Background: Pharmacists are integral members of the multidisciplinary healthcare team who, with their skills, knowledge, and training, are well positioned to prevent, identify, and manage medication-related issues. Many published articles related to COVID-19 management have highlighted the important role of the pharmacists in assuring the safe, effective, and cost-effective use of medications. During such challenging times of COVID-19 pandemic that resulted in a high demand on medical resources and healthcare providers, pharmacists are well positioned to contribute and add more efforts to the healthcare system to achieve best use of the available resources including medications and providing high quality pharmaceutical care to help the patients and support the healthcare providers. Methods: This is a retrospective chart review included all admitted adult patients with confirmed COVID-19 diagnosis from 1 March 2020 till 30 June 2020. The documented clinical pharmacist interventions were extracted from the EMR and reviewed by multiple clinical pharmacists to identify type, number, frequency, outcome, and physician’s acceptance rate of documented interventions. Results: A total of 484 pharmacist interventions included in the final analysis. Antimicrobial stewardship interventions were the most reported (149, 30.8%) and antibiotics were the most reported class of medication, constituting 31.1% of the total interventions. “Optimized therapy” was the most commonly reported outcome (58.8%). Overall, 50.8% (246) of the interventions were rated as having “moderate” clinical significance using the clinical significance scoring tool. The physicians’ acceptance rate was 94.7%. Conclusion: Pharmacist interventions are associated with improved communication and medication use in admitted adult patients with COVID-19. Clinical pharmacists can play a crucial role in optimizing medication use in patients with COVID-19 through prevention, identification, and resolving existing or potential drug-related problems.

Background Although recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients. Methods We performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission. Results A total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07-1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04-1.80; P = 0.026). Conclusions Obesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.

Background There is a high prevalence of liver injury (LI) in patients with coronavirus disease 2019 (COVID-19); however, few large-scale studies assessing risk factors and clinical outcomes in these patients have been done. Aims To evaluate the risk factors and clinical outcomes associated with LI in a large inpatient cohort of COVID-19 patients. Methods Adult patients with COVID-19 between March 1 and April 30, 2020, were included. LI was defined as peak levels of alanine aminotransferase/aspartate aminotransferase that were 3 times the ULN or peak levels in alkaline phosphatase/total bilirubin that were 2 times the ULN. Mild elevation in liver enzymes (MEL) was defined as abnormal peak liver enzyme levels lower than the threshold for LI. Patients with MEL and LI were compared to a control group comprising patients with normal liver enzymes throughout hospitalization. Results Of 1935 hospitalized COVID-19 patients, 1031 (53.2%) had MEL and 396 (20.5%) had LI. Compared to control patients, MEL and LI groups contained proportionately more men. Patients in the MEL cohort were older compared to control, and African-Americans were more highly represented in the LI group. Patients with LI had an increased risk of mortality (relative risk [RR] 4.26), intensive care unit admission (RR, 5.52), intubation (RR, 11.01), 30-day readmission (RR, 1.81), length of hospitalization, and intensive care unit stay (10.49 and 10.06 days, respectively) compared to control. Conclusion Our study showed that patients with COVID-19 who presented with LI had a significantly increased risk of mortality and poor clinical outcomes.

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Goals:We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis.Background: ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis.Study: Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes.Results: A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P < 0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P < 0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P < 0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P < 0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P < 0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P < 0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P < 0.0001) and cholecystitis (1.9 vs. 3.1%; P < 0.0001) compared with those who received diagnostic ERCP.Conclusions: Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.