COVID-19 Testing in Patients with Vascular Disorders-A Prospective Cohort Study at a Tertiary Care Hospital in Austria

Background: To investigate the prevalence of SARS-CoV-2 infection in hospitalized patients with vascular disorders after implementing institutional and governmental safety measures in Austria. Methods: Vascular Patients (VPs) admitted to our tertiary care hospital were routinely tested for SARS-CoV-2 infection on a two days basis between March and December, 2020. The prevalence of SARS-CoV-2 was compared between VPs and two independent Austrian populations. The results were also compared to a cohort of Health Care Personnel (HCP) working in close proximity to the study patients, tested weekly, between March and December, 2020. Results: A total of five (0.2%) SARS-CoV-2 positive patients were detected out of 2,243 included patients. The proportion of SARS-CoV-2 infected patients during the first lockdown, post lockdown, and second lockdown was 0.34%, 0.17%, and 0.49% respectively. The estimated risk ratio for SARSCoV-2 prevalence between the VPs and the general population was 0.05% (95% CI, 0.02% to 0.17%) during the second lockdown (p<0.0001). In 22 (5%) out of 441 members of the HCP cohort, SARSCoV-2 infection was detected. However, no contagion has been observed between study patients and HCP during the entire observational period. Conclusion: Our study provides evidence of SARS-CoV-2 prevalence in Austrian patients with vascular disorders. VPs were less often infected than the general population. Thus, we demonstrate that continuous patient treatment and follow-up visits in a large tertiary care hospital during the pandemic are reasonable when in compliance with the common safety precautions. Routine SARSCoV-2 testing of patients with vascular disorders is advisable to detect asymptomatic patients and avoid uncontrolled viral spread. Mohammad Mahdi Kasiri1*, Martina Mittlboeck2, Georgiana-Aura Giurgea3, Norbert Fortner1, Phillip Lirk4, Wolf Eilenberg1, Christoph Neumayer1 and Bernd Gollackner1 1Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria 2Section for Clinical Biometrics, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria 3Department of ‘Internal Medicine II, Clinical Divisions of Angiology, Medical University of Vienna, Austria 4Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Mohammad Mahdi Kasiri, et al., 2 Clinics in Surgery Urology Remedy Publications LLC., | http://clinicsinsurgery.com/ 2022 | Volume 7 | Article 3402 Unfortunately, those measures, also had significant consequences on the clinical outcome of patients with advanced vascular disorders regardless of SARS-CoV-2 infection status [5,6]. Therefore, it is vital to determine the true prevalence of SARS-CoV-2 infection in patients with vascular disorders compared to that of the general population after implementation of governmental safety measures in Austria. Approximately 41% of all SARS-CoV-2 cases in Wuhan/China have been caused by nosocomial transmission [7]. Furthermore, 9% of Health Care Personnel (HCP) in Italy have been reportedly infected with SARS-CoV-2 [8]. In this study, we aimed to assess the SARS-CoV-2 infection prevalence among HCP working in close proximity to admitted patients to determine if contagion occurred between HCP and VP in our large tertiary care hospital in Vienna, Austria after implementation of institutional safety measures. Materials and Methods This study employed a prospective single-center, observational cohort design at a large tertiary care hospital (Departments of General Surgery, Division of Vascular Surgery and Department of Internal Medicine). We investigated clinical data from all patients presenting at the hospital with vascular disorders, including Peripheral Artery Disease (PAD), Cardiac Disorders (CD), Aortic Aneurysm (AA), Extracranial Artery Disorders (EAD) and Venous Disorders (VD). All patients’ private information was de-identified by giving them a number after data collection. We routinely tested for SARS-CoV-2 between March 16th and December 07th, 2020. The first lockdown in Austria was implemented from March 16th to May 04th, 2020. We defined the time from May 05th to November 16th, 2020, as the post-lockdown period. The second lockdown was implemented from November 17th to December 07th, 2020. This study was approved by the ethics committee of the Medical University of Vienna (EC2049/2020) and conducted according to the principles of the Helsinki Declaration and Good Clinical Practice. In addition, this study has been reported in accordance with the STROCSS criteria and guidelines [9]. Primary and secondary endpoints The primary endpoint of the present study was to determine the prevalence and incidence of SARS-CoV-2 infection in patients with vascular disease after the implementation of institutional and governmental safety measures and compared it to SARS-CoV-2 infections among the general population in Austria. The secondary