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Article ; Online: Post-COVID-19 Condition After SARS-CoV-2 Infections During the Omicron Surge vs the Delta, Alpha, and Wild Type Periods in Stockholm, Sweden.

Hedberg, Pontus / Nauclér, Pontus

2023 Volume 229, Issue 1, Page(s) 133–136

Abstract: Little is known about the post-COVID-19 condition (PCC) after infections with different SARS-CoV-2 variants. We investigated the risk of PCC diagnosis after primary omicron infections as compared with preceding variants in population-based cohorts in ... ...

Abstract	Little is known about the post-COVID-19 condition (PCC) after infections with different SARS-CoV-2 variants. We investigated the risk of PCC diagnosis after primary omicron infections as compared with preceding variants in population-based cohorts in Stockholm, Sweden. When compared with omicron (n = 215 279, 0.2% receiving a PCC diagnosis), the adjusted hazard ratio (95% CI) was 3.26 (2.80-3.80) for delta (n = 52 182, 0.5% PCC diagnosis), 5.33 (4.73-5.99) for alpha (n = 97 978, 1.0% PCC diagnosis), and 6.31 (5.64-7.06) for the wild type (n = 107 920, 1.3% PCC diagnosis). These findings were consistent across all subgroup analyses except among those treated in the intensive care unit.
MeSH term(s)	Humans ; COVID-19 ; Sweden/epidemiology ; SARS-CoV-2 ; Post-Acute COVID-19 Syndrome ; Chronic Disease
Language	English
Publishing date	2023-09-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jiad382
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Article ; Online: Reducing Diagnostic Bias Through Multiplex Polymerase Chain Reaction (PCR) Testing for SARS-CoV-2, Influenza A/B, and RSV.

Hedberg, Pontus / Valik, John Karlsson / Halim, Lina Abdel / Alfvén, Tobias / Naucler, Pontus

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2024

Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad747
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Article ; Online: Multimodal fine-tuning of clinical language models for predicting COVID-19 outcomes.

Henriksson, Aron / Pawar, Yash / Hedberg, Pontus / Nauclér, Pontus

Artificial intelligence in medicine

2023 Volume 146, Page(s) 102695

Abstract: Clinical prediction models tend only to incorporate structured healthcare data, ignoring information recorded in other data modalities, including free-text clinical notes. Here, we demonstrate how multimodal models that effectively leverage both ... ...

Abstract	Clinical prediction models tend only to incorporate structured healthcare data, ignoring information recorded in other data modalities, including free-text clinical notes. Here, we demonstrate how multimodal models that effectively leverage both structured and unstructured data can be developed for predicting COVID-19 outcomes. The models are trained end-to-end using a technique we refer to as multimodal fine-tuning, whereby a pre-trained language model is updated based on both structured and unstructured data. The multimodal models are trained and evaluated using a multicenter cohort of COVID-19 patients encompassing all encounters at the emergency department of six hospitals. Experimental results show that multimodal models, leveraging the notion of multimodal fine-tuning and trained to predict (i) 30-day mortality, (ii) safe discharge and (iii) readmission, outperform unimodal models trained using only structured or unstructured healthcare data on all three outcomes. Sensitivity analyses are performed to better understand how well the multimodal models perform on different patient groups, while an ablation study is conducted to investigate the impact of different types of clinical notes on model performance. We argue that multimodal models that make effective use of routinely collected healthcare data to predict COVID-19 outcomes may facilitate patient management and contribute to the effective use of limited healthcare resources.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Emergency Service, Hospital ; Hospitals ; Language ; Patient Discharge ; Natural Language Processing
Language	English
Publishing date	2023-10-31
Publishing country	Netherlands
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645179-2
ISSN	1873-2860 ; 0933-3657
ISSN (online)	1873-2860
ISSN	0933-3657
DOI	10.1016/j.artmed.2023.102695
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Article ; Online: Outcomes of Pediatric SARS-CoV-2 Omicron Infection vs Influenza and Respiratory Syncytial Virus Infections.

Hedberg, Pontus / Abdel-Halim, Lina / Valik, John Karlsson / Alfvén, Tobias / Nauclér, Pontus

JAMA pediatrics

2023 Volume 178, Issue 2, Page(s) 197–199

MeSH term(s)	Humans ; Child ; Influenza, Human ; Respiratory Syncytial Virus Infections ; SARS-CoV-2 ; COVID-19 ; Respiratory Tract Infections
Language	English
Publishing date	2023-12-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2023.5734
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Article ; Online: Sociodemographic disparities affect COVID-19 vaccine uptake in non-elderly adults with increased risk of severe COVID-19.

