Weekly Review: What’s new in the COVID-19 clinical world? – May 10, 2021

Weekly Review: What’s new in the COVID-19 clinical world? – May 10, 2021

New onset heart failure related to COVID-19

In this article, authors aim to described the point-prevalence and outcomes of new heart failure diagnoses among patients hospitalized with COVID-19. Research was conducted using retrospective analysis of patients whom were admitted with a positive PCR test in a New York hospital from February 27, 2020 to June 26, 2020 and followed through October 7, 2020. Characteristics and outcomes were evaluated from electronic health records and included those patients who has a history of, or new diagnosis of heart failure. New HF diagnoses were established by ensuring no prior history of HF was linked to the patient, and ensured the patient met 2 of 3 criteria: signs and symptoms of congestion, elevated BNP levels, and/or x-ray findings compatible with HF such as cardiomegaly and/or congestion or echo evidence of diastolic/systolic dysfunction. Of 6,439 patients, 37 (0.6%) had new HF and 422 (6.6%) had a history of HF. The mean age was 64 years, and 45% were women. Of the 37 newly diagnosed HF patients, 13 presented with shock, 5 with acute coronary syndrome, with 8 of these patients having no prior cardiovascular history. The article concludes that although point prevalence of new onset HF is low, a cohort of younger patients without typical cardiovascular risk factors or previous disease may experience HF in relation to COVID-19. Authors suggest further studies to support this claim.

Geriatric antibody response to COVID-19

In this research letter from Journal of the American Geriatrics Society, a study was performed to determine the immune response of geriatric patients infected with COVID-19. Current studies indicate that antibody production begins around day 5 after symptom onset with 78-100% of patients producing antibodies, and studies also suggest antibody production is positively correlated with disease severity. In more mild cases or those who are asymptomatic have lower antibody titers. The study aimed to determine the incidence of detectable antibody response in a LTC facility and characterize the relationship between immune response, individual characteristics, and disease progression. The researchers examined the IgG antibody response in geriatric residents of a long-term care facility at 4 weeks post infection, 3 months and 6 months post infection. Results show that of the 49 COVID-19 positive residents the average age is 84-years, 77.5% were female, and there was an average of seven chronic comorbidities. Among the comorbidities, dementia and heart disease were most common. 55.1% of patients were on antiplatelets and 32.6% were on proton pump inhibitors, and 10% on immune modulator treatments. Overall, 59.2% of positive patients were asymptomatic while 22.4% experienced severe symptoms. The study delves into data found while the study was ongoing. Results indicate that patients maintained antibody response for at least 6 months. This implies that a vaccine may produce similar effects and provide protection to geriatric patients. 34% of patients lost their antibodies within six months which reflects the need for further protective measures.

Post-COVID depression, anxiety, and post-traumatic stress symptoms

This prospective cohort study, examines the psychiatric symptoms associated with COVID-19 infection during the acute illness phase or beyond. In the study, nasopharyngeal swabs were collected by trained healthcare professionals. Those who tested positive were classified as mild cases (N = 895) and assessed for psychiatric symptoms. The patients were further assessed for presence of psychiatric symptoms at approximately day 56.6 after intake. The researchers investigated the association between the number of COVID-19 symptoms at intake and depression, anxiety, and PTS symptoms approximately two months later, with adjustments made for those with previous mental health issues and other confounders. Results indicate that significant levels of depressive, anxiety, and post-traumatic stress symptoms were reported by 26.2% (N = 235), 22.4% (N=201), and 17.3% (N = 155) of the participants. Increased COVID related symptoms was associated with clinically significant levels of psychiatric symptoms. Researchers conclude that those who are exposed to an increased number of COVID symptoms may be more highly associated with depressive symptoms, anxiety, and post-traumatic symptoms after the acute phase of the disease. Patients should be monitored for the development of psychiatric complications upon discharge with a COVID-19 diagnosis. Early interventions could greatly benefit these individuals.

Risk factors for secondary pulmonary infection in patients with COVID-19

In this article, authors aim to investigate the distribution and risk factors of pathogens in secondary pulmonary infections in patients with COVID-19. The study included 142 patients with confirmed COVID-19, and 32 patients with pulmonary infection were dedicated as the infection group and their sputum was applied for retrospective analysis. The other 110 patients who were COVID-19 positive, but without pulmonary infection were assigned as the asymptomatic group. The pathogens expressed in the infectious group include gram-negative bacteria (68.8%), mainly Klebsiella pneumoniae. Gram-positive bacteria and fungi accounted for 40.6% (Staphylococcus aureus and Candida albicans). The comparison of the groups found that patients with elder age, underlying disease, lung lesions, and low protein counts were more likely to develop lung infections. Univariate analysis indicated that indwelling gastric catheters, deep vein catheters, tracheal intubation, invasive mechanical ventilation, hormonal application, and use of more than three antibacterial medications increased risk factors for secondary COVID-19 pulmonary infections. Antimicrobial use was found to be an independent risk factor for secondary lung infections in those with COVID-19. Authors recommend reasonable consideration of antimicrobial use and close attention should be paid to those with mechanical ventilation and other invasive measures to reduce the risk for secondary pulmonary infections.

|2021-05-10T08:12:03-04:00May 10th, 2021|COVID-19 Literature|Comments Off on Weekly Review: What’s new in the COVID-19 clinical world? – May 10, 2021

About the Author: Casey Cummins

Casey Cummins
Casey Cummins, MSN, APRN, NP-C is a board-certified Family Nurse Practitioner who currently serves as the Chief Nurse Consultant for the Immunizations Division at the Indiana Department of Health. She is part of the ISDH COVID-19 Outbreak Response Team, and has assisted with coordinating testing efforts state-wide during the pandemic. She enjoys spending time with her husband and their children, being outdoors, gardening, and traveling whenever possible.

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