Objectives: To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 . Design: Retrospective single-center observational study. Setting and participants: Eighty-one patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium. Measurements: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical, and radiologic variables, comorbidities, symptoms, and treatment were extracted from electronic medical records. Results: Participants (N ¼ 48 women, 59%) had a median age of 85 years (range 65-97 years) and a median CFS score of 7 (range 2-9); 42 (52%) were long-term care residents. Within 6 weeks, 19 patients died. Mortality was significantly but weakly associated with age (Spearman r ¼ 0.241, P ¼ .03) and CFS score (r ¼ 0.282, P ¼ .011), baseline lactate dehydrogenase (LDH; r ¼ 0.301, P ¼ .009), lymphocyte count (r ¼ À0.262, P ¼ .02), and RT-PCR cycle threshold (Ct, r ¼ À0.285, P ¼ .015). Mortality was not associated with long-term care residence, dementia, delirium, or polypharmacy. In multivariable logistic regression analyses, CFS, LDH, and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH, and viral load significantly predicted survival. Conclusions and Implications: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

No abstract

HSV-1 occurred more in critically ill patients and high loads in BALF were associated with an increased mortality. The higher mortality observed in patients with HSV-1 load>10(5) ge/ml enforces its clinical relevance and necessitates to start randomized medical intervention studies.

Background and objectives: Faecal calprotectin is a valuable noninvasive marker for inflammatory bowel disease (IBD). The aim of our study was to determine the correlation between six different calprotectin assays and compare their performance for diagnosis and follow up of IBD. Methods: Thirty-one patients with suspected IBD and 31 patients in follow up were included. We determined calprotectin by means of three rapid immmunochromatographic tests, two enzyme-linked immunosorbent assays, and one automated fluoroimmunoassay. Results were correlated with endoscopic and histological findings. Results: Although all methods correlated significantly, slopes and intercepts differed extensively, with up to 5-fold quantitative differences between assays. Sensitivity and specificity for diagnosis of IBD were 82-83 and 84-89%, respectively. For follow up, sensitivity in detecting mild ulcerative colitis was 71-100%. In moderate-to-severe ulcerative colitis, sensitivity was 100% for all assays. Specificity was 67-86% in both subgroups. In Crohn's disease, only moderate-to-severe disease could be differentiated from remission, with sensitivity 83-86% and specificity 75% for all tests. Conclusions: All calprotectin assays showed comparable clinical performance for diagnosis of IBD. For follow up, performance was acceptable, except for mild Crohn's disease. Because of the large quantitative differences, further efforts are needed to standardize calprotectin assays.

No abstract

Purpose Diagnostic value of point-of-care lung ultrasound (POCUS) in detection of coronavirus disease (COVID-19) in an emergency setting is currently unclear. In this study, we aimed to compare diagnostic performance, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of POCUS lung, chest CT, and RT-PCR for clinically suspected COVID-19 infections in patients submitting to the emergency room (ER). Material and methods This retrospective study enrolled 93 patients with a suspected COVID-19 infection, admitted to the ER between March 28th and April 20th, 2020. Test subjects showed one or more symptoms of an acute respiratory infection, for which consequent COVID-19 testing was achieved using POCUS lung, chest CT, and RT-PCR. CT images were analyzed by 2 radiologists blinded to RT-PCR results. POCUS lung was performed by three emergency medical doctors, and reports were analyzed by the researcher, blinded to clinical information, US imaging, CT, and RT-PCR test results. Results Compared with RT-PCR, POCUS lung demonstrated outstanding sensitivity and NPV (93.3% and 94.1% respectively) while showing poor values for specificity, PPV, and accuracy (21.3%, 19.2%, and 33.3% respectively). In contrast, similar inquiries using chest CT as index test, excellent sensitivity, specificity, NPV, and accuracy (80.0%, 86.7%, 95.6%, and 85.6%, respectively) were reported, beside a moderate value for PPV (54.5%). Conclusion POCUS may provide early ER triage with a useful, rapid, low-threshold, and safe screening tool in evaluating possible COVID-19 infections. Due to limited specificity, suggestive POCUS lung findings should be confirmed with RT-PCR or chest CT.

To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients. Materials and Methods: This was a HIPAA-compliant, institutional review board-approved retrospective study. From March 15 to June 1, 2020, 250 RT-PCR confirmed COVID-19 patients were studied with low-dose chest CT at admission. Visual and AI-assisted analysis of lung involvement was performed by using a semi-quantitative CT score and a quantitative percentage of lung involvement. Adverse outcome was defined as intensive care unit (ICU) admission or death. Cox regression analysis, Kaplan-Meier curves, and cross-validated receiver operating characteristic curve with area under the curve (AUROC) analysis was performed to compare model performance. Intraclass correlation coefficients (ICCs) and Bland-Altman analysis was used to assess intra-and interreader reproducibility. Results: Adverse outcome occurred in 39 patients (11 deaths, 28 ICU admissions). AUC values from AI-assisted analysis were significantly higher than those from visual analysis for both semiquantitative CT scores and percentages of lung involvement (all P<0.001). Intrareader and interreader agreement rates were significantly higher for AI-assisted analysis than visual analysis (all ICC 0.960 versus 0.885). AI-assisted variability for quantitative percentage of lung involvement was 17.2% (coefficient of variation) versus 34.7% for visual analysis. The sample size to detect a 5% change in lung involvement with 90% power and an  error of 0.05 was 250 patients with AI-assisted analysis and 1014 patients with visual analysis. Conclusion: AI-assisted analysis of lung involvement on submillisievert low-dose chest CT outperformed conventional visual analysis in predicting outcome in COVID-19 patients while I n p r e s s 3 reducing CT variability. Lung involvement on chest CT could be used as a reliable metric in future clinical trials.

Cytomegalovirus (CMV) and Parvovirus B19 infections acquired during pregnancy may result in developmental disabilities of the foetus. This study evaluates the occupational risk of these infections in female day care personnel. IgG seroprevalence was determined in 310 Dutch day care workers and 158 nursing school students. CMV seroprevalence was age-related, starting at 21% in those <20 years and reaching 65% in those >35 years. Between the ages of 20 and 24 years the CMV prevalence was higher in day care personnel than in controls, 50% versus 31% (p=0.03). In the first 2 years of employment the risk of attracting CMV was significantly increased (OR adj =3.80; p<0.001) and the occupational risk was also increased (OR adj 2.19; p<0.001). Parvovirus seropositivity (71-77%) was not related to age or working at a day care centre. In conclusion, an occupational risk was observed for CMV, but not for Parvovirus infection in female day care personnel.