By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
NEJM Journal Watch
Check out some of the latest findings on novel coronavirus disease (COVID-19):
Venous thrombosis: Deep vein thrombosis was identified in 65% of 34 COVID-19 patients who underwent venous ultrasound upon admission to a French intensive care unit, researchers report in JAMA Network Open. When second ultrasounds performed 48 hours after ICU admission were included, the prevalence rose to 79%. Of note, all patients had received anticoagulant prophylaxis at hospital admission. The researchers say that “prognosis might be improved with early detection and a prompt start of anticoagulant therapy.”
Perioperative infection: Surgery in patients with perioperative SARS-CoV-2 infection carries a high 30-day mortality rate, largely due to pulmonary complications, a Lancet study finds. Researchers examined outcomes in over 1100 patients who underwent surgery in 235 hospitals across 24 countries. All had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. Overall, mortality within 30 days of surgery was 24%. The mortality rate was higher in men, older patients, those undergoing emergency procedures, and those having major surgeries. Roughly half the cohort developed at least one pulmonary complication, and 38% of these patients died — accounting for 83% of all deaths in the entire cohort. The researchers conclude: “Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.”
Comorbid diabetes: Roughly 1 in 10 COVID-19 patients with diabetes dies within 7 days of hospital admission, according to a study in Diabetologia. The analysis included over 1300 diabetics with COVID-19 admitted to French hospitals in March. Some 29% required intubation or died within 7 days (the primary composite outcome), and body-mass index was the only variable independently associated with this outcome. Roughly 18% of the patients were discharged by day 7.
Early NYC patients: Of the first 1000 COVID-19 patients admitted to a New York City hospital, 34% developed acute kidney injury and 14% required dialysis, researchers report in The BMJ. Over 90% of the cohort had major comorbidities at baseline. Roughly a quarter of patients were admitted to the ICU, and about one fifth overall died. Patients’ first intubations occurred most commonly at 3–4 days and at 9 days after symptom onset — which, the researchers say, “could suggest a biphasic nature” of the disease course. The median length of invasive ventilation was 6 days in patients who died, 9 days in patients who were discharged, and 29 days in those who were still hospitalized at the end of follow-up.