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Objectives To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis. Methods All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6 min walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied. Results Of 1295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score. Conclusion COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Complicacions infeccioses; Càncer Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Complicaciones infecciosas; Cáncer Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Infectious complications; Cancer Background We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa . Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized. This study was supported by the Spanish Plan Nacional de IDi 2013-2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, and the Spanish Network for Research in Infectious Diseases (REIPI grant: RD16/0016/0001). It was also co-financed by the European Development Regional Fund ‘A Way to Make Europe’, Operational Programme Smart Growth 2014-2020.

Background: Although contraindicated in patients with severe chronic kidney disease (CKD) due to a lack of safety data, bisphosphonates are commonly used to prevent or treat bone fragility in these patients. We studied the safety of bisphosphonates in patients with moderate-to-severe CKD. Methods: Patients with stage 3b+ CKD based on 2+ estimated glomerular filtration rate (eGFR) measures were identified in two primary-care records databases, the UK CPRD GOLD during 1997-2016 and the Catalan (Spain) SIDIAP during 2007-2015. New bisphosphonate users were propensity-scorematched with up to five non-users to minimise confounding, and followed until treatment discontinuation, switching, dropout, death, or 10 years. The primary outcome was CKD stage worsening (eGFR decline or renal replacement therapy). Secondary outcomes included hospitalised acute kidney injury (AKI), gastrointestinal bleeding/ulcers (GIE), and hypocalcaemia. Hazard ratios (HRs) were estimated using Cox regression for SIDIAP participants, and sub-HRs (sHRs) calculated using Fine-Gray models for CPRD. Findings: We matched 2,447 bisphosphonate users with 8,931 non-users from CPRD, and 1,399 users with 6,547 non-users from SIDIAP. Bisphosphonate use was associated with greater risk of CKD progression in both CPRD (HR [95% CI]: 1·14 [1·04, 1·26]) and SIDIAP (HR: 1·16 [1·04, 1·29]). No statistically significant risk differences were found for AKI, GIE, or hypocalcaemia. Interpretation: A modest (10%-15%) increased risk of CKD progression was identified in association with bisphosphonate use amongst patients with moderate-severe disease. No other safety concerns were identified. Our findings should be considered in combination with effectiveness data before prescribing bisphosphonates to patients with moderate-severe CKD. Funding Statement: Funding was provided by the National Institute of Health Research Health Technology Assessment project number 14/36/02. The project was partially funded by CIBERFES, Instituto Carlos III, Spain. JP and MJP-S are supported by PI16/00619 (Spanish Ministry of Health ISCIII FIS-FEDER) and RD16/0009/0013 (ISCIII FEDER RedinRen). Declaration of Interests: B Abrahamsen reports research grants from UCB and Novartis. NK Arden reports personal fees from Flexion, Freshfields, Janssen, Merck, and Regeneron. C Cooper reports lecture fees and honoraria from the Alliance for Better Bone Health Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. A Judge is a subpanel member of the NIHR PGfAR, has received consultancy fees from Freshfields Bruckhaus Deringer, and has held advisory board positions (which involved receipt of fees) at Anthera Pharmaceuticals, INC. MK Javaid reports research support and speaker fees from Amgen. D Prieto-Alhambra reports research grants from UCB, Amgen, and Les Laboratoires Servier, and departmental (not personal) speaker and consultancy fees from UCB and Amgen. D Prieto-Alhambra is a member of the NIHR HTA CET panel since November 2017. DE Robinson, MS Ali, VY Strauss, L Elhussein, Y Ben-Shlomo, F Caskey, D Dedman, and A Delmestri have nothing to disclose. Ethics Approval Statement: This study was approved by the CPRD Independent Scientific Advisory Committee (protocol number 15_ 53R2A).