Hedberg, Pontus / Sotoodeh, Adonis / Askling, Helena H / Nauclér, Pontus

Journal of internal medicine

2023 Volume 294, Issue 5, Page(s) 640–652

Abstract: Background: There is limited information about sociodemographic disparities in COVID-19 vaccine uptake among non-elderly adults with an increased risk of severe COVID-19. We investigated the COVID-19 vaccine uptake in individuals aged 18-64 years with ... ...

Abstract	Background: There is limited information about sociodemographic disparities in COVID-19 vaccine uptake among non-elderly adults with an increased risk of severe COVID-19. We investigated the COVID-19 vaccine uptake in individuals aged 18-64 years with an increased risk of severe COVID-19 (non-elderly risk group) in Stockholm County, Sweden. Method: We used population-based health and sociodemographic registries with high coverage to perform a cohort study of COVID-19 vaccine uptake of one to four doses up until 21 November 2022. The vaccine uptake in the non-elderly risk group was compared with non-risk groups aged 18-64 years (non-elderly non-risk group) and individuals aged ≥65 years (elderly). Results: The uptake of ≥3 vaccine doses was 55%, 64% and 87% in the non-elderly non-risk group (n = 1,005,182), non-elderly risk group (n = 308,904) and elderly (n = 422,604), respectively. Among non-elderly risk group conditions, Down syndrome showed the strongest positive association with receiving three doses (adjusted risk ratio [aRR] 1.62, 95% confidence interval [CI] 1.54-1.71), whereas chronic liver disease showed the strongest negative association (aRR 0.90, 95% CI 0.88-0.92). Higher vaccine uptake among the non-elderly risk group was associated with increasing age, being born in Sweden, higher education, higher income and living in a household where other adults had been vaccinated. Similar trends were observed for the first, second, third and fourth doses. Conclusion: These results call for measures to tackle sociodemographic disparities in vaccination programmes during and beyond the COVID-19 pandemic.
MeSH term(s)	Aged ; Adult ; Humans ; Middle Aged ; COVID-19 Vaccines ; COVID-19/epidemiology ; COVID-19/prevention & control ; Cohort Studies ; Pandemics ; Income ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-07-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13700
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Article ; Online: Influence of perioperative SARS-CoV-2 infection on mortality in orthopaedic inpatients with surgically treated traumatic fractures.

Granqvist, Mathias / Hedberg, Pontus / Nauclér, Pontus / Enocson, Anders

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

2022 Volume 33, Issue 4, Page(s) 1043–1049

Abstract: Background: SARS-CoV-2 has had an extensive influence on orthopaedic surgery practice and has been associated with an increased risk of mortality. There is limited evidence of how this pertains to acute orthopaedic surgery with inpatient care.: ... ...

Abstract	Background: SARS-CoV-2 has had an extensive influence on orthopaedic surgery practice and has been associated with an increased risk of mortality. There is limited evidence of how this pertains to acute orthopaedic surgery with inpatient care. Methods: A retrospective cohort study on traumatic fracture patients requiring inpatient care between February 25, 2020 and March 25, 2021 was conducted. Patients were grouped by perioperative SARS-CoV-2 infection, defined as a positive SARS-CoV-2 test from 7 days before to 7 days after orthopaedic surgery, and compared using linear regression and Cox proportional hazards model for primary outcome 30-day mortality and secondary outcome hospital length of stay. Results: In total, 5174 adults with a length of stay ≥ 48 h and an orthopaedic procedure due to a registered traumatic fracture were admitted from February 25, 2020 and discharged before March 26, 2021. Among the 5174 patients, 65% (3340/5174) were female, 22% (1146/5174) were 60-74 years and 56% (2897/5174) were 75 years or older. In total, 144 (3%) had a perioperative SARS-CoV-2 infection. Perioperative SARS-CoV-2 infection was associated with an increased 30-day mortality (aOR 4.19 [95% CI 2.67-6.43], p < 0.001). The median (IQR) length of stay after surgery was 13 days (IQR 6-21) for patients with, and 7 days (IQR 2-13) for patients without, perioperative SARS-CoV-2 infection. Conclusions: Perioperative SARS-CoV-2 infection increased 30-day mortality risk and hospital length of stay for traumatic fracture patients requiring inpatient surgical care. Pre- and postoperative infection were both associated with similar increases in mortality risk.
MeSH term(s)	Adult ; Humans ; Female ; Male ; COVID-19 ; SARS-CoV-2 ; Orthopedics ; Retrospective Studies ; Inpatients ; Fractures, Bone
Language	English
Publishing date	2022-03-24
Publishing country	France
Document type	Journal Article
ZDB-ID	1231084-0
ISSN	1432-1068 ; 1633-8065 ; 0948-4817 ; 0940-3264
ISSN (online)	1432-1068
ISSN	1633-8065 ; 0948-4817 ; 0940-3264
DOI	10.1007/s00590-022-03226-x
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Article ; Online: Clinical outcomes during and beyond different COVID-19 critical illness variant periods compared with other lower respiratory tract infections.

