November 24, 2020

In today's episode we discuss: —Epidemiology: Body Mass Index is correlated with Risk for Intubation or Death in SARS-CoV-2 Infection according to a retrospective cohort study. The study, conducted at Columbia University Irving Medical Center, investigated the association between body mass index (BMI) and risk for intubation or death, inflammation, cardiac injury, or fibrinolysis from SARS-CoV-2 infection in 2,466 hospitalized COVID-19-positive adults. Compared to overweight patients, patients with class 3 obesity had the highest risk of intubation or death (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]), though these effects were most clear in patients less than 65 years old. BMI was not associated with admission levels of biomarkers for inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiac injury (troponin level), or fibrinolysis (D-dimer level). These results support previous studies showing increased risk of severe complications in overweight individuals, though this study also shows that other clinical correlates may demonstrate this increased risk upon admission. —Management: Association of SARS-CoV-2 genomic load trends with clinical status in COVID-19 were found in a study of 42 COVID-19 patients with associated pneumonia admitted to NYU Langone Medical Center. Investigators analyzed each patients' genetic load of SARS-CoV-2 Cycle threshold (Ct) by rapid RT-PCR versus their Sequential Organ Failure Assessment (SOFA) score and found a statistically significant inverse correlation between the change in Ct value and change in clinical SOFA score. These findings suggest that a “decrease in viral load over time was associated with clinical improvement," highlighting the potential use of SARS-CoV-2 genomic load as a potential predictive value in disease outcome. —Adjusting Practice During COVID-19: There may be increased susceptibility to SARS-CoV-2 infection in patients with reduced left ventricular ejection fraction. Cardiovascular and regenerative medicine researchers at the Université de Strasbourg in France followed-up via telephone interviews with 889 acute coronary syndrome patients who received percutaneous coronary intervention. They found that the incidence of COVID-19-associated hospitalization or mortality was significantly greater in patients with reduced left ventricular ejection fraction (LVEF, n=91) versus patients with moderately reduced and preserved LVEF (n=798; 9% versus 1%, P 60; 0.001). Further, they observed that reduced LVEF was an independent predictor of COVID-19 hospitalization or mortality via multivariate logistic regression (OR: 6.91; 95% CI: 2.60-18.35, P 60; 0.001), suggesting that COVID-19 testing and treatment plans should be considered for patients with reduced cardiac function.