Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(7), P. 1837 - 1837

Published: March 22, 2024

Background: Despite advancements in vaccination, early treatments, and understanding of SARS-CoV-2, its impact remains significant worldwide. Many patients require intensive care due to severe COVID-19. Remdesivir, a key treatment option among viral RNA polymerase inhibitors, lacks comprehensive studies on factors associated with effectiveness. Methods: We conducted retrospective study 2022, analyzing data from 252 hospitalized COVID-19 treated remdesivir. Six machine learning algorithms were compared predict influencing remdesivir’s clinical benefits regarding mortality hospital stay. Results: The extreme gradient boost (XGB) method showed the highest accuracy for both (95.45%) stay (94.24%). Factors worse outcomes terms included limitations life support, ventilatory support needs, lymphopenia, low albumin hemoglobin levels, flu and/or coinfection, cough. For stay, vaccine doses, lung density, pulmonary radiological status, comorbidities, oxygen therapy, troponin, lactate dehydrogenase asthenia. Conclusions: These findings underscore XGB’s effectiveness accurately categorizing undergoing remdesivir treatment.

Language: Английский

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Antiviral combination treatment strategies for SARS-CoV-2 infection in immunocompromised patients

Current Opinion in Infectious Diseases, Journal Year: 2024, Volume and Issue: 37(6), P. 506 - 517

Published: Oct. 23, 2024

Purpose of review The purpose this is to report the available evidence regarding use combination regimens antivirals and/or antibody-based therapy in treatment SARS-CoV-2 immunocompromised patients. Recent findings Literature search identified 24 articles, excluding single case reports, which included mainly patients with hematological malignancies B-cell depletion. Data were divided based on timing and reason for administration treatment, that is, early prevent progression severe COVID-19 prolonged or relapsed infection. We described treated populations, duration composition treatment. briefly addressed new options we proposed an algorithm management infection affected by malignancies. Summary Combination seems effective (73–100%) well tolerated (<5% reported bradycardia, hepatotoxicity, neutropenia) strategy treating prolonged/relapsed infections host, although its optimal cannot be defined currently evidence. role as at a high risk disease/persistent shedding requires further from comparison monotherapy, even though efficacy was combinations plus mAbs previous viral variants.

Language: Английский

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Case Report: Favorable outcome of allogeneic hematopoietic stem cell transplantation in SARSCoV2 positive recipient, risk-benefit balance between infection and leukemia

Frontiers in Immunology, Journal Year: 2023, Volume and Issue: 14

Published: May 23, 2023

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) in SARS-CoV-2 positive candidates is usually delayed until the clinical resolution of infection's symptoms and a negative nasopharyngeal molecular test. However, prolonged positivity has been frequently observed haematological malignancies, thus representing challenge for timing transplant procedures. Here, we report on case 34-year-old patient with recent pauci-symptomatic COVID-19 undergoing high-risk acute B-lymphoblastic leukemia before achieving viral clearance. Shortly their scheduled allogeneic HSCT from matched unrelated donor, developed mild Omicron BA.5 infection receiving nirmatrelvir/ritonavir fever within 72 hours. Twenty-three days after diagnosis, because increasing minimal residual disease values context refractory SARS-2-CoV reduction load at surveillance swabs, it was decided not to delay further allo-HSCT. During myelo-ablative conditioning, increased while remained asymptomatic. Consequently, two transplant, intra-muscular tixagevimab/cilgavimab 300/300 mg 3-day course intravenous remdesivir were administered. pre-engraftment phase, veno-occlusive (VOD) occurred day +13, requiring defibrotide treatment obtain slow but complete recovery. The post-engraftment phase characterized by +23 (cough, rhino-conjunctivitis, fever) that spontaneously resolved, clearance +28. At +32, she experienced grade I graft-versus host (a-GVHD, skin II) treated steroids photo-apheresis, without complications during follow-up +180. Addressing issue allo-HSCT patients recovering malignant diseases challenging 1] high risk progression, 2] impact prognosis 3] occurrence endothelial such as VOD, a-GVHD, associated thrombotic micro-angiopathy. Our describes favourable outcome recipient active SARS-CoV2 thanks timely anti-SARS-CoV-2 preventive therapies prompt management transplant-related complications.

