scholarly journals Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center

2020 ◽  
Vol 35 (7) ◽  
pp. 1250-1261 ◽  
Author(s):  
Michelle Lubetzky ◽  
Meredith J Aull ◽  
Rebecca Craig-Schapiro ◽  
John R Lee ◽  
Jehona Marku-Podvorica ◽  
...  
Keyword(s):  
Graft Failure ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Ambulatory Setting ◽  
Kidney Graft ◽  
Fatality Rate ◽  
Early Management ◽  
Ambulatory Patients

Abstract Background Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies. Methods We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate. Results Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients. Conclusions Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.

scholarly journals Ruxolitinib versus dexamethasone in hospitalized adults with COVID-19: multicenter matched cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
O. V. Stanevich ◽  
D. S. Fomina ◽  
I. G. Bakulin ◽  
S. I. Galeev ◽  
E. A. Bakin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
High Fever ◽  
Cytokine Therapy ◽  
Fatality Rate ◽  
Matched Cohort ◽  
Matched Cohort Study

Abstract Background Several anti-cytokine therapies were tested in the randomized trials in hospitalized patients with severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Previously, dexamethasone demonstrated a reduction of case-fatality rate in hospitalized patients with respiratory failure. In this matched control study we compared dexamethasone to a Janus kinase inhibitor, ruxolitinib. Methods The matched cohort study included 146 hospitalized patients with COVID-19 and oxygen support requirement. The control group was selected 1:1 from 1355 dexamethasone-treated patients and was matched by main clinical and laboratory parameters predicting survival. Recruitment period was April 7, 2020 through September 9, 2020. Results Ruxolitinib treatment in the general cohort of patients was associated with case-fatality rate similar to dexamethasone treatment: 9.6% (95% CI [4.6–14.6%]) vs 13.0% (95% CI [7.5–18.5%]) respectively (p = 0.35, OR = 0.71, 95% CI [0.31–1.57]). Median time to discharge without oxygen support requirement was also not different between these groups: 13 vs. 11 days (p = 0.13). Subgroup analysis without adjustment for multiple comparisons demonstrated a reduced case-fatality rate in ruxolitnib-treated patients with a high fever (≥ 38.5 °C) (OR 0.33, 95% CI [0.11–1.00]). Except higher incidence of grade 1 thrombocytopenia (37% vs 23%, p = 0.042), ruxolitinib therapy was associated with a better safety profile due to a reduced rate of severe cardiovascular adverse events (6.8% vs 15%, p = 0.025). For 32 patients from ruxolitinib group (21.9%) with ongoing progression of respiratory failure after 72 h of treatment, additional anti-cytokine therapy was prescribed (8–16 mg dexamethasone). Conclusions Ruxolitinib may be an alternative initial anti-cytokine therapy with comparable effectiveness in patients with potential risks of steroid administration. Patients with a high fever (≥ 38.5 °C) at admission may potentially benefit from ruxolitinib administration. Trial registration The Ruxolitinib Managed Access Program (MAP) for Patients Diagnosed With Severe/Very Severe COVID-19 Illness NCT04337359, CINC424A2001M, registered April, 7, 2020. First participant was recruited after registration date

scholarly journals Kidney Allograft Recipients Diagnosed with Coronavirus Disease-2019: A Single Center Report

2020 ◽  
Author(s):  
Michelle Lubetzky ◽  
Meredith Aull ◽  
Rebecca Craig-Schapiro ◽  
Jun B. Lee ◽  
John R. Lee ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Bacterial Infections ◽  
Case Fatality Rate ◽  
Clinical Course ◽  
Case Fatality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

