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Hypertensive patients most likely to develop post-Covid complications: Study

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People with hypertension, or high blood pressure, are most likely to develop complications when infected by Covid-19, says an analysis of medical records of over 1,800 patients admitted to hospitals run by the Mayo Clinic in the United States. A similar study of 18,000 Covid patients by Max Healthcare also established the role of hypertension in complications.
The findings could help hospitals give priority in treatment to patients susceptible to the listed complications.
The American study showed that hypertension was associated with 10 complications, including acute respiratory distress syndrome, improper beating of the heart and anaemia. In the analysis carried out using an artificial intelligence (AI) platform developed by nference Labs, a Bengaluru-based company, cardiovascular chronic disease (heart failure, coronary artery disease, cardiomyopathy) and chronic kidney disease proved the other most significant predictors of complication in early Covid infection.
“These findings will help clinicians prioritise patients according to their vulnerability for developing complications and at the same time focus on the commonest complications that are associated with different co-morbidities and, thus, save lives,” Venky Soundararajan, co-founder and chief scientific officer of nference, the parent company of nference Labs, told TOI.
For the analysis, results of which have been accepted for publication in Nature Digital Medicine, Soundararajan explained the researchers leveraged 1.1 million clinical notes from 1,803 hospitalised Covid patients and deep neural network models to characterise associations between 21 pre-existing conditions and the development of 20 complications throughout the course of Covid infection. “Pleural effusion, or accumulation of fluid in the lungs, was the most common of early Covid infection complications (4.9%) followed by cardiac arrhythmia,”’ he said.
nference’s AI platform has been used previously for several discoveries regarding Covid — from demonstrating the “real-world” effectiveness and safety of the Covid vaccines manufactured by Moderna, Pfizer/BioNTech and Johnson & Johnson to finding that a loss of smell (anosmia) preceded a positive Covid test in many patients by up to a week before their diagnosis date. The AI platform also studied how mass vaccination was fundamentally restricting the evolution of SARS-CoV-2 variants (like alpha, beta, gamma, delta), the company said.
Dr Sandeep Budhiraja, group medical director of Max Healthcare, said his own hospital group’s study involving over 18,000 Covid patients similarly showed how hypertension was a major risk factor for developing complications due to the infection.
“The coronavirus that causes Covid enters the body by attaching itself to ACE-2 receptors on the cells in the lungs, liver, heart and kidneys,” said Budhiraja. “Initially, it was hypothesised that some of the blood pressure-lowering drugs led to the increase in the number of ACE-2 receptors, thus putting the organs at higher risk of colonisation by the virus and, therefore, increased severity. But that theory was proved wrong. Another hypothesis is that hypertension causes chronic inflammation and damage to the tissues. Covid aggravates it further leading to more complications,” Budhiraja said, adding that the jury on the matter was still out.
Dr Neeraj Nischal of AIIMS said that hypertension was a common comorbidity in older patients known to be at higher risk of complications. “The causal association between hypertension and morbidity and mortality still needs to be established though we have seen it is commonly associated with patients who have poor outcomes,” said Nischal. Dr Rajesh Chawla, senior consultant, pulmonary medicine and critical care, Apollo Hospitals, added, “It is important to control blood pressure to prevent severe disease. The prognosis of patients with uncontrolled hypertension is worse.”

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Covid-19 patients at greater risk of mental disorders find Oxford University study

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LONDON: Patients are at an estimated 44 per cent greater risk of neurological and mental health diagnoses after Covid-19 than after flu, and a 16 percent greater risk than with other respiratory tract infections, the largest study of its kind by the University of Oxford revealed on Wednesday.
Overall, the estimated incidence of being diagnosed with a neurological or mental health disorder following Covid-19 infection was 34 percent, and for 13 per cent of these people, it was their first recorded neurological or psychiatric diagnosis.
The most common diagnoses after Covid-19 were anxiety disorders (occurring in 17 per cent of patients), mood disorders (14 per cent), substance misuse disorders (7 percent), and insomnia (5 per cent). The incidence of neurological outcomes was lower, including 0.6 per cent for a brain haemorrhage, 2.1 per cent for ischaemic stroke, and 0.7 per cent for dementia.
“These are real-world data from a large number of patients. They confirm the high rates of psychiatric diagnoses after Covid-19 and show that serious disorders affecting the nervous system (such as stroke and dementia) occur too. While the latter is much rarer, they are significant, especially in those who had severe Covid-19,” said Professor Paul Harrison, lead author of the study, from the Department of Psychiatry at Oxford University.
“Although the individual risks for most disorders are small, the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic. As a result, health care systems need to be resourced to deal with the anticipated need, both within primary and secondary care services,” he said.
This latest study analyzed data from the electronic health records of 236,379 Covid-19 patients from the US-based TriNetX network, which includes more than 81 million people.
This group was compared with 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with any respiratory tract infection (including influenza).
“Our results indicate that brain diseases and psychiatric disorders are more common after Covid-19 than after flu or other respiratory infections, even when patients are matched for other risk factors,” Dr. Max Taquet, a co-author of the study from Oxford University.
“We now need to see what happens beyond six months. The study cannot reveal the mechanisms involved, but does point to the need for urgent research to identify these, with a view to preventing or treating them,” he said.
Their peer-reviewed paper, published in ‘Lancet Psychiatry’, was funded by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.

