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Myers LC, Lawson BL, Escobar GJ, Daly KA, Chen YFI, Dlott R, Lee C, Liu V. Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study. BMJ Open 2024; 14:e073622. [PMID: 38191255 PMCID: PMC10806839 DOI: 10.1136/bmjopen-2023-073622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES In the first year of the COVID-19 pandemic, health systems implemented programmes to manage outpatients with COVID-19. The goal was to expedite patients' referral to acute care and prevent overcrowding of medical centres. We sought to evaluate the impact of such a programme, the COVID-19 Home Care Team (CHCT) programme. DESIGN Retrospective cohort. SETTING Kaiser Permanente Northern California. PARTICIPANTS Adult members before COVID-19 vaccine availability (1 February 2020-31 January 2021) with positive SARS-CoV-2 tests. INTERVENTION Virtual programme to track and treat patients with 'CHCT programme'. OUTCOMES The outcomes were (1) COVID-19-related emergency department visit, (2) COVID-19-related hospitalisation and (3) inpatient mortality or 30-day hospice referral. MEASURES We estimated the average effect comparing patients who were and were not treated by CHCT. We estimated propensity scores using an ensemble super learner (random forest, XGBoost, generalised additive model and multivariate adaptive regression splines) and augmented inverse probability weighting. RESULTS There were 98 585 patients with COVID-19. The majority were followed by CHCT (n=80 067, 81.2%). Patients followed by CHCT were older (mean age 43.9 vs 41.6 years, p<0.001) and more comorbid with COmorbidity Point Score, V.2, score ≥65 (1.7% vs 1.1%, p<0.001). Unadjusted analyses showed more COVID-19-related emergency department visits (9.5% vs 8.5%, p<0.001) and hospitalisations (3.9% vs 3.2%, p<0.001) in patients followed by CHCT but lower inpatient death or 30-day hospice referral (0.3% vs 0.5%, p<0.001). After weighting, there were higher rates of COVID-19-related emergency department visits (estimated intervention effect -0.8%, 95% CI -1.4% to -0.3%) and hospitalisation (-0.5%, 95% CI -0.9% to -0.1%) but lower inpatient mortality or 30-day hospice referral (-0.5%, 95% CI -0.7% to -0.3%) in patients followed by CHCT. CONCLUSIONS Despite CHCT following older patients with higher comorbidity burden, there appeared to be a protective effect. Patients followed by CHCT were more likely to present to acute care and less likely to die inpatient.
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Affiliation(s)
- Laura C Myers
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Brian L Lawson
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Gabriel J Escobar
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Kathleen A Daly
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | | | - Richard Dlott
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Vincent Liu
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
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Alp Çavuş S, Çelik M, Irmak Ç, Helvacı G, Ömeroğlu Şimşek G, Coşkun F. 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. THORACIC RESEARCH AND PRACTICE 2023; 24:284-291. [PMID: 37721490 PMCID: PMC10724727 DOI: 10.5152/thoracrespract.2023.22234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
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.
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Affiliation(s)
- Sema Alp Çavuş
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Muammer Çelik
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Çağlar Irmak
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gamze Helvacı
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gökçen Ömeroğlu Şimşek
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Figen Coşkun
- Department of Emergency Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Myers LC, Kipnis P, Greene JD, Chen A, Creekmur B, Xu S, Sankar V, Roubinian NH, Langer-Gould A, Gould MK, Liu VX. The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure. J Crit Care 2023; 77:154322. [PMID: 37163851 PMCID: PMC10165890 DOI: 10.1016/j.jcrc.2023.154322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality. METHODS Using data from Kaiser Permanente Northern/Southern California's 36 medical centers, we identified patients with COVID-19-related acute respiratory failure who reached ≥80% FiO2 on high flow nasal cannula or non-invasive ventilation. Exposure was IMV initiation each day after reaching high FiO2 threshold (T0). We developed propensity scores with overlap weighting for receipt of IMV each day adjusting for confounders. We reported relative risk of inpatient death with 95% Confidence Interval. RESULTS Of 28,035 hospitalizations representing 21,175 patient-days, 5758 patients were included (2793 received and 2965 did not receive IMV). Patients receiving IMV had higher unadjusted mortality (63.6% versus 18.2%, P < 0.0001). On each day after reaching T0 through day >10, the adjusted relative risk was higher for those receiving IMV compared to those not receiving IMV (Relative Risk>1). CONCLUSIONS Initiation of IMV on each day after patients reach high FiO2 threshold was associated with higher inpatient mortality after adjusting for time-varying confounders. Remaining on high flow nasal cannula or non-invasive ventilation does not appear to be harmful compared to IMV. Prospective evaluation is needed.
