Clinical Characteristics and prognostic factors for Intensive Care Unit Admission of Patients With COVID-19. Retrospective Study Using Machine Learning and Natural Language Processing.

13 p.Background: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results: A total of 10,504 patients with a clinical or polymerase chain reaction?confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature 39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admissio

Impact of the COVID-19 pandemic in mortality due to respiratory diseases: A comparative analysis of 2021 and 2020 vs 2019 in Spain.

Introduction: We previously reported an increase in respiratory mortality in 2020 in Spain after COVID-19. It is unclear if this rise is sustained in the longer-term. We aimed to determine whether respiratory mortality in 2021 in Spain returned to pre-pandemic levels. Material and methods: In an observational, large study using official National Institute of Statistics data, we explored deaths due to respiratory diseases, that is, all causes of death by the standard WHO list of diseases of the respiratory system plus COVID-19, tuberculosis and lung cancer. Using the latest available official data of Spain, we analyzed changes in the mortality pattern in Spain from January 2019 to December 2021. We endorsed STROBE guidance for observational research. Results: There were 98,714 deaths due to respiratory diseases in 2021 in Spain, corresponding to 21.9% of all deaths, becoming second in the ranking of causes of death. Respiratory diseases mortality in Spain has not returned to pre-pandemic levels in 2021, still with an increase of 30.3% (95% CI 30.2-30.4) compared to rates in 2019. All respiratory-specific causes of death decreased in 2021, except for lung cancer, that increased in women and decreased in men compared to 2019 (both p<0.05). In a multivariate analysis some established risk factors for respiratory diseases mortality were confirmed, such as male gender and older age; further, an association with reduced mortality in rural Spain was observed, still with a large geographical variability. Conclusions: The COVID-19 pandemic has had a lasting impact on deaths due to respiratory diseases and certain specific causes of death in 2021, and it has disproportionately affected certain regions

Ethical issues in using Twitter for population-level depression monitoring: a qualitative study

Risk of bias summary. (JPEG 60 kb

Face Mask Exemptions, Respiratory Patients, and COVID-19 in Spain. Data From the 2021 ITC EUREST-PLUS Spain Survey

Dear Editor, During the initial waves of the COVID-19 pandemic, respiratory patients received confusing messages by several patient associations and the World Health Organization1, 2 to be exempted from wearing face masks. Allegedly, many assumed that difficult breathing through face masks might exacerbate their respiratory condition, producing asthma attacks or chronic obstructive pulmonary disease (COPD) exacerbations. In its December 2020 Interim Guidance on Mask use in the context of COVID-19, WHO cited studies suggesting that masks might have an adverse impact on respiratory disease patients, but they did not provide any guidance about whether respiratory disease patients should or should not wear masks; explicitly, it reads in page 10 of 22 the following paragraph and references

The ATLAS ASMA Study : Assessing the Impact of Asthma on Patients' Life - The Spanish Patients' Perspective

ATLAS ASMA described the psychosocial impact of asthma on patients' daily life from patients' perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life. This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients' data are included. A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p<0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p<0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%). The study reported important insights on psychosocial impact of asthma on patients' daily life from patients' perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors

Sleep apnea-COPD overlap syndrome is associated with larger left carotid atherosclerotic plaques

BackgroundLittle is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome increases the risk of stroke associated with COPD itself.MethodsWe prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated.ResultsPolygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjusted-multivariate linear regression revealed age, current smoking and the apnea/hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients.ConclusionsThis study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke

Pharmacological Interactions of Nintedanib and Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis in Times of COVID-19 Pandemic

The discovery of antifibrotic agents have resulted in advances in the therapeutic management of idiopathic pulmonary fibrosis (IPF). Currently, nintedanib and pirfenidone have become the basis of IPF therapy based on the results of large randomized clinical trials showing their safety and efficacy in reducing disease advancement. However, the goal of completely halting disease progress has not been reached yet. Administering nintedanib with add-on pirfenidone is supposed to enhance the therapeutic benefit by simultaneously acting on two different pathogenic pathways. All this becomes more important in the context of the ongoing global pandemic of coronavirus disease 2019 (COVID-19) because of the fibrotic consequences following SARS-CoV-2 infection in some patients. However, little information is available about their drug-drug interaction, which is important mainly in polymedicated patients. The aim of this review is to describe the current management of progressive fibrosing interstitial lung diseases (PF-ILDs) in general and of IPF in particular, focusing on the pharmacokinetic drug-drug interactions between these two drugs and their relationship with other medications in patients with IPF

Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19

Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be associated with serious and life-threatening conditions, including acute respiratory distress syndrome (ARDS). Severity and mortality have been related to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic state. We conducted an observational retrospective cohort study from a community-based large population of hospitalized COVID-19 PCR + patients admitted from March 01, 2020, to January 24, 2021, with integrated primary to tertiary care information in Castilla la Mancha, Spain. We explored the potential benefits of the antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC) administered orally in high doses (600 mg every 8 h), added to standard of care in COVID-19 patients by using the free text information contained in their electronic health records (EHRs). Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071 (10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were older, predominantly male, and with more comorbidities such as hypertension, dyslipidemia, diabetes, and COPD when compared with those not on NAC (all p < 0.05). Despite greater baseline risk, use of NAC in COVID-19 patients was associated with significantly lower mortality (OR 0.56; 95%CI 0.47–0.67), a finding that remained significant in a multivariate analysis adjusting by baseline characteristics and concomitant use of corticosteroids. There were no significant differences with the use of NAC on the mean duration of hospitalization, admission to the intensive care unit or use of invasive mechanical ventilation. The observed association signaling to better relevant outcomes in COVID-19 patients treated with NAC at high doses should be further explored in other settings and populations and in randomized controlled trial

Characteristics and prognosis of COVID-19 in patients with COPD

Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher prevalence of coronary ischemia and other factors that put them at risk for COVID-19-related complications. We aimed to explore the impact of COVID-19 in a large population-based sample of patients with COPD in Castilla-La Mancha, Spain. We analyzed clinical data in electronic health records from 1 January to 10 May 2020 by using Natural Language Processing through the SAVANA Manager® clinical platform. Out of 31,633 COPD patients, 793 had a diagnosis of COVID-19. The proportion of patients with COVID-19 in the COPD population (2.51%; 95% CI 2.33–2.68) was significantly higher than in the general population aged >40 years (1.16%; 95% CI 1.14–1.18); p < 0.001. Compared with COPD-free individuals, COPD patients with COVID-19 showed significantly poorer disease prognosis, as evaluated by hospitalizations (31.1% vs. 39.8%: OR 1.57; 95% CI 1.14–1.18) and mortality (3.4% vs. 9.3%: OR 2.93; 95% CI 2.27–3.79). Patients with COPD and COVID-19 were significantly older (75 vs. 66 years), predominantly male (83% vs. 17%), smoked more frequently, and had more comorbidities than their non-COPD counterparts. Pneumonia was the most common diagnosis among COPD patients hospitalized due to COVID-19 (59%); 19% of patients showed pulmonary infiltrates suggestive of pneumonia and heart failure. Mortality in COPD patients with COVID-19 was associated with older age and prevalence of heart failure (p < 0.05). COPD patients with COVID-19 showed higher rates of hospitalization and mortality, mainly associated with pneumonia. This clinical profile is different from exacerbations caused by other respiratory viruses in the winter seasonGrant COVID-19 UAH 2019/00003/016/001/005 from Alcalá Universit