+++ Comorbidities +++
* * * Next update: 24 November. In the meantime, find the global updates at 7 Days. * * *
Shah GL, DeWolf S, Lee YJ, et al. Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation. J Clin Invest. 2020 Nov 16:141777. PubMed: https://pubmed.gov/32897885. Full-text: https://doi.org/10.1172/JCI141777
Gunjan L. Shah from Memorial Sloan Kettering Cancer Center and colleagues retrospectively investigated 77 patients with SARS-CoV-2 who were recipients of cellular therapy (Allo, 35; Auto, 37; CAR T, 5; median time from cellular therapy, 782 days). Overall survival at 30 days was 78%. Mortality was largely driven by patients with active malignancy, especially relapsed leukemia, in whom the goals of care were affected both by COVID-19 severity and the decision to forgo anti-cancer treatment during an active infection. Immune profiling revealed reductions and rapid recovery in lymphocyte populations across lymphocyte subsets. Many patients were able to recover from COVID-19 infection and mount an antibody response with similar overall survival to the general hospitalized population.
Luo X, Liao Q, Shen Y, et al. Vitamin D Deficiency Is Inversely Associated with COVID-19 Incidence and Disease Severity in Chinese People. The Journal of Nutrition 13 November 2020. Full-text: https://doi.org/10.1093/jn/nxaa332
Vitamin D might have beneficial potential due to its immunomodulatory and anti-inflammatory properties. But is a deficiency associated with disease severity? Perhaps. In this cross-sectional study, 335 COVID-19 patients admitted to the Wuhan Tongji Hospital were retrospectively analyzed. A vitamin D deficiency (< 30 nmol/L) was significantly associated with COVID-19 severity (OR 2.7). Prospective studies have to confirm these results.
Lim S, Bae JH, Kwon HS, et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol (2020). Full-text: https://doi.org/10.1038/s41574-020-00435-4
Patients with diabetes mellitus are at increased risk of severe COVID-19. The authors discuss potential pathogenetic links between COVID-19 and diabetes mellitus; tight control of glucose levels; explain that insulin and dipeptidyl peptidase 4 inhibitors can be used safely in patients with diabetes mellitus and COVID-19; and caution that metformin and sodium–glucose co-transporter 2 inhibitors might need to be withdrawn in patients at high risk of severe disease.
Taquet M, Luciano S, Geddes JR, et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62,354 COVID-19 cases in the USA. Lancet Psychiatry November 09, 2020. Full-text: https://doi.org/10.1016/S2215-0366(20)30462-4
Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae. Here, Maxime Taquet and colleagues used a global federated network that captures anonymized data from electronic health records in 54 health care organizations in the US, totaling 69.8 million patients and 62,354 patients diagnosed with COVID-19. In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (i.e., hazard ratio [HR] 2.1 vs influenza). The HR was greatest for anxiety disorders, insomnia, and dementia. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1.6% in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1.65).
Rentsch CT, De Vito NJ, MacKenna B, et al. Effect of pre-exposure use of hydroxychloroquine on COVID-19 mortality: a population-based cohort study in patients with rheumatoid arthritis or systemic lupus erythematosus using the OpenSAFELY platform. Lancet Neurology, November 05, 2020. Full-text: https://doi.org/10.1016/S2665-9913(20)30378-7
This population-based cohort study using national primary care data and linked death registrations in the OpenSAFELY platform, which covers approximately 40% of the general population in England, UK. Between September 1, 2019, and March 1, 2020, of 194,637 people with rheumatoid arthritis or systemic lupus erythematosus, 30,569 (16%) received two or more prescriptions of HCQ. Between March 1 and July 13, 2020, there were 547 COVID-19 deaths, 70 among HCQ users. Estimated standardized cumulative COVID-19 mortality was 0.23% among users and 0.22% among non-users. These findings are not surprising given the mounting body of literature suggesting no clinical benefit for HCQ. However, this study is the largest to date and adds further evidence to the lack of any preventive effect.
Altuntas F, Ata N, Yigenoglu TN, et al. COVID-19 in hematopoietic cell transplant recipients. Bone Marrow Transplant (2020). https://doi.org/10.1038/s41409-020-01084-x
Case fatality rate (CFR) was 5.6% in patients without cancer, 11.8 in patients with hematological malignancy and 15.6% in hematopoietic cell transplant (HCT) recipients. The CFR in HCT recipients who were not receiving immunosuppressive agents at the time of COVID-19 diagnosis was 11.5%, whereas it was 33% in HCT recipients who were receiving an immunosuppressive agent at the time of COVID-19 diagnosis. This is the result of a study by Fefzi Altuntas and colleagues who analyzed the outcome of 21 HCT recipients, 465 comorbid disease-matched hospitalized COVID-19 patients with hematological malignancy but without HCT, and 497 comorbid disease-matched hospitalized COVID-19 patients without cancer (n = 497).
Martínez-López J, Mateos M, Encinas C. et al. Multiple myeloma and SARS-CoV-2 infection: clinical characteristics and prognostic factors of inpatient mortality. Blood Cancer J. 10, 103 (2020). Full-text: https://doi.org/10.1038/s41408-020-00372-5
Retrospective case series, investigating 167 MM patients reported from 73 Spanish hospitals. Compared to non-cancer patients, mortality was 50% higher. The main predictors of inpatient mortality for MM were male sex, age >65 years, renal disease, and active/progressive disease.
Li L, Li F, Fortunati F, et al. Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection. JAMA Netw Open September 30, 2020; 3(9):e2023282. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.23282
Among a total of 1685 patients who were hospitalized with COVID-19, 473 (28%) received psychiatric diagnoses prior to hospitalization. After controlling for demographic characteristics, other medical comorbidities, and hospital location, the risk of death remained significantly greater among patients with a psychiatric disorder (hazard ratio, 1.5; 95% CI, 1.1-1.9; P = .003). Reasons are unclear. Psychiatric symptoms may arise as a marker of systemic pathophysiologic processes such as inflammation, that may, in turn, predispose to mortality. Similarly, psychiatric disorders may augment systemic inflammation and compromise the function of the immune system, while psychotropic medications may also be associated with mortality risk. Or is there confounding?