High rates of both venous and arterial thromboembolic events were observed early during the global COVID-19 pandemic, with severity of illness and need for intensive care unit admission correlating with increased thrombotic risk.Study Summary: This paper is a review of several observational studies that document the relatively high rates of thrombosis seen in hospitalized patients with COVID-19. Overall, the aggregate data demonstrate that the rates of arterial and venous thrombotic complications in patients with COVID-19 were low in nonhospitalized individuals with asymptomatic or mild disease. Also, thrombotic risk increased with severity of COVID-19 illness (up to 31%), with patients needing intensive care being at greatest risk. Caveats were the retrospective nature of the reports, variable reporting of types of thrombosis, the variable use or availability of screening or imaging studies in symptomatic patients, and resource utilization such as extracorporeal membrane oxygenation. Venous thrombotic events were much more commonly seen than arterial thromboses, and the risk of thrombosis did not disappear at hospital discharge.Commentary: This was a frightening year. The guidance from medical colleagues around the world as they experienced surges in SARS-CoV2 infections at differing time points helped others be better prepared. Most facilities had to triage patients, redeploy physicians, limit use of technicians, support persons, and scanner in attempts to spread resources and prevent exposure. The ongoing multisystem inflammatory state of COVID-19 beyond the acute illness has made the development of thromboprophylaxis guidelines, best practices for treatment, and therapy strategies paramount.

Aims To assess whether frailty or reduced physical performance status may have an impact on clinical outcomes after pacemaker implantation in aging patients.Methods A prospective cohort of patients aged more than 70 years, admitted to the hospital for pacemaker implantation, was enrolled. Patients were evaluated with the Short Physical Performance Battery (SPPB) and Handgrip Strength Test at hospital discharge and at 1 year. Overall mortality was the primary study endpoint.Results Out of the 119 patients, the majority (71%) of patients had reduced physical performance (defined by an SPPB score <10 points). After a median follow-up of 46 months, the mortality was 31% of the population. SPPB value at discharge predicted death even after adjusting for pertinent confounders (adjusted hazard ratio 0.91, 95% confidence interval (CI) 0.84-0.99, P U 0.02). Patients with a poorer SPPB score at discharge (SPPB 0-3) had also an increased risk of death or rehospitalization at 1 year compared with patients with highest SPPB score (odds ratio OR 4.05, 95% CI 1-16.6). ConclusionReduced physical performance is associated with increased mortality in aging patients with bradyarrhythmia requiring pacemaker implantation. The identification of patients with poor SPPB may tailor specific interventions to improve physical performance and outcomes after pacemaker implantation. The trial was registered in clinicaltrial.gov with the identifier NCT02386124.

Background COVID-19 is characterized by interstitial pneumonia, but a presentation of the disease with digestive symptoms only may occur. This work was aimed at evaluating: (1) the prevalence of presentation with digestive symptoms only in our cohort of COVID-19 inpatients; (2) differences between patients with and without gastrointestinal onset; (3) differences among males and females with gastrointestinal presentation; (4) outcomes of the groups of subjects with and without gastrointestinal onset. Method We retrospectively divided the patients hospitalized with COVID-19 into two groups: (1) the one with digestive symptoms (DSG) and (2) the other without digestive symptoms (NDSG). We compared the subjects of DSG with those of NDSG and males with females in the DSG group only, in terms of demographics (age, sex), inflammation and organ damage indexes, length of stay, in-hospital and 100-day mortality. Results The prevalence of gastrointestinal symptoms at presentation was 12.5%. The DSG group showed a prevalence of females, and these tended to a shorter hospital stay; DSG patients were younger and with a higher load of comorbidities, but no differences concerning inflammation and organ damage indexes, need for intensification of care, in-hospital and 100-day mortality were detected. Among DSG patients, males were younger than females, more comorbid, with higher serum CRP and showed a longer length of hospital stay. Survival functions of DSG patients, in general, are more favourable than those of NDSG if adjusted for sex, age and comorbidities. Conclusions (1) The prevalence of gastrointestinal presentation among hospitalized COVID-19 patients was 12.5%; (2) DSG patients were on average younger, more comorbid and with a prevalence of females, with a shorter hospital stay; (3) in the DSG group, males had a higher Charlson Comorbidity Score and needed a longer hospital stay; (4) DSG subjects seem to survive longer than those of the NDSG group.

The current literature still gives a little information about the relationships between the ABO blood group system and the immune response to the virus or the different disease outcomes. Hypothesizing the presence of a predisposition by some blood groups to COVID-19, we searched for differences between patients towards the different outcomes of disease.We enrolled 330 inpatients with a diagnosis of COVID-19, determining both their ABO blood group system and Rh factor, collecting demographic, clinical and laboratory data. We searched for relationships with COVID-19 outcomes within an observation period of 180 days (Intensification of Care - IoC, Inhospital death, 180-days mortality). The most frequent ABO blood group was A (45.8%); a minor part was represented by group O (38.8%), B (11.5%), AB (3.9%). As for the Rh factor, 86.7% of patients were Rh-positive. There were no significant differences between blood groups and Rh factors as for age, length of hospital stays (LoS), or Charlson Comorbidity Index (CCI), nor we found significant relationships between the ABO groups and COVID-19 outcomes. A significant relation was found between AB group and IoC (p=0.03) while as for the Rh factor, the patients with Rh factor positive died with less frequency during the stay (p=0.03). Cox regression analyses showed substantial differences in the survival functions concerning the Rh factors. The Rh factor seems to be involved in the 180-day prognosis. The survival functions of patients with Rh factor positive show, in fact, significantly better curves when compared to those with Rh factor negative.