Language: Английский

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Local and Systemic Immunity During Five Vaccinations Against SARS-CoV-2 in Zanubrutinib-Treated Patients With Chronic Lymphocytic Leukemia

Journal of Hematology, Journal Year: 2023, Volume and Issue: 12(4), P. 170 - 175

Published: Aug. 1, 2023

Patients with chronic lymphocytic leukemia (CLL) are vulnerable to coronavirus disease 2019 (COVID-19) and at risk of inferior response severe acute respiratory syndrome 2 (SARS-CoV-2) vaccination, especially if treated the first-generation Bruton's tyrosine kinase inhibitor (BTKi) ibrutinib. We aimed evaluate impact third-generation BTKi, zanubrutinib, on systemic mucosal SARS-CoV-2 vaccination.Nine patients CLL ongoing zanubrutinib therapy were included donated blood saliva during before vaccine doses 3 5 - weeks after 3, 4, 5. Ibrutinib-treated control (n = 7) healthy aged-matched controls gave dose quantified reactivity neutralization capacity SARS-CoV-2-specific IgG IgA antibodies (Abs) in both serum saliva, T cells activated viral peptides.Both zanubrutinib- ibrutinib-treated had significantly, up 1,000-fold, lower total spike-specific Ab levels compared (P < 0.01). Spike-IgG from zanubrutinib-treated correlated well (r 0.68; P 0.0001) thus functional. Mucosal immunity (specific saliva) was practically absent even five doses, whereas significantly higher (tested 5) 0.05). In contrast, T-cell against peptides equally high as donors.In our small cohort patients, we conclude that vaccination induced no detectable immunity, which likely will impair primary barrier defence infection. Systemic responses also impaired, normal. Further larger studies needed these findings protection.

Language: Английский

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Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach

Published: Feb. 24, 2024

Despite widespread vaccination, early treatments, and improved understanding of the disease, effects SARS-CoV-2 infection remain significant worldwide. Many patients still suffer from severe COVID-19, necessitating admission to intensive care units. Remdesivir is a primary treatment option among viral RNA polymerase inhibitors for hospitalized patients. However, there lack studies examining factors influencing its effectiveness in this context. We conducted retrospective study throughout 2022, analyzing clinical, laboratory, sociodemographic data 252 COVID-19 treated with remdesivir. Six machine learning algorithms were compared validated predict associated loss clinical benefit remdesivir terms mortality hospital stay. Data extracted electronic health records. The eXtreme Gradient Boost (XGB) method achieved highest balanced accuracy both (95.45%) stay (94.24%). Factors worse outcomes use included limitation life support treatment, need ventilatory (especially invasive mechanical ventilation) on day 14 after first dose remdesivir, lymphopenia, low levels albumin hemoglobin, presence flu and/or coinfection, cough. number doses vaccine, patchy lung density, bilateral pulmonary radiological status, comorbidities, oxygen therapy, troponin lactate dehydrogenase levels, asthenia. These findings highlight XGB as strong candidate accurately categorizing undergoing treatment.

Language: Английский

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Covid-19 in patients with haematological malignancies

Acta Haematologica Polonica, Journal Year: 2024, Volume and Issue: 55(2), P. 73 - 89

Published: March 14, 2024

In most cases, the COVID-19 is characterized by mild clinical course, however, there are groups of patients at high risk mortality and morbidity COVID-19, including older age group (>65 years), diabetes, hypertension, obesity, cancer as well haematological malignancies. Hematological due to disease-related immune disorders treatment-related factors. This review aimed summarize studies on in with common neoplasms. We described fatality rate severe disease, efficacy side effects vaccine against vaccine-drug interactions chronic lymphocytic leukaemia (CLL), multiple myeloma (MM), acute myeloid (AML), myelodysplastic syndrome (MDS), diffuse large B cell lymphoma (DLBCL) disorders. focused mainly use mRNA vaccines, not other types vaccines. a priority for vaccination but serological response varied according type hematologic malignancy, better responses malignancies lower observed CLL patients. Extended needed that will answer question about limited vaccines utilization booster doses treated anti-CD38 therapy, BTKi anti-CD20 antibody or ruxolitinib therapy Non-Hodgkin (NHL).