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Higher than expected stroke risk in Covid-19 patients, says study

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WASHINGTON: New research found patients hospitalised with Covid-19 had a higher risk of stroke, compared with patients who had similar infectious conditions such as influenza and sepsis in prior studies.
Those who had an ischemic stroke were more likely to be older, male, Black race, or have high blood pressure, Type 2 diabetes or an irregular heartbeat (atrial fibrillation) compared with other Covid-19 patients, according to late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2021.
The meeting held virtually, March 17-19, 2021 and is a world premiere meeting for researchers and clinicians dedicated to the science of stroke and brain health.
For this analysis, researchers accessed the American Heart Association‘s Covid-19 Cardiovascular Disease Registry to investigate stroke risk among patients hospitalized for Covid-19, their demographic characteristics, medical histories and in-hospital survival. The Covid-19 Registry data pulled for this study included more than 20,000 patients hospitalized with COVID-19 across the US between January and November 2020.
“These findings suggest that Covid-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” said lead study author Saate S. Shakil, M.D., a cardiology fellow at the University of Washington in Seattle. “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”
Two hundred eighty-one people (1.4 per cent) in the Covid-19 CVD Registry had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7 per cent) experienced an ischemic stroke; 7 patients (2.5 per cent) had transient ischemic attack (TIA); and 127 patients (45.2 per cent) experienced a bleeding stroke or unspecified type of stroke.
The analysis of Covid-19 patients also found:- Those with any type of stroke were more likely to be male (64 per cent) and older (average age 65) than patients without stroke (average age 61).
Forty four per cent of patients who had an ischemic stroke also had Type 2 diabetes vs. about one-third of patients without stroke, and most of the ischemic stroke patients had high blood pressure (80 per cent) compared to patients without stroke (58 per cent);
Eighteen per cent of ischemic stroke patients had atrial fibrillation, while 9 per cent of those without stroke also had atrial fibrillation;
Patients who had a stroke spent an average of 22 days in the hospital, compared to 10 days of hospitalization for patients without stroke; and
In-hospital deaths were more than twice as high among stroke patients (37 per cent) compared to patients without stroke (16 per cent).
In addition, stroke risk varied by race. Black patients accounted for 27 per cent of the patients in the Covid-19 CVD Registry pool for this analysis; however, 31 per cent of ischemic stroke cases were among Black patients.
“We know the Covid-19 pandemic has disproportionately affected communities of colour, but our research suggests Black Americans may have a higher risk of ischemic stroke after contracting the virus, as well,” Shakil said. “Stroke on its own can have devastating consequences and recover from Covid-19 is often a difficult path for those who survive. Together, they can exact a significant toll on patients who have had both conditions.”
Shakil added, “It is more important than ever that we curb the spread of Covid-19 via public health interventions and widespread vaccine distribution.”

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Cancer patients less protected after first Covid vaccine jab, UK study finds

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LONDON: Cancer patients may not be protected to the same degree as the rest of the population after they receive their first of two doses of a Covid-19 vaccine, a new UK study has found on Thursday.
A team of experts from King’s College London and Francis Crick Institute found in the first real-world study of its kind that a shorter than the stipulated 12-week gap between the two vaccine doses for such patients appeared to be the answer.
The study’s senior authors, Dr Sheeba Irshad and Professor Adrian Hayday, believe that there should be urgent re-evaluation of UK policy for the dosing interval for all cancer patients, and likewise for many other high-risk groups of immuno-suppressed patients.
“Our data provides the first real-world evidence of immune efficacy following one dose of the Pfizer vaccine in immunocompromised patient populations,” said Dr Sheeba Irshad, a senior clinical lecturer from the School of Cancer and Pharmaceutical Sciences at King’s College London.
“We show that following the first dose, most solid and haematological cancer patients remained immunologically unprotected up until at least five weeks following primary injection; but this poor one dose efficacy can be rescued with an early booster at day 21,” she said.
Data from the world’s first reported trial to examine the level of immune protection after the Pfizer/BioNTech vaccine in cancer patients has found that anti-SARS-CoV-2 – the virus which causes Covid-19 – antibody responses at week three following the first dose of the vaccine were only 39 per cent and 13 per cent in the solid and haematological cancers, compared to 97 per cent in those without cancer.
The preprint study, which is to be peer-reviewed, also reports that when the second dose of the vaccine was given three weeks after the first dose, the immune response improved significantly for solid cancer patients with 95 per cent of them showing detectable antibodies to the SARS-CoV-2 virus within just two weeks.
By contrast, those who did not get a vaccine boost at three weeks did not see any real improvement, with only 43 per cent of solid cancer patients and 8 per cent of blood cancer patients developing antibodies to the Pfizer vaccine at five weeks compared to 100 per cent of healthy controls.
The evidence of vaccine responses in cancer patients shows that a gap of 12 weeks between doses of the Pfizer-BioNTech vaccine could leave many cancer patients vulnerable to serious Covid-19, the study finds.
Prof. Adrian Hayday from King’s College London and the Francis Crick Institute said: “Cancer patients should be vaccinated and boosted quickly and their responses, particularly those of blood cancer patients, should be intensively monitored so that those who mix with family, friends and carers can be confident of their environment.”
Dr Simon Vincent, Director of Research, Support and Influencing at Breast Cancer Now, called on the Joint Committee on Vaccination and Immunisation (JCVI), which determines the UK’s vaccine rollout cohorts, to urgently review the evidence and to consider adapting its strategy to ensure that cancer patients can receive both the first and second dose of the Pfizer/BioNTech Covid-19 vaccine within a three-week timeframe to minimise their risk of both contracting and becoming seriously ill with coronavirus.
“Worryingly, this study suggests that people affected by cancer, including breast cancer, get little protection against the virus when they only receive a single dose of the Pfizer Covid-19 vaccine, and then do not receive their vaccine boost in the following three weeks,” he said.
But Cancer Research UK said the small study had not yet been reviewed by other scientists and people undergoing cancer treatment should continue to follow the advice of their doctors, while the government said that antibody response “was only part of the protection provided by the vaccine”.
Meanwhile, the UK study will continue to follow cancer patients after their vaccinations for up to six months.

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