Hedberg, Pontus / Baltzer, Nicholas / Granath, Fredrik / Fored, Michael / Mårtensson, Johan / Nauclér, Pontus

Critical care (London, England)

2023 Volume 27, Issue 1, Page(s) 427

Abstract: Background: It is yet to be better understood how outcomes during and after the critical illness potentially differ between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from other lower respiratory tract infections (LRTIs). We ... ...

Abstract	Background: It is yet to be better understood how outcomes during and after the critical illness potentially differ between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from other lower respiratory tract infections (LRTIs). We aimed to compare outcomes in adults admitted to an intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) during the Wild-type, Alpha, Delta, and Omicron periods with individuals admitted with other LRTI. Methods: Population-based cohort study in Stockholm, Sweden, using health registries with high coverage, including ICU-admitted adults from 1 January 2016 to 15 September 2022. Outcomes were in-hospital mortality, 180-day post-discharge mortality, 180-day hospital readmission, 180-day days alive and at home (DAAH), and incident diagnoses registered during follow-up. Results: The number of ICU admitted individuals were 1421 Wild-type, 551 Alpha, 190 Delta, 223 Omicron, and 2380 LRTI. In-hospital mortality ranged from 28% (n = 665) in the LRTI cohort to 35% (n = 77) in the Delta cohort. The adjusted cause-specific hazard ratio (CSHR) compared with the LRTI cohort was 1.33 (95% confidence interval [CI] 1.16-1.53) in the Wild-type cohort, 1.53 (1.28-1.82) in the Alpha cohort, 1.70 (1.30-2.24) in the Delta cohort, and 1.59 (1.24-2.02) in the Omicron cohort. Among patients discharged alive from their COVID-19 hospitalization, the post-discharge mortality rates were lower (1-3%) compared with the LRTI cohort (9%), and the risk of hospital readmission was lower (CSHRs ranging from 0.42 to 0.68). Moreover, all COVID-19 cohorts had compared with the LRTI cohort more DAAH after compared with before the critical illness. Conclusion: Overall, COVID-19 critical was associated with an increased hazard of in-hospital mortality, but among those discharged alive from the hospital, less severe long-term outcomes were observed compared with other LRTIs.
MeSH term(s)	Adult ; Humans ; COVID-19 ; SARS-CoV-2 ; Aftercare ; Cohort Studies ; Critical Illness ; Patient Discharge ; Respiratory Tract Infections
Language	English
Publishing date	2023-11-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-023-04722-0
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Article ; Online: Outcomes of SARS-CoV-2 Omicron Variant Infections Compared With Seasonal Influenza and Respiratory Syncytial Virus Infections in Adults Attending the Emergency Department: A Multicenter Cohort Study.

Hedberg, Pontus / Karlsson Valik, John / Abdel-Halim, Lina / Alfvén, Tobias / Nauclér, Pontus

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023 Volume 78, Issue 4, Page(s) 900–907

Abstract: Background: There is a controversy over the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in an era of less virulent variants and an increasing population immunity. We compared outcomes in adults attending the ... ...

