Analysis of laboratory blood parameter results for patients diagnosed with COVID‐19, from all ethnic group populations: A single centre study

Introduction: Although factors such as age, sex, diabetes, obesity and changes in certain laboratory investigations are important prognostic factors in COVID-19 infection, these may not apply to all ethnic/racial groups. We hypothesized differences in routine biochemistry and haematology indices in Caucasian and a combined group of Black, Asian and Minority Ethnic (BAME) patients who tested positive for COVID-19 who died, compared to survivors. Methods: We tested our hypothesis in 445 patients (229 Caucasian, 216 BAME) admitted to secondary care with proven COVID-19 infection, in whom standard routine laboratory indices were collected on admission. Results: After 28 weeks, 190 (42.7%) had died within 28 days of COVID diagnosis (97 Caucasians [42.4%], 93 BAMEs [43.1%], P =.923). A general linear model analysis found the ethnicity interaction with mortality to be significant for fibrinogen, ferritin and HbA 1c (after controlling for age). In a multivariate analysis, a neutrophil/lymphocyte ratio > 7.4 and a urea/albumin ratio > 0.28 increased the odds of death for both the Caucasian and the BAME group. Additional factors increasing the odds ratio in the BAME group included age >60 years and being diabetic. Conclusion: Neutrophil/lymphocyte ratio and urea/albumin ratio are simple metrics that predict death to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce mortality. In the BAME groups, intensive monitoring even at younger age and those with diabetes may also help reduce COVID-19 associated mortality

Exploring the attitude of the UK diverse ethnic communities towards Covid-19 public health announcements

© 2022 EJBPS. This is the published version of an article published by EJBPS on 01/11/2022, available online: https://www.ejbps.com/ejbps/abstract_id/9288Introduction: COVID-19 preventative guidance has been communicated to the public through multiple media channels and mostly in English. Aim: To gather students‟ opinions on how useful COVID-19 messages have been for them and their families and what can be done to make these better and more sensitive to people from different ethnicities, origins or sub-cultures. Method: This study is a mixed-method survey based, with university students being the target participants. The survey was online and anonymous, with two reminders sent out two weeks apart. Results: Of the 150 students only 112 completed or partially completed the survey, with 51 participants (46%) answering the demographics questions only. Of the 61 participants, 49% agreed that asking about race or ethnicity is acceptable and 44% agreed that it should continue to be collected, but 62% disagreed that the term BAME accurately described them or their families. Regarding the understandability of public health messages for their families and communities, 24.5% and 33% of participants selected „no.‟ Social distancing was not strictly observed by 46% of the participants and 38% said that it was not observed in their communities. Regarding their personal approach to wearing a face covering, 88.5% selected „yes‟, vs. 77% in the community they live in. Regarding public health messages about vaccination, being vaccinated and if the participants‟ families are vaccinated, the majority answered „yes‟ (59-61%). Regarding testing availability and uptake, the majority answered „yes‟ (59%). Finally, participants were asked to indicate if the pandemic had exerted a negative impact on them and their families; 61% selected „yes‟. Conclusion: In this study most participants indicated they consider the term BAME does not represent them. The most reported COVID-19 health impact was a decline of mental health, followed by physical health. Receiving false information, poor access and availability were factors shared by the participants for not being tested or vaccinated. Participants indicated that health sector needs to be more effective in discussing misinformation and disseminating health facts in accessible forms. Participants indicated early intervention as the major missed opportunity that might have protected their community from COVID-19 pandemic

SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score

Background: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. Methods: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. Results: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =—0.162). Interpretation: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications

Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial

Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients’ own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of ‘bone pain’, simply ‘pain’. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47–8.44]), bone disease (OR 3.71 [CI 1.88–7.32]) and age >65 years (OR 1.58 [CI 1.15–2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28–3.91]), age >65 years (OR 2.14 [CI1.28–3.91]) and absence of back pain (OR 0.44 [CI 0.29–0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of ‘symptom-directed’ screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures

Real-world tyrosine kinase inhibitor treatment pathways, monitoring patterns and responses in patients with chronic myeloid leukaemia in the United Kingdom: the UK TARGET CML study.