endpoint was to assess the occurrence of SARS-CoV-2 infection among HCP workers (in close proximity to the admitted patients and routinely tested for SARS-CoV-2) after implementing institutional safety measures to evaluate viral transmission between HCP and VP. Cohorts We compiled the following groups: Patient cohort: All patients with vascular disorders consecutively admitted at our tertiary care hospital from March 16th to December 07th, 2020. Control cohort: Data of two nationwide PCR-based studies conducted in a representative random sample, from April 01st to 06th, and November 12th to 14th, 2020, collected by the Austrian Ministry of Science and the Austrian Red Cross to estimate the spread of SARSCoV-2 infection among the non-hospitalized Austrian population [10,11]. HCP cohort: HCP worker data, including nurses, nurse technicians, physicians, surgical personal, physical therapists, nurse practitioners, environmental service workers, administrative staff, and dietitians, working in close proximity to admitted patients at our tertiary care hospital from March 16th to December 07th, 2020. SARS-CoV-2 testing Beginning in March 2020, nasal or pharyngeal respiratory swabs were routinely taken of each patient admitted at our departments and repeated regularly at 48 h intervals during the inpatient stay. In the HCP cohort testing for SARS-CoV-2 RNA was performed, on a weekly basis, at the Department of Laboratory Medicine, Medical University of Vienna, Austria, using Real-Time Polymerase Chain Reaction (RT-PCR). Comparability of the results of all test methods used was confirmed by participation in international quality control ring trials [12]. In the HCP cohort testing for SARS-CoV-2 RNA was performed until November, 2020 and since then RT-PCR was only used to confirm positive results of antigen testing. Statistics Statistical analyses were performed using IBM SPSS© Statistics for iOS, version 25 (IBM Corp. Chicago, Ill., USA) and SAS©, Version 9.4 (SAS Institute Inc, Cary, NC, USA). Continuous variables are described by median, minimum and maximum. Categorical variables are presented as frequencies and percentages and corresponding 95% Confidence Intervals (95% CI) are calculated according to the method of Wilson. Group differences of binary variables were tested χ2 test or Fisher’s exact test in case of sparse data. Estimation and group comparisons of incidence rates and corresponding confidence intervals were performed by a generalized linear model with loglink and Poisson distribution also accounting for the weeks under observation. A two-sided p-value ≤ .05 was considered statistically significant. Results Patient characteristics Within the observation period between March 16th and December 07th, 2020, a total of 2,243 patients (1,336 [60%] men and 907 [40%] women, with a median age of 70 years and various vascular disorders were admitted to our hospital departments. Patient characteristics are presented in Table 1. The most common causes for inpatient admission were CD, including atherosclerotic, valvular, and ischemic heart disease (692 [31%]), non-vascular complaints in VPs (691 [31%]), followed by PAD (611 [27%]). All elective admissions occurred a week after one or more outpatient hospital visits. Out of 2,240 patients with relevant comorbidities, 994 (44%) cases were co-diagnosed with endocrinological disorders such as diabetes and thyroid disorders, and 903 (40%) with cardiac comorbidities. SARS-CoV-2 infection During the observational period, a total of five SARS-CoV-2 infections were detected, three in men and two in women. In one asymptomatic patient with EAD, SARS-CoV-2 was detected a day before the elective admission, and the admission as well as the planned intervention was postponed. In two other cases, an asymptomatic infection was detected two days after the elective admission. Both noticed only a mild fever. Two symptomatic cases were admitted to an acute setting with confirmed SARS-CoV-2 infection. One patient was found to have an acute myocardial infarction, and one patient Mohammad Mahdi Kasiri, et al., 3 Clinics in Surgery Urology Remedy Publications LLC., | http://clinicsinsurgery.com/ 2022 | Volume 7 | Article 3402 was in critical condition with respiratory distress in urgent need of extracorporeal membrane oxygenation. They were co-diagnosed with coronary artery disease and pulmonary comorbidities. No SARSCoV-2 related deaths were observed, and all five patients achieved viral clearance (PCR cycle threshold >35) 12 to 27 days after testing positive. The proportion of patients with positive results during the first lockdown period was 0.34% (95% CI, 0.06% and 1.9%). The calculated proportion for the post lockdown period was 0.17% (95% CI, 0.05% to 0.5%) and for the second lockdown period was 0.50% (95% CI, 0.09% to 2.75%). The proportion of patient with positive result during the whole observational period is 0.22% (95% CI, 0.10% to 0.52%), but on