AbstractBackgroundOrgan graft recipients receiving immunosuppressive therapy are likely to be at heightened risk for the Coronavirus Disease 2019 (Covid-19) and adverse outcomes including death. It is therefore important to characterize the clinical course and outcome of Covid-19 in this vulnerable population and identify therapeutic strategies that are safe.MethodsWe performed a retrospective chart review of 54 adult kidney transplant patients diagnosed with Covid-19 and all managed in New York State, the epicenter of Covid-19 pandemic. All 54 patients were evaluated by video visits, or phone interviews, and referred to our Fever Clinic or Emergency Room for respiratory illness symptoms consistent with Covid-19 and admitted if deemed necessary from March 13, 2020 to April 20, 2020. Characteristics of the patients were stratified by hospitalization status and disease severity. Clinical course including alterations in immunosuppressive therapy were retrieved from their electronic medical records. Primary outcomes included recovery from Covid-19 symptoms, acute kidney injury, graft failure, and case fatality rate.ResultsOf the 54 SARS-Cov-2 positive kidney transplant recipients, 39 with moderate to severe symptoms were admitted and 15 with mild symptoms were managed at home. Hospitalized patients compared to non-hospitalized patients were more likely to be male, of Hispanic ethnicity, and to have cardiovascular disease. At baseline, all but 2 were receiving tacrolimus, mycophenolate mofetil (MMF) and 32 were on a steroid free immunosuppression regimen. Tacrolimus dosage was reduced in 46% of hospitalized patients and maintained at baseline level in the non-hospitalized cohort. Mycophenolate mofetil (MMF) dosage was maintained at the baseline dosage in 11% of hospitalized patients and 64% of non-hospitalized patients and was stopped in 61% hospitalized patients and 0% in the non-hospitalized cohort. Azithromycin or doxycycline were prescribed at a similar rate among hospitalized and non-hospitalized patients (38% vs. 40%). In addition, 50% of hospitalized patients were treated for concurrent bacterial infections including pneumonia, urinary tract infections and sepsis. Hydroxychloroquine was prescribed in 79% of hospitalized patients and only one of 15 non-hospitalized patients. Acute kidney injury occurred in 51% of hospitalized patients. Patients with severe disease were more likely to have elevations in inflammatory biomarkers at presentation. At a median of 21 days follow up, 67% of patients have had their symptoms resolved or improved and 33% have persistent symptoms. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%). Three of 39 (8%) hospitalized patients expired and none of the 15 non-hospitalized patients expired.ConclusionsClinical presentation of Covid-19 in kidney transplant recipients was similar to what has been described in the general population. The case fatality rate in our entire cohort of 54 kidney transplant recipients was reassuringly low and patients with mild symptomology could be successfully managed at home. Data from the our study suggest that a strategy of systematic screening and triage to outpatient or inpatient care, close monitoring, early management of concurrent bacterial infections and judicious use of immunosuppressive drugs rather than cessation is beneficial.

scholarly journals Association between rRT-PCR test results upon admission and outcome in hospitalized chest CT-Positive COVID-19 patients; a provincial retrospective cohort with active follow-up

2020 ◽  
Author(s):  
Saeed Nemati ◽  
Hamid Reza Najari ◽  
Anita Eftekharzadeh ◽  
Amir Mohammad Kazemifar ◽  
Ali Qandian ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Study Data ◽  
Chest Ct ◽  
Hospitalized Patients ◽  
Multivariate Logistic Regression Model ◽  
Fatality Rate ◽  
Test Results ◽  
Pcr Test

AbstractBackgroundThe Covid-19 pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in RT-PCR testing for SARS-CoV-2 and ventilators availabilities throughout the COVID-19 outbreak. This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different rRT-PCR test results during the first 3 weeks of the outbreak in Qazvin province, Iran.MethodsFor this retrospective cohort study, data of hospitalized patients primarily diagnosed as having COVID-19 in all 12 centers across the whole Qazvin province during Feb 20-Mar 11, 2020 was analyzed. A multivariate logistic regression model was applied to assess the independent associates of death among COVID-19 patients.Results998 patients (57% male, median age 54 years) with positive chest CT-scan changes were included in this study. Among them, 558 patients were examined with rRT-PCR test and 73·8% tested positive. Case fatality rate was 20·68% and 7·53% among test-positive and test negative hospitalized patients, respectively. While only 5·2% of patients were ICU admitted, case fatality rates outside ICU were 17·70% and 4·65% in test-positive and test-negative non-ICU admitted patients, correspondingly. The independent associates of death were age ≥ 70 years, testing positive with rRT-PCR test, having immunodeficiency disorders and ICU admission.ConclusionsHospitalized COVID-19 patients with mild symptoms despite positive chest CT changes and major comorbidities were more probable to have negative rRT-PCR test result, hence lower case fatality rate and a more favorable outcome.

