Xiansong Wang
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Researcher at Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong
BackgroundRecent studies have reported numerous significant predictors for adverse outcomes in COVID-19 disease. However, there have been few simple clinical risk score for prompt risk stratification. The objective is to develop a simple risk score for severe COVID-19 disease using territory-wide healthcare data based on simple clinical and laboratory variables. MethodsConsecutive patients admitted to Hong Kongs public hospitals between 1st January and 22nd August 2020 diagnosed with COVID-19, as confirmed by RT-PCR, were included. The primary outcome was composite intensive care unit admission, need for intubation or death with follow-up until 8th September 2020. ResultsCOVID-19 testing was performed in 237493 patients and 4445 patients (median age 44.8 years old, 95% CI: [28.9, 60.8]); 50% male) were tested positive. Of these, 212 patients (4.8%) met the primary outcome. A risk score including the following components was derived from Cox regression: gender, age, hypertension, stroke, diabetes mellitus, ischemic heart disease/heart failure, respiratory disease, renal disease, increases in neutrophil count, monocyte count, sodium, potassium, urea, alanine transaminase, alkaline phosphatase, high sensitive troponin-I, prothrombin time, activated partial thromboplastin time, D-dimer and C-reactive protein, as well as decreases in lymphocyte count, base excess and bicarbonate levels. The model based on test results taken on the day of admission demonstrated an excellent predictive value. Incorporation of test results on successive time points did not further improve risk prediction. ConclusionsA simple clinical score accurately predicted severe COVID-19 disease, even without including symptoms, blood pressure or oxygen status on presentation, or chest radiograph results.
BackgroundProgrammed death 1 (PD-1) and programmed death 1 ligand (PD-L1) inhibitors, such as pembrolizumab, nivolumab and atezolizumab, are a major class of immune checkpoint inhibitors that are increasingly used for cancer treatment. However, their use is associated with adverse cardiovascular events. We examined the incidence of new-onset cardiac complications in patients receiving PD-1 or PD-L1 inhibitors. MethodsPatients receiving PD-1 or PD-L1 inhibitors since their launch up to 31st December 2019 at the Hospital Authority of Hong Kong, without pre-existing cardiac complications were included. The primary outcome was a composite of incident heart failure, acute myocardial infarction (AMI), atrial fibrillation (AF) or atrial flutter with the last follow-up date of 31st August 2020. ResultsA total of 1959 patients were included. Over a median follow-up of 136 days (IQR: 42-279), 320 (16.3%) patients met the primary outcome (heart failure: n=244, AMI: n=38, AF: n=54, atrial flutter: n=6) after PD-1/PD-L1 treatment. Univariate Cox regression showed that age, respiratory diseases, gastrointestinal diseases, a shorter readmission interval and total number of hospitalizations before PD-1/PD-L1 inhibitor prescription, PD-L1 inhibitor use, hyponatraemia, and reduced triglyceride levels were significant predictors of the primary outcome. On multivariate adjustment, older age, a shorter average readmission interval, and a higher number of hospital admissions remained significant predictors. Patients who developed cardiovascular complications had a shorter average readmission interval and a higher number of hospitalizations after PD-1/PD-L1 treatment. ConclusionsCardiovascular complications are found in 16% of patients receiving PD-1 or PD-L1 inhibitors and are associated with more healthcare utilization.