Abstract	Background: There is a controversy over the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in an era of less virulent variants and an increasing population immunity. We compared outcomes in adults attending the emergency department (ED) with an Omicron, influenza, or respiratory syncytial virus (RSV) infection. Methods: Retrospective multicenter cohort study including adults attending the ED in 6 acute care hospitals in Stockholm County, Sweden, with an Omicron, influenza, or RSV infection during 2021-2022 and 2015-2019. During 2021-2022, patients were tested for all 3 viruses by multiplex polymerase chain reaction (PCR) testing. The primary outcome was 30-day all-cause mortality. Secondary outcomes were 90-day all-cause mortality, hospitalization, and intensive care unit (ICU) admission. Results: A total of 6385 patients from 2021-2022 were included in the main analyses: 4833 Omicron, 1099 influenza, and 453 RSV. The 30-day mortality was 7.9% (n = 381) in the Omicron, 2.5% (n = 28) in the influenza, and 6.0% (n = 27) in the RSV cohort. Patients with Omicron had an adjusted 30-day mortality odds ratio (OR) of 2.36 (95% confidence interval [CI] 1.60-3.62) compared with influenza and 1.42 (95% CI .94-2.21) compared with RSV. Among unvaccinated Omicron patients, stronger associations were observed compared with both influenza (OR 5.51 [95% CI 3.41-9.18]) and RSV (OR 3.29 [95% CI 2.01-5.56]). Similar trends were observed for secondary outcomes. Findings were consistent in comparisons with 5709 pre-pandemic influenza 995 RSV patients. Conclusions: In patients attending the ED, infections with Omicron were both more common and associated with more severe outcomes compared with influenza and RSV, in particular among unvaccinated patients.
MeSH term(s)	Adult ; Humans ; Respiratory Syncytial Virus Infections ; Influenza, Human/epidemiology ; SARS-CoV-2 ; Cohort Studies ; Seasons ; COVID-19/epidemiology ; Emergency Service, Hospital ; Respiratory Syncytial Virus, Human
Language	English
Publishing date	2023-11-14
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad660
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Article ; Online: Incidence and severity of COVID-19 in adults with and without HIV diagnosis.

Hedberg, Pontus / Vesterbacka, Jan / Blennow, Ola / Missailidis, Catharina / Nowak, Piotr / Naucler, Pontus

Journal of internal medicine

2022 Volume 292, Issue 1, Page(s) 168–171

MeSH term(s)	Adult ; COVID-19 ; HIV Infections/complications ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Humans ; Incidence ; Risk Factors
Language	English
Publishing date	2022-03-21
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13481
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Article ; Online: Impact of the COVID-19 pandemic on the incidence and mortality of hospital-onset bloodstream infection: a cohort study.

Valik, John Karlsson / Hedberg, Pontus / Holmberg, Fredrik / van der Werff, Suzanne Desirée / Nauclér, Pontus

BMJ quality & safety

2022 Volume 31, Issue 5, Page(s) 379–382

Abstract: The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an academic centre between January 2018 ... ...

Abstract	The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an academic centre between January 2018 and January 2021. Data were collected from the hospitals' electronic health record data repository. Hospital-onset bloodstream infection (HOB) was defined as any positive blood culture obtained ≥48 hours after admission classified based on microbiological and hospital administrative data. Subgroup analyses were performed with exclusion of potential contaminant bacteria. The cohort was divided into three groups: controls (prepandemic period), non-COVID-19 (pandemic period) and COVID-19 (pandemic period) based on either PCR-confirmed SARS-CoV-2 infections from respiratory samples or International Classification of Diseases 10th Revision diagnoses U071 and U72 at discharge. Adjusted incidence rate ratios (aIRR) and risk of death in patients with HOB were compared between the prepandemic and pandemic periods using Poisson and logistic regression. The incidence of HOB was increased for the COVID-19 group compared with the prepandemic period (aIRR 3.34, 95% CI 2.97 to 3.75). In the non-COVID-19 group, the incidence was slightly increased compared with prepandemic levels (aIRR 1.20, 95% CI 1.08 to 1.32), but the difference decreased when excluding potential contaminant bacteria (aIRR 1.15, 95% CI 1.00 to 1.31, p=0.04). The risk of dying increased for both the COVID-19 group (adjusted odds ratio (aOR) 2.44, 95% CI 1.75 to 3.38) and the non-COVID-19 group (aOR 1.63, 95% CI 1.22 to 2.16) compared with the prepandemic controls. These findings were consistent also when excluding potential contaminants. In summary, we observed a higher incidence of HOB during the COVID-19 pandemic, and the mortality risk associated with HOB was greater, compared with the prepandemic period. Results call for specific attention to quality of care during the pandemic.
MeSH term(s)	Adult ; COVID-19 ; Cohort Studies ; Cross Infection/epidemiology ; Hospitals ; Humans ; Incidence ; Pandemics ; SARS-CoV-2 ; Sepsis
Language	English
Publishing date	2022-01-18
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2021-014243
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