney,
| | - Ashleigh Hamilton
- Northern Ireland Cancer Centre, Belfast, UK,Centre For Public Health, Queens University Belfast, Belfast, UK
| | - Anita Lavery
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK,Northern Ireland Cancer Centre, Belfast, UK
| | - Conor O’Neill
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK,Centre For Public Health, Queens University Belfast, Belfast, UK
| | - Gerard Walls
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK,Northern Ireland Cancer Centre, Belfast, UK
| | | | - Richard C Turkington
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK,Northern Ireland Cancer Centre, Belfast, UK
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Shumacher ME, Markman S, Scales K, Fritsche L, Cassidy K, Holl JL, Umscheid CA. Use of an innovation center to foster high-value COVID-19 care at an academic healthcare system. J Hosp Med 2022; 17:384-388. [PMID: 35527521 PMCID: PMC9324841 DOI: 10.1002/jhm.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Sharon Markman
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
| | - Kayla Scales
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
| | - Laura Fritsche
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
| | - Kimisha Cassidy
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
| | - Jane L. Holl
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
- Department of Neurology, Biological Sciences DivisionUniversity of ChicagoChicagoIllinoisUSA
| | - Craig A. Umscheid
- Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoIllinoisUSA
- Department of Medicine, Biological Sciences DivisionUniversity of ChicagoChicagoIllinoisUSA
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Shah MK, Parikh M, Prajapati D, Kute VB, Bhende P, Prajapati A, Chhajwani SH, Yajnik K, Ganjiwale J, Mannari JG, Vaishnav B. Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Indian J Crit Care Med 2022; 26:619-625. [PMID: 35719430 PMCID: PMC9160629 DOI: 10.5005/jp-journals-10071-24168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction The use of remdesivir is not recommended in patients with end-stage renal disease (ESRD) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection unless potential advantage offset disadvantage due to limited safety data. Our objective was to assess the safety of remdesivir in patients with end-stage renal failure and evaluate the outcome of this vulnerable group. Methodology We carried out a retrospective observational study in dialysis-dependent ESRD patients with SARS-CoV-2 infection who received a standard 5-day course of remdesivir (powder form) from June 2020 to December 2020. Oxygen requirement, hemogram, inflammatory markers, and liver function tests before and after remdesivir treatment were compared. Result We found thirty-nine such patients with mean age of patients 58.79 ± 12.13 years. Diabetes mellitus, hypertension, and cardiac diseases were present in 58.97, 87.17, and 23.07% of patients, respectively. Mean oxygen saturation on admission was 85.41% (±7.73). There were no events of hepatotoxicity, altered behavior, or infusion reaction. There was statistically significant improvement in total leukocyte count, absolute lymphocyte counts, and C-reactive protein (p value <0.001, 0.01, and 0.02, respectively) post remdesivir treatment. A total of 60% of patients had improved oxygenation while 13% of patients had no change in oxygen requirement after completion of remdesivir course. Mortality in our study was 28.21%. We did not find any significant benefit of early remdesivir administration (3-6 days of illness) on mortality or days of hospitalization. Conclusion The use of remdesivir in end-stage kidney disease is safe. Improvement in oxygenation was significant when baseline oxygen requirement was less. It requires prospective controlled trials with larger population to assess its impact on mortality. How to cite this article Shah MK, Parikh M, Prajapati D, Kute VB, Bhende P, Prajapati A, et al. Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Indian J Crit Care Med 2022;26(5):619-625.
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Affiliation(s)
- Maulin K Shah
- Division of Nephrology, Department of Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Mital Parikh
- Department of Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Dhavalkumar Prajapati
- Department of Critical Care Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Vivek B Kute
- Department of Nephrology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Punam Bhende
- Department of Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Abhishek Prajapati
- Department of Critical Care Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Sunil H Chhajwani
- Department of Anaesthesiology and Critical Care, Pramukh Swami Medical College, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Bhaikaka University, Karamsad, Gujarat, India
| | - Krushan Yajnik
- Department of Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Jaishree Ganjiwale
- Department of Community Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
| | - Jyoti G Mannari
- Department of Medicine, Pramukh Swami Medical College, Vadodara, Gujarat, India
| | - Bhalendu Vaishnav
- Department of Medicine, Shree Krishna Hospital, HM Patel Centre for Medical Care and Education, Anand, Gujarat, India
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Stainer A, Amati F, Suigo G, Simonetta E, Gramegna A, Voza A, Aliberti S. COVID-19 in Immunocompromised Patients: A Systematic Review. Semin Respir Crit Care Med 2021; 42:839-858. [PMID: 34918325 DOI: 10.1055/s-0041-1740110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first identified as a novel coronavirus in Wuhan, Hubei province, central China, in December 2019, and is responsible for the 2019-to-present pandemic. According to the most recent data released by the World Health Organization, more than 200 million people have been infected by SARS-CoV-2 so far, and more than 4 million people died worldwide. Although our knowledge on SARS-CoV-2 and COVID-19 is constantly growing, data on COVID-19 in immunocompromised patients are still limited. The aim of the present systematic review is to describe clinical picture, disease severity, proposed treatment regimen, and response to vaccination in patients with different types and severity of immunosuppression.
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Affiliation(s)
- Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Suigo
- Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edoardo Simonetta
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Emergency Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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