Occurrence and outcomes of possible superadded infections in older adults with COVID-19—cohort study

Purpose: Current guidance discourages use of antibiotics in COVID-19. However, in older adults, superadded infection may be common and require treatment. Our aim was to investigate the occurrence and outcomes from possible superadded infections, occurring within 2 weeks of hospitalization, in older adults with COVID-19. Methods: This was a single centre, observational cohort study. We collected data from patients admitted to older adult wards who had tested positive for the Sars-CoV-2 virus on viral PCR between 1st October and 1st December 2020. The primary outcome was inpatient death occurring within 90 days of COVID-19 diagnosis. The secondary outcome was length of stay in hospital. Associations were described using univariable and multivariable models, and time to event data. Results: Of 266 patients with COVID-19, 43% (115) had evidence of superadded infections (91 with positive bacterial cultures and 36 instances of radiological lobar consolidation). Patients with superadded infections were more likely to die (45.2 versus 30.7%, p = 0.020) and had an increased length of stay (23 versus 18 days, p = 0.026). Conclusions: Recommendations to avoid antibiotics in COVID-19 may not be applicable to an older adult population. Assessing for possible superadded infections is warranted in this group

Comparison between first and second wave of COVID-19 outbreak in older people. The COPE multicentre European observational cohort study

Background: Effective shielding measures and virus mutations have progressively modified the disease between the waves, likewise health care systems have adapted to the outbreak. Our aim was to compare clinical outcomes for older people with COVID-19 in Wave 1 (W1) and 2 (W2). Methods: All data, including the Clinical Frailty Scale (CFS), were collected for COVID-19 consecutive patients, aged ≥65, from thirteen hospitals, in W1 (February-June 2020) and W2 (October 2020-March 2021). The primary outcome was mortality (time to mortality and 28-day mortality). Data were analysed with multilevel Cox proportional hazards, linear and logistic regression models, adjusted for wave baseline demographic and clinical characteristics. Results: Data from 611 people admitted in W2 were added to and compared with data collected during W1 (N = 1340). Patients admitted in W2 were of similar age, median [IQR], W2 = 79 [73-84]; W1 = 80 [74-86]; had a greater proportion of men (59.4% vs 53.0%); had lower 28-day mortality (29.1% vs 40.0%), compared to W1. For combined W1-W2 sample, W2 was independently associated with improved survival: time-to-mortality aHR= 0.78 (95%CI 0.65-0.93), 28-day mortality aOR = 0.80 (95%CI 0.62-1.03). W2 was associated with increased length of hospital stay aHR = 0.69 (95%CI 0.59-0.81). Patients in W2 were less frail, CFS (adjusted mean difference [aMD]=-0.50, 95%CI -0.81, -0.18), as well as presented with lower CRP (aMD=-22.52, 95%CI -32.00, -13.04). Conclusions: COVID-19 older adults in W2 were less likely to die than during W1. Patients presented to hospital during W2 were less frail and with lower disease severity and less likely to have renal decline

Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study

Background: The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality. Methods: Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (February–June 2020 and October 2020–March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics. Results: One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73–86] years) were included in the study. 28-day mortality was 42.3% (n = 742). 48% (n = 801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥ 60 [Stage 1&2]): eGFR 45–59 [Stage 3a] aHR = 1.26 (95%CI 1.02–1.55); eGFR 30–44 [Stage 3b] aHR = 1.41 (95%CI 1.14–1.73); eGFR 1–29 [Stage 4&5] aHR = 1.42 (95%CI 1.13–1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR) = 1.18 (95%CI 0.88–1.58), Stage 3b aOR = 1.40 (95%CI 1.03–1.89); and Stage 4&5 aOR = 1.65 (95%CI 1.16–2.35). Conclusion: eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality

Origin of enriched-type mid-ocean ridge basalt at ridges far from mantle plumes: The East Pacific Rise at 11°20′N

The East Pacific Rise (EPR) at 11°20′N erupts an unusually high proportion of enriched mid-ocean ridge basalts (E-MORB) and thus is ideal for studying the origin of the enriched heterogeneities in the EPR mantle far from mantle plumes. These basalts exhibit large compositional variations (e.g., [La/Sm]N = 0.68–1.47, 87Sr/86Sr = 0.702508–0.702822, and 143Nd/144Nd = 0.513053–0.513215). The 87Sr/86Sr and 143Nd/144Nd correlate with each other, with ratios of incompatible elements (e.g., Ba/Zr, La/Sm, and Sm/Yb) and with the abundances and ratios of major elements (TiO2, Al2O3, FeO, CaO, Na2O, and CaO/Al2O3) after correction for fractionation effect. These correlations are interpreted to result from melting of a two-component mantle with the enriched component residing as physically distinct domains in the ambient depleted matrix. The observation of [Nb/Th]PM > 1 and [Ta/U]PM > 1, plus fractionated Nb/U, Ce/Pb, and Nb/La ratios, in lavas from the northern EPR region suggests that the enriched domains and depleted matrix both are constituents of recycled oceanic lithosphere. The recycled crustal/eclogitic lithologies are the major source of the enriched domains, whereas the recycled mantle/peridotitic residues are the most depleted matrix. On Pb-Sr isotope plot, the 11°20′N data form a trend orthogonal to the main trend defined by the existing EPR data, indicating that the enriched component has high 87Sr/86Sr and low 206Pb/204Pb and 143Nd/144Nd. This isotopic relationship, together with mantle tomographic studies, suggests that the source material of 11°20′N lavas may have come from the Hawaiian plume. This “distal plume-ridge interaction” between the EPR and Hawaii contrasts with the “proximal plume-ridge interactions” seen along the Mid-Atlantic Ridge. The so-called “garnet signature” in MORB is interpreted to result from partial melting of the eclogitic lithologies. The positive Na8-Si8/Fe8 and negative Ca8/Al8-Si8/Fe8 trends defined by EPR lavas result from mantle compositional (vs. temperature) variation