Impact of hydroxychloroquin/azithromycin protocol on COVID-19 case-fatality rate reduction in Algeria. (Preprint)

2020 ◽  
Author(s):  
Ahmed Youssef Kada
Keyword(s):  
Case Fatality Rate ◽  
Doubling Time ◽  
Case Fatality ◽  
World Health ◽  
Fatality Rate ◽  
Therapeutic Protocol ◽  
First Case ◽  
The World ◽  
The Impact ◽  
At Home

BACKGROUND Covid-19 is an emerging infectious disease like viral zoonosis caused by new coronavirus SARS CoV 2. On December 31, 2019, Wuhan Municipal Health Commission in Hubei province (China) reported cases of pneumonia, the origin of which is a new coronavirus. Rapidly extendable around the world, the World Health Organization (WHO) declares it pandemic on March 11, 2020. This pandemic reaches Algeria on February 25, 2020, date on which the Algerian minister of health, announced the first case of Covid-19, a foreign citizen. From March 1, a cluster is formed in Blida and becomes the epicentre of the coronavirus epidemic in Algeria, its total quarantine is established on March 24, 2020, it will be smoothly alleviated on April 24. A therapeutic protocol based on hydroxychloroquine and azithromycin was put in place on March 23, for complicated cases, it was extended to all the cases confirmed on April 06. OBJECTIVE This study aimed to demonstrate the effectiveness of hydroxychloroquin/azithromycin protocol in Algeria, in particular after its extension to all patients diagnosed COVID-19 positive on RT-PCR test. We were able to illustrate this fact graphically, but not to prove it statistically because the design of our study, indeed in the 7 days which followed generalization of therapeutic protocol, case fatality rate decrease and doubling time increase, thus confirming the impact of wide and early prescription of hydroxychloroquin/azithromycin protocol. METHODS We have analyzed the data collected from press releases and follow-ups published daily by the Ministry of Health, we have studied the possible correlations of these data with certain events or decisions having a possible impact on their development, such as confinement at home and its reduction, the prescription of hydroxychloroquine/azithromycin combination for serious patients and its extension to all positive COVID subjects. Results are presented in graphics, the data collection was closed on 31/05/2020. RESULTS Covid-19 pandemic spreads from February 25, 2020, when a foreign citizen is tested positive, on March 1 a cluster is formed in the city of Blida where sixteen members of the same family are infected during a wedding party. Wilaya of Blida becomes the epicentre of coronavirus epidemic in Algeria and lockdown measures taken, while the number of national cases diagnosed begins to increases In any event, the association of early containment measures combined with a generalized initial treatment for all positive cases, whatever their degree of severity, will have contributed to a reduction in the fatality rate of COVID 19 and a slowing down of its doubling time. CONCLUSIONS In Algeria, the rapid combination of rigorous containment measure at home and early generalized treatment with hydroxychloroquin have demonstrated their effectiveness in terms of morbidity and mortality, the classic measures of social distancing and hygiene will make it possible to perpetuate these results by reducing viral transmission, the only unknown, the reopening procedure which can only be started after being surrounded by precautions aimed at ensuring the understanding of the population. CLINICALTRIAL Algeria, Covid-19, pandemic, hydroxychloroquin, azithromycin, case fatality rate

scholarly journals Author Correction: Calcium channel blocker amlodipine besylate therapy is associated with reduced case fatality rate of COVID-19 patients with hypertension

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Lei-Ke Zhang ◽  
Yuan Sun ◽  
Haolong Zeng ◽  
Qingxing Wang ◽  
Xiaming Jiang ◽  
...  
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Case Fatality Rate ◽  
Channel Blocker ◽  
Case Fatality ◽  
Fatality Rate ◽  
Amlodipine Besylate

A Correction to this paper has been published: https://doi.org/10.1038/s41421-021-00267-0

scholarly journals Early determination of case fatality rate of COVID-19 pandemic during the ongoing Yemeni armed conflict

2021 ◽  
pp. 1-15
Author(s):  
Abdulla Salem Bin Ghouth ◽  
Ali Ahmed Al-Waleedi ◽  
Marhami Fahriani ◽  
Firzan Nainu ◽  
Harapan Harapan
Keyword(s):  
Young Adults ◽  
Intensive Care ◽  
Armed Conflict ◽  
Case Fatality Rate ◽  
Preventive Measures ◽  
Case Fatality ◽  
Fatality Rate ◽  
Mechanical Ventilators ◽  
Poor Outcomes

