COVID-19 research looks at aspirin, disparities, long-term outcomes

Outcomes were better in hospitalized COVID-19 patients who received aspirin, according to a retrospective study from multiple U.S. hospitals published in the April Anesthesia & Analgesia. It compared 98 patients who received aspirin any time from seven days before to 24 hours after admission with 314 patients who did not receive aspirin. In unadjusted analysis, aspirin use was associated with lower risk of mechanical ventilation (35.7% vs. 48.4%, P=0.03) and ICU admission (38.8% vs. 51.0%, P=0.04) but not inpatient mortality. After adjustment, all three outcomes were lower in aspirin users (adjusted hazard ratios, 0.56, 0.57, and 0.53, respectively). There were no differences between groups in major bleeding or overt thrombosis. The authors called the results intriguing but noted that more research is needed “to confirm our findings and assess the extent to which the relationships observed in our study are causal.”

Several new studies looked at disparities in outcomes from COVID-19. Mortality rates from COVID-19 varied widely by hospital in April 2020, according to an analysis of more than 14,000 patients and 117 hospitals published by the Journal of Hospital Medicine on March 17. Hospitals' mortality rates ranged from 0% to 44.4%, and mortality was significantly higher in hospitals that had a high patient burden (measured by the ratio of COVID-19 admissions to bed count). The difference wasn't significant when the sample was restricted to hospitals with at least 100 beds and 20 COVID-19 admissions or when data were adjusted for patients' race or income. “Still, there was large variability in outcomes, even among hospitals with a similar level of COVID-19 burden and after adjusting for age, sex, and comorbidities,” the authors said. “To the extent that this variability reflects differences in patient management, hospital staffing, or use of investigational or advanced therapies, it will be critical to identify and disseminate any replicable best practices from high-burden hospitals with low mortality rates.”

Higher rates of COVID-19 were seen in nursing homes with older patients, fewer White patients, more Medicaid beneficiaries, and fewer direct care hours per patient per day, according to a research letter published by JAMA Network Open on March. 16 A retrospective study from Miami, published by Annals of the American Thoracic Society on March 16, found that higher test positivity rates were seen in Black and Hispanic patients and were mediated by socioeconomic factors.

Multiple new studies looked at long-term outcomes. Ongoing symptoms were common in a French study of patients who had been hospitalized for COVID-19. The study, published by JAMA on March 17, evaluated 478 patients by phone four months after discharge and found that 51% reported current symptoms (fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%). Lung CT was performed on 171 patients (97 who had been treated in an ICU), showing abnormalities in 63%, mainly subtle ground-glass opacities. The study authors concluded that symptoms and lung abnormalities were common at four months but severe pulmonary sequelae were infrequent. They cautioned that the findings were limited by the absence of a control group and of pre-illness assessments.

Postintensive care syndrome appeared common among patients who had been treated in a New York ICU for COVID-19, according to a study published by Critical Care Medicine on March 19. Of 45 patients who had a telehealth visit a month after discharge, 91% fit diagnostic criteria for postintensive care syndrome (86.7% impaired in the physical domain, 48% in the psychiatric domain), leading the authors to conclude that COVID-19 survivors are at high risk. “These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population,” they said.