March 30, 2023

VIEW TRANSCRIPT

Clinical Reports

Severe Infection and Risk of Cardiovascular Disease:
- Researchers analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006–2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 533 community-dwelling participants from Finland (baseline 1986–2005). Cardiovascular risk factors were measured at baseline. Researchers diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and mortality registers. Researchers computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. They also calculated population-attributable fractions for long-term risk. In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the subtype of infection. This association was strongest during the first month after infection, but remained elevated during the entire follow-up. The findings were similar in the replication cohort during the first month; HR, 1.41 during mean follow-up of 19.2 years. After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort.
Risk Factors Associated With Post−COVID-19 Condition
- The findings of the meta-analysis showed that female sex, age, high BMI, and smoking were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC. Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated.This systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination.

Antiviral Therapeutics and Vaccines

Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization
- Infants are at a higher risk of COVID-19-related hospitalizations compared to older children. In this study, researchers investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. Researchers conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36–65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.
Association of Treatment With Nirmatrelvir and the Risk of Post–COVID-19 Condition
- In this cohort study of 281 793 people with SARS-CoV-2 infection who had at least 1 risk factor for progression to severe COVID-19 illness, compared with 246 076 who had no treatment, nirmatrelvir use in the acute phase (n = 35 717) was associated with reduced risk of PCC, including reduced risk of 10 of 13 post–acute sequelae in various organ systems, as well as reduced risk of post–acute death and post–acute hospitalization. Nirmatrelvir was associated with reduced risk of PCC in people who were unvaccinated, vaccinated, and boosted, and in people with primary SARS-CoV-2 infection and reinfection. In people with SARS-CoV-2 infection and at least 1 risk factor for progression to severe COVID-19 illness, treatment with nirmatrelvir during the acute phase of COVID-19 was associated with reduced risk of PCC.

Epidemiology

Antibiotics don't reduce risk of death from viral respiratory infections
- A total of 2111 patients were included in the analysis. Antibiotic therapy was initiated at admission in 54.6% of the patients and overall 62.6% received antibiotics during hospitalization. The 30-day mortality rate was 8.0%. Patients prescribed antibiotics during hospitalization had lower survival as assessed by the Kaplan-Meier estimator (Figure 2). In analyses adjusted for virus, sex, age, severity of disease at baseline, and comorbidities, antibiotics prescribed during hospitalization (hazard ratio [HR] 2.10, 95% CI 1.31 - 3.38) and days of antibiotic therapy (HR per DOT 1.03, 95% CI 1.01-1.05) were associated with increased 30-day mortality, whereas antibiotics initiated at hospital admission was not (hazard ratio 1.16, 95% CI 0.81 - 1.68). No protective association between in-hospital antibiotic therapy and 30-day mortality suggests that a restrictive antibiotic strategy in viral respiratory infections is warranted.
ABO blood types and SARS-CoV-2 infection assessed using seroprevalence data in a large population-based sample: the SAPRIS-SERO multi-cohort study
- ABO blood type has been reported as a potential factor influencing SARS-CoV-2 infection, but so far mostly in studies that involved small samples, selected population and/or used PCR test results. In contrast this study aimed to assess the association between ABO blood types and SARS-CoV-2 infection using seroprevalence data (independent of whether or not individuals had symptoms or sought for testing) in a large population-based sample. This study included 67,340 French participants to the SAPRIS-SERO multi-cohort project. Anti-SARS-CoV-2 antibodies were detected using ELISA (targeting the proteins spike (S) and nucleocapsid (NP)) and seroneutralisation (SN) tests on dried blood spots collected in May–November 2020. Non-O individuals (and especially types A and AB) were more likely to bear anti SARS-CoV-2 antibodies (ELISA-S, 2964 positive cases: ORnon-Ovs.O = 1.09[1.01–1.17], ORAvs.O = 1.08[1.00–1.17]; ELISA-S/ELISA-NP/SN, 678 triple positive cases: ORnon-Ovs.O = 1.19 [1.02–1.39], ORAvs.O = 1.19[1.01–1.41], ORABvs.O = 1.43[1.01–2.03]). Hence, these results provided additional insights into the dynamic of SARS-CoV-2 infection, highlighting a higher susceptibility of infection for individuals of blood types A and AB and a lesser risk for blood type O.
Mechanically Ventilated Patients With Coronavirus Disease 2019 Had a Higher Chance of In-Hospital Death If Treated With High-Flow Nasal Cannula Oxygen Before Intubation
- A total of n = 440 patients were identified, of whom 311 (70.7%) received HFNC before intubation, and 129 (29.3%) were intubated without prior use of HFNC. Patients who received HFNC before intubation had a higher chance of in-hospital death (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.06–4.05). No difference was found in the chance of successful extubation between the 2 groups (0.70, 0.41–1.20). Among patients with respiratory failure from COVID-19 requiring mechanical ventilation, patients receiving HFNC before intubation had a higher chance of in-hospital death. Decisions on initial respiratory support modality should weigh the risks of intubation with potential increased mortality associated with HFNC.