Language: Английский

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Severe acute respiratory syndrome coronavirus 2 infection in patients with hematological malignancies in the Omicron era: Respiratory failure, need for mechanical ventilation and mortality in seronegative and seropositive patients

eJHaem, Journal Year: 2024, Volume and Issue: 5(3), P. 505 - 515

Published: April 9, 2024

Abstract Background Patients with hematological malignancies (HM) have a high risk of severe coronavirus disease 2019 (COVID‐19), also in the Omicron period. Material and methods Retrospective single‐center study including HM patients acute respiratory syndrome Coronavirus 2 (SARS‐CoV2) infection from January 2022 to March 2023. Study outcomes were failure (RF), mechanical ventilation (MV), COVID‐related mortality, comparing according SARS‐CoV2 serology. Results Note that, 112 included: 39% had negative Seronegative older (71.5 vs. 65.0 years, p = 0.04), more often lymphoid neoplasm (88.6% 69.1%, 0.02), underwent anti‐CD20 therapy (50.0% 30.9% 0.04) frequently (23.0% 3.0%, 0.02) than seropositive. Kaplan‐Meier showed higher for seronegative RF ( 0.014), MV 0.044), mortality 0.021). Negative serostatus resulted factor (hazards ratio [HR] 2.19, 95% confidence interval [CI] 1.03–4.67, (HR 3.37, CI 1.06–10.68, 4.26, 1.09–16.71, 0.04). Conclusions : serology, despite vaccinations previous infections, worse clinical compared seropositive era. The use serology diagnosis could be an easy tool identify prone developing complications.

Language: Английский

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Antiviral combination regimens as rescue therapy in immunocompromised hosts with persistent COVID-19

Journal of Chemotherapy, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 5

Published: June 14, 2024

The management of severe/prolonged SARS-CoV-2 infections in immunocompromised hosts is still challenging. We describe nine patients with hematologic malignancies a history unsuccessful treatment receiving antiviral combination for persistent infection at tertiary hospital central Italy (University Hospital Careggi, Florence). Combination treatments consisted nirmatrelvir/ritonavir plus molnupiravir (n = 4), remdesivir 4) or 1) 10 days, some cases associated sotrovimab. Combinations were generally well tolerated. One patient obtained viral clearance but died due to the underlying disease. In eight cases, clinical and virological success was confirmed by radiological follow-up. Antivirals likely become mainstay future COVID-19 among patients, knowledge this field very limited prospective studies on larger cohorts are urgently warranted.

Language: Английский

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Clinical and immunological characteristics of prolonged SARS-CoV-2 Omicron infection in hematologic disease

Blood Cancer Journal, Journal Year: 2023, Volume and Issue: 13(1)

Published: Sept. 5, 2023

Language: Английский

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Early combination therapy of COVID-19 in high-risk patients

Research Square (Research Square), Journal Year: 2023, Volume and Issue: unknown

Published: Aug. 18, 2023

Abstract Purpose Prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed in immunocompromised hosts. Early monotherapy with direct-acting antivirals or monoclonal antibodies, as recommended the international guidelines, does not prevent this certainty. Dual therapies might therefore act synergistically. Methods This retrospective, multicentre study compared treatment strategies for corona virus disease-19 (COVID-19) combinations nirmatrelvir/ritonavir, remdesivir, molnupiravir, and/ mABs during Omicron surge. Co-primary endpoints were prolonged viral (≥10 6 copies/ml at day 21 after initiation) and days SARS-CoV-2 load ≥10 copies/ml. Therapeutic risk groups by odds ratios Fisher’s tests Kaplan-Meier analysis long-rank tests. Multivariable regression was performed. Results 144 patients included a median time 8.0 (IQR 6.0-15.3). Underlying haematological malignancies (HM) (p=0.03) initiations later than five diagnosis (p<0.01) significantly associated longer shedding. Viral 14.6% (n=21/144), especially underlying HM (OR 3.5; 95% CI 1.2-9.9; p=0.02). Clinical courses COVID-19 mild to moderate only few adverse effects potentially contributed combination treatment. Conclusion effectively prevented 85.6% cases. Considering rapid clearance rates low toxicity, individualized dual therapeutic approaches may thus be advantageous high-risk patients.

Language: Английский

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