2 Minute Medicine Rewind January 11, 2021

Diagnosis-wide analysis of COVID-19 complications: an exposure-crossover study

1. The most common complications associated with COVID-19 with high absolute risk were viral pneumonia, respiratory failure, acute kidney failure, and sepsis.

2. Complications highly associated with COVID-19 with low absolute risk were myocarditis, pneumothorax, and disseminated intravascular coagulation.

Evidence Rating Level: 2 (Good)

During the COVID-19 pandemic, greater than 50 million individuals worldwide have been diagnosed with the disease. Although most people present with mild or no symptoms, 20% of patients have had severe cases requiring hospitalization. Respiratory sequelae such as pneumonia have been identified as common complications of COVID-19. However, previous literature often relied on small cohorts that could not estimate the risk of various COVID-19 complications. The current retrospective cohort study aimed  to identify complications that were highly associated with COVID-19, and to estimate the odds ratio and absolute risk of developing these complications. The study population comprised of 70,288 patients diagnosed with COVID-19 in the United States. Medical claims data was used to compare diagnoses made in a patient’s “hazard” period (between 7 days prior to and 30 days after a COVID-19 diagnosis) to diagnoses made in the baseline period (between 120 days prior and 30 days prior to COVID-19 diagnosis). The results found 69 diagnoses that were significantly associated with COVID-19 diagnosis. As expected, the most common diagnoses included respiratory conditions, such as viral pneumonia (odds ratio 177.63, 95% CI 147.19–214.37, absolute risk 27.6%) and respiratory failure (OR 11.36, 95% CI 10.74–12.02, absolute risk 22.6%),  in addition to other common conditions such as acute kidney failure (OR 3.50, 95% CI 3.34–3.68, absolute risk 11.8%) and sepsis (OR 4.23, 95% CI 4.01–4.46, absolute risk 10.4%). Conditions that had high association with COVID-19 diagnosis but low absolute risk included myocarditis, pneumothorax, and disseminated intravascular coagulation (absolute risk ranging from 0.1-0.4%). Overall, this study demonstrated identified several complications associated with COVID-19, which can help inform patient management and treatment decisions for COVID-19 patients.


Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States

1. During the COVID-19 pandemic, 45.2% of college students experienced higher than average levels of emotional distress and worry time, with 40.4% experiencing moderate levels of these factors.

2. Those at higher risk of experiencing worse mental health include women, students aged 18-24, Asian students, students with below-average social class, students with fair or poor health, and students who know an individual with COVID-19.

Evidence Rating Level: 2 (Good)

The COVID-19 pandemic has had a serious impact on people’s mental health, as evidenced by the 1000% increase in mental health hotline use in the United States, during April 2020. Although all populations have been affected, college students may be especially vulnerable, as even prior to the pandemic, they were reported to experience high levels of anxiety, depression, substance use issues, and other mental health concerns.. The current study aimed to expand prior single institution studies to examine the effect COVID-19 may have had on the mental health of college students in 7 different Universities. The study population included 2,534 students from Arizona, North and South Carolina, Pennsylvania, and Montana. Participants were asked to fill out a survey containing open-ended questions on how COVID-19 has affected their behaviour, and quantitative questions measuring concepts such as negative emotion, preoccupation, stress, and worry. Data was collected on gender, age, race/ethnicity, socioeconomic status (SES), and academic status (undergrad or graduate student). The results found that 45.2% of students were classified as high profile (experiencing higher than average levels of emotional distress and worry time), with 40.4% of students classified as moderate profile (moderate levels of both factors), and 14.3% classified as low profile. Furthermore, from the demographics analysis, women were identified as being more likely to be high profile (residuals = 8.02, p < 0.001), students aged 18 to 24 years old more likely to be moderate profile (RES = 3.81, p = 0.0013), Asian students were less likely to be low profile (RES = -3.42, p = 0.0076) compared to White students (RES = 2.98, p = 0.035), and those in a below-average social class were more likely to be high profile (RES = 3.38, p = 0.0065). In terms of lifestyle factors, individuals with fair or poor health were more likely to be high profile (RES = 5.90, p < 0.001), and those who knew someone infected with COVID-19 were more likely to be high profile (RES = 3.06, p = 0.013). Overall, this study demonstrated how prevalent poor mental health for college students is during the pandemic, and also identified certain groups as being higher risk than others, which underlies the urgency for public health services to address the mental health need in these populations.


Targeting body composition in an older population: do changes in movement behaviours matter? Longitudinal analyses in the PREDIMED-Plus trial

1. For older adults with overweight or obesity, and metabolic syndrome, replacing 30 minutes of inactive time with moderate to vigorous physical activity was associated with a decrease in body fat and increase in muscle mass.

Evidence Rating Level: 2 (Good)