Management of chronic myeloid leukaemia (CML) has recently undergone dramatic changes, prompting the European LeukemiaNet (ELN) to issue recommendations in 2013; however, it remains unclear whether real-world CML management is consistent with these goals. We report results of UK TARGET CML, a retrospective observational study of 257 patients with chronic-phase CML who had been prescribed a first-line TKI between 2013 and 2017, most of whom received first-line imatinib (n = 203). Although 44% of patients required ≥1 change of TKI, these real-world data revealed that molecular assessments were frequently missed, 23% of patients with ELN-defined treatment failure did not switch TKI, and kinase domain mutation analysis was performed in only 49% of patients who switched TKI for resistance. Major molecular response (MMR; BCR-ABL1IS ≤0·1%) and deep molecular response (DMR; BCR-ABL1IS ≤0·01%) were observed in 50% and 29%, respectively, of patients treated with first-line imatinib, and 63% and 54%, respectively, receiving a second-generation TKI first line. MMR and DMR were also observed in 77% and 44% of evaluable patients with ≥13 months follow-up, receiving a second-generation TKI second line. We found little evidence that cardiovascular risk factors were considered during TKI management. These findings highlight key areas for improvement in providing optimal care to patients with CML

COVID-19 in haematology patients: A multi-centre West Midlands clinical outcomes analysis on behalf of West Midlands Research Consortium

This is an accepted manuscript of an article published by Wiley in British Journal of Haematology, available online on 05/11/2020 at: https://doi.org/10.1111/bjh.17136 The accepted version of the publication may differ from the final published version

Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial.

Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of 'bone pain', simply 'pain'. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47-8.44]), bone disease (OR 3.71 [CI 1.88-7.32]) and age >65 years (OR 1.58 [CI 1.15-2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28-3.91]), age >65 years (OR 2.14 [CI1.28-3.91]) and absence of back pain (OR 0.44 [CI 0.29-0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of 'symptom-directed' screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures

COVID-19 in hematology patients: real world experience in hospitals in the UK West Midlands

© 2021 The Authors. Published by Hilaris. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: [DOI/weblink]Objectives: This study aimed to understand the consequences of coronavirus disease 2019 (COVID-19) in patients diagnosed with haematological conditions, malignant and non-malignant. Method: A detailed insight into the first 112 patients with comorbidity of haematological conditions and COVID-19, admitted into nine National Health Services Trusts in the West Midlands Area of the United Kingdom, between 1st of March 2020 and 31st May 2020. Results: In the study cohort, 82% of patients had a malignant haematological disorder whilst 18% had a non-malignant haematological condition. Increasing age, breathlessness, reduction in oxygen saturation under 90% and abnormal chest x-ray were independently associated with higher mortality. Other long term co-morbidities did not present adverse impacts in this population. Survival analysis demonstrated that the COVID-19 severity score had a significant adverse correlation on patient outcome. COVID-19 patients who were classified as low risk, based on their primary haematological condition, showed significantly shorter survival time than those in the high risk category, which might be due to the shielding strategy for high infection risk patients. Conclusion: The 55% overall mortality in this cohort suggests that patients with haematological conditions had a higher mortality rate than patients with other acute, chronic or long term conditions. Significance: Previous studies have suggested poor outcomes for COVID‐19 infection in patients with haematological cancers, with short‐term mortality rates ranging from 32% to 62%. We report here the outcome of COVID-19 infection in patients with haematological conditions with both malignant and non-malignant, admitted to secondary care in acute care hospitals of the UK West Midlands. This study also examined the impact of chemo immunotherapy on outcomes from COVID-19 infection. This will be useful information to guide decision making during this second UK national lockdow