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Affiliation(s)
- Laura C Myers
- Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America.
| | - Patricia Kipnis
- Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - John D Greene
- Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Beth Creekmur
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Stan Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Viji Sankar
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Nareg H Roubinian
- Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Annette Langer-Gould
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA, United States of America; Clinical & Translational Neuroscience, Kaiser Permanente and Southern California Permanente Medical Group, Los Angeles, CA, United States of America
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America; Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA, United States of America; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Vincent X Liu
- Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States of America
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Chen L, Shao Z, Liu H, Shi Q, Lv C, Bai Y, Wu Z, Wei W, Wei H, Gao H, Wang M. Clinical observation of neutralizing antibody DXP-604 for treatment critical COVID-19 patients infected with SARS-CoV-2 Delta variant. J Med Virol 2023; 95:e28742. [PMID: 37185844 DOI: 10.1002/jmv.28742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
From January to March 2022, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) infection was prevalent in Yuzhou and Zhengzhou. DXP-604 is a broad-spectrum antiviral monoclonal antibody, which has excellent viral neutralization ability in vitro and a long half-life in vivo, with good biosafety and tolerability. Preliminary results showed that DXP-604 can accelerate recovery from Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 Delta variant in hospitalized patients with mild to moderate clinical symptoms. However, the efficacy of DXP-604 has not been fully studied in high-risk severe patients. Here, we prospectively enrolled 27 high-risk patients, two groups were divided, in addition to receiving standard of care (SOC), 14 of them additionally received the neutralizing antibody DXP-604 therapy, and another 13 intensive care unit (ICU) patients simultaneously underwent SOC as a control group matched for age, gender, and clinical type. The results revealed lower C-reactive protein, interleukin-6, lactic dehydrogenase and neutrophil counts, and higher lymphocyte and monocyte counts from Day 3 post-DXP-604 treatment compared with SOC treatment. Besides, thoracic CT images showed improvements in lesion areas and degrees, along with changes in blood inflammatory factors. Moreover, DXP-604 reduced the invasive mechanical ventilation and mortality of high-risk SARS-CoV-2 infected patients. The ongoing clinical trials of DXP-604 neutralizing antibody will clarify its utility as a new attractive countermeasure for high-risk COVID-19.
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Affiliation(s)
- Lijuan Chen
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zehua Shao
- Heart Center of Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongmei Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Shi
- Beijing Singlomics Biopharmaceuticals Co., Ltd, Beijing, China
| | - Chuanjian Lv
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Bai
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziai Wu
- Beijing Singlomics Biopharmaceuticals Co., Ltd, Beijing, China
| | - Wei Wei
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanhuan Wei
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyan Gao
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meiyun Wang
- Medical Imaging Department, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
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Ticinesi A, Parise A, Cerundolo N, Nouvenne A, Prati B, Chiussi G, Guerra A, Meschi T. Multimorbidity and Frailty Are the Key Characteristics of Patients Hospitalized with COVID-19 Breakthrough Infection during Delta Variant Predominance in Italy: A Retrospective Study. J Clin Med 2022; 11:jcm11185442. [PMID: 36143095 PMCID: PMC9503996 DOI: 10.3390/jcm11185442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73−88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573−0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977−0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152−2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389−6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Correspondence:
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Giulia Chiussi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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Calabrese C, Annunziata A, Mariniello DF, Coppola A, Mirizzi AI, Simioli F, Pelaia C, Atripaldi L, Pugliese G, Guarino S, Fiorentino G. Evolution of the Clinical Profile and Outcomes of Unvaccinated Patients Affected by Critical COVID-19 Pneumonia from the Pre-Vaccination to the Post-Vaccination Waves in Italy. Pathogens 2022; 11:pathogens11070793. [PMID: 35890037 PMCID: PMC9323253 DOI: 10.3390/pathogens11070793] [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] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
The vaccination campaign and the new SARS-CoV-2 variants may have changed the clinical profile and outcomes of patients admitted to sub-intensive unit care. We conducted a retrospective study aimed to compare the clinical and radiological features of unvaccinated critical COVID-19 patients hospitalized during the last pandemic wave (December 2021−February 2022, No-Vax group) and before starting the vaccination campaign (March−December 2020, Pre-Vax group). The No-Vax group was also compared with vaccinated patients of the same pandemic wave (Vax group). With respect to the Pre-Vax group, the No-Vax group contained a higher percentage of smokers (p = 0.0007) and a lower prevalence of males (p = 0.0003). At admission, the No-Vax patients showed both a higher CT score of pneumonia and a worse severe respiratory failure (p < 0.0001). In the No-Vax group, a higher percentage of deaths occurred, though this was not significant. In comparison with the No-Vax group, the Vax patients were older (p = 0.0097), with a higher Charlson comorbidity index (p < 0.0001) and a significantly lower HRCT score (p = 0.0015). The percentage of deaths was not different between the two groups. The No-Vax patients showed a more severe disease in comparison with the Pre-Vax patients, and were younger and had fewer comorbidities than the Vax patients.
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Affiliation(s)
- Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (D.F.M.); (L.A.); (G.P.)
- Correspondence:
| | - Anna Annunziata
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (A.A.); (A.C.); (A.I.M.); (F.S.); (G.F.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (D.F.M.); (L.A.); (G.P.)
| | - Antonietta Coppola
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (A.A.); (A.C.); (A.I.M.); (F.S.); (G.F.)
| | - Angela Irene Mirizzi
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (A.A.); (A.C.); (A.I.M.); (F.S.); (G.F.)
| | - Francesca Simioli
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (A.A.); (A.C.); (A.I.M.); (F.S.); (G.F.)
| | - Corrado Pelaia
- Respiratory Medicine Unit, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Lidia Atripaldi
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (D.F.M.); (L.A.); (G.P.)
| | - Gaia Pugliese
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (D.F.M.); (L.A.); (G.P.)
| | - Salvatore Guarino
- Department of Radiology, Monaldi Hospital, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy;
| | - Giuseppe Fiorentino
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, 80131 Napoli, Italy; (A.A.); (A.C.); (A.I.M.); (F.S.); (G.F.)
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