Aging tends to lead to changes in body composition, including loss of muscle mass and adipose accumulation in central body areas: This could lead to mobility issues and chronic diseases, such as cardiovascular conditions and diabetes. Although physical activity (PA) is well known to combat these body composition changes, previous research has not fully elucidated the optimal relationship between PA and sedentary behaviour (SB), as well as the extent of PA that needs to be done to make a significant improvement in body composition. In this prospective cohort study, researchers investigated body composition changes associated with time spent in PA and SB, as well as the effect of replacing SB with PA at varying intensities or with time in bed. The study population included 1,565 participants (average age 65, 48% women) from Spain who were overweight, obese, or had 3 or more components of metabolic syndrome. In addition to self-reported PA and SB data collected for a year, accelerometer data (to measure PA and SB) was collected for one week at baseline, 6 months follow-up, and 12 months follow-up. Data on body fat mass and body muscle mass were collected from DXA scanners at those same three time points. The results demonstrated that, after adjusting for confounders, a 30 minute daily increase in total PA and moderate to vigorous physical activity (MVPA) were significantly correlated with a decrease in body fat (β coefficient − 0.07%, 95% CI − 0.10 to 0.04% for total PA; β -0.08%, 95% CI -0.11 to -0.04% for MVPA) and an increase in muscle mass (β 0.07%, 95% CI 0.04 to 0.10; β 0.07%, 95% CI 0.04 to 0.10 respectively). Low levels of PA (LPA) did not have significant associations. Furthermore, replacing 30 min daily of inactive time with time in bed, LPA, and MVPA were all associated with a decrease in body fat (β -0.09%, -0.13%, and -0.54% respectively) and an increase in muscle mass (β 0.08%, 0.12%, and 0.51% respectively). Overall, this study demonstrated the positive impact of just 30 minutes of MVPA can have on fat composition and muscle mass in older adults, which can help health care providers better inform and motivate patients who have overweight, obesity, and/or metabolic syndrome.


Statin Exposure and Risk of Heart Failure After Anthracycline‐ or Trastuzumab‐Based Chemotherapy for Early Breast Cancer: A Propensity Score‒Matched Cohort Study

1. In early breast cancer, exposure to statins during anthracycline-based chemotherapy was associated with a significantly lower risk of heart failure after 5 years.

2. Statin use during trastuzumab-based chemotherapy was associated with a non-significantly lower risk.

Evidence Rating Level: 2 (Good)

Early breast cancer (EBC) treatment often involves the use of anthracyclines and/or trastuzumab as chemotherapy. However, these treatments carry a risk of cardiotoxicity and therefore contribute to heart failure (HF), which may explain why heart disease is a leading cause of death for survivors of EBC. From some previous studies, statins have been identified as potential cardioprotective agents for these EBC treatments. The aim of the current retrospective cohort study was to investigate the association of HF risk and statin exposure in elderly EBC survivors who were treated with anthracyclines and/or trastuzumab. The study population consisted statin-exposed and unexposed women, matched 1:1 with propensity scores. This resulted in 666 pairs in the anthracycline cohort and 390 pairs in the trastuzumab cohort, and an overall median age of 69 (interquartile range 67-73 years). Individuals were considered statin-exposed if they were dispensed 2 statin prescriptions in the year before the date of the first anthracycline or trastuzumab treatment (index date), and with 1 prescription overlapping with the index date. For the anthracycline cohort, the study found the cumulative incidence of HF presentations at 5 years to be significantly different, at 1.2% (95% CI 0.5-2.6%) and 2.9% (95% CI 1.7-4.6%) in statin-exposed and unexposed patients respectively (p = 0.01). As well, the cause-specific hazard ratio for statins was 0.45 (95% CI 0.24-0.85, p = 0.01). For patients taking trastuzumab, the 5-year cumulative incidence was 2.7% (95% CI 1.2-5.2%) and 3.7% (95% CI 2.0-6.2%) for statin-exposed and unexposed respectively (p = 0.09), and the cause-specific HR for statins was 0.46 (95% CI 0.20-1.07, p = 0.07). Overall, this study demonstrated that statins are a potential cardioprotective agent for anthracycline-based EBC chemotherapy, with implications for further exploration through randomized controlled trials.


Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial

1. Lansoprazole was not found to be efficacious in the treatment of persistent throat symptoms.

Evidence Rating Level: 1 (Excellent)

Persistent throat symptoms are frequently encountered in primary and secondary care settings. These symptoms may include voice hoarseness, the feeling of a lump in the throat, continuously clearing the throat, and general throat discomfort. As well, gastroesophageal reflux disease (GERD) affects 20% of the Western world, and is often linked to throat and voice symptoms. As a result, treatments for GERD such as proton pump inhibitors (PPIs) have become commonly prescribed for persistent throat symptoms, without sufficient evidence for their efficacy. In this double-blind, randomized controlled trial examining whether lansoprazole (a PPI) was superior to placebo in improving persistent throat symptoms. The study population consisted of 220 adults from eight otolaryngology clinics in the UK, who presented with at least 6 weeks of inexplicable throat symptoms, and sufficient severity determined by the reflux symptom index (RSI), a well-established self-report questionnaire scored out of 45 (higher scores indicate greater severity). Participant symptoms were classified as mild or severe based on the RSI score. The participants were randomized by blocks into the placebo or lansoprazole (30 mg twice daily) groups, stratified by the treatment clinic and symptom severity classification. The primary outcome measured was the RSI-score after 16 weeks, and secondary outcomes included treatment compliance, RSI-score after 12 months, quality of life, and appearance of the throat. From the results, no statistically significant difference was found in the primary outcome: At baseline, the mean RSI-scores were 22.0 (95% CI 20.4-23.6) and 21.7 (95% CI 20.5-23.0) for the lansoprazole and placebo groups respectively, and at 16 weeks, the scores were 17.4 (95% CI 15.5-19.4) and 15.6 (95% CI 13.8-17.3) respectively. The estimated difference was 1.9 points (95% CI -0.3 to 4.2, p = 0.096). Furthermore, there were no benefits for lansoprazole over placebo in the secondary outcome measures. Overall, the study did not show evidence for the advantage of treating persistent throat symptoms with PPIs, which has implication for informing clinical guidelines as well as current prescription practices by primary care doctors and otolaryngologists.

Image: PD

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