Abstract Objectives: To determine the case-fatality rate (CFR) of coronavirus disease 2019 (COVID-19) and its associated determinants in order to understand the true magnitude of the problem during ongoing conflict in Yemen. Methods: The CFR among confirmed COVID-19 cases in Yemen was calculated. The data was retrieved from national COVID-19 surveillance between April 10, when the first COVID-19 case reported, and May 31, 2020. Results: A total of 419 confirmed COVID-19 cases were reported. There were 14.1% and 5.7% of cases who required intensive care and mechanical ventilators, respectively. Out of total cases, 95 deaths were reported, giving CFR of 22.6% which is much higher compared to other countries. CFR was significantly higher among elderly compared to young adults and varied between governorates. Mortality was associated with preexisting hypertension (OR: 2.30; 95%CI: 1.58, 3.54) and diabetes (OR: 1.68; 95%CI: 1.08, 2.61). Conclusions: Elderly and those with comorbidities, in particular hypertension and diabetes, have higher risk for poor outcomes and therefore should receive more attention in the clinical setting. Preventive measures should also be prioritized to protect those groups in order to reduce the severe cases and deaths-associated COVID-19 in armed-conflict.

scholarly journals Regional Variability in COVID-19 Case Fatality Rate in Canada, February–December 2020

2021 ◽  
Vol 18 (4) ◽  
pp. 1839
Author(s):  
Eunha Shim
Keyword(s):  
British Columbia ◽  
Case Fatality Rate ◽  
Case Reports ◽  
Case Fatality ◽  
Health Interventions ◽  
Fatality Rate ◽  
Older Individuals ◽  
Regional Variability ◽  
Provincial Level ◽  
Mortality Burden

A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)—where the proportion of deaths among older individuals was also the highest among the four provinces—followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.

scholarly journals Age and Infectious Dose Significantly Affect Disease Progression after RHDV2 Infection in Naïve Domestic Rabbits

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1184
Author(s):  
Robyn N. Hall ◽  
Tegan King ◽  
Tiffany O’Connor ◽  
Andrew J. Read ◽  
Jane Arrow ◽  
...  
Keyword(s):  
New Zealand ◽  
Disease Progression ◽  
Case Fatality Rate ◽  
Low Dose ◽  
Case Fatality ◽  
Wild Rabbit ◽  
Fatality Rate ◽  
Infectious Dose ◽  
Welfare Impacts ◽  
Rabbit Haemorrhagic Disease

Rabbit haemorrhagic disease virus 2 (RHDV2 or GI.2, referring to any virus with lagovirus GI.2 structural genes) is a recently emerged calicivirus that causes generalised hepatic necrosis and disseminated intravascular coagulation leading to death in susceptible lagomorphs (rabbits and hares). Previous studies investigating the virulence of RHDV2 have reported conflicting results, with case fatality rates ranging from 0% to 100% even within a single study. Lagoviruses are of particular importance in Australia and New Zealand where they are used as biocontrol agents to manage wild rabbit populations, which threaten over 300 native species and result in economic impacts in excess of $200 million AUD annually to Australian agricultural industries. It is critically important that any pest control method is both highly effective (i.e., virulent, in the context of viral biocontrols) and has minimal animal welfare impacts. To determine whether RHDV2 might be a suitable candidate biocontrol agent, we investigated the virulence and disease progression of a naturally occurring Australian recombinant RHDV2 in both 5-week-old and 11-week-old New Zealand White laboratory rabbits after either high or low dose oral infection. Objective measures of disease progression were recorded through continuous body temperature monitoring collars, continuous activity monitors, and twice daily observations. We observed a 100% case fatality rate in both infected kittens and adult rabbits after either high dose or low dose infection. Clinical signs of disease, such as pyrexia, weight loss, and reduced activity, were evident in the late stages of infection. Clinical disease, i.e., welfare impacts, were limited to the period after the onset of pyrexia, lasting on average 12 h and increasing in severity as disease progressed. These findings confirm the high virulence of this RHDV2 variant in naïve rabbits. While age and infectious dose significantly affected disease progression, the case fatality rate was consistently 100% under all conditions tested.

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