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Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med 2020. [DOI: 10.1038/s41591-020-0968-3 or (select 2501 from(select count(*),concat(0x717a766b71,(select (elt(2501=2501,1))),0x716a626a71,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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756
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Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med 2020. [DOI: 10.1038/s41591-020-0968-3 and 3417=convert(int,(select char(113)+char(122)+char(118)+char(107)+char(113)+(select (case when (3417=3417) then char(49) else char(48) end))+char(113)+char(106)+char(98)+char(106)+char(113)))-- uudh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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757
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Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med 2020. [DOI: 10.1038/s41591-020-0968-3 and 7381=(select (case when (7381=7381) then 7381 else (select 9289 union select 2024) end))-- gggv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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758
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759
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Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med 2020. [DOI: 10.1038/s41591-020-0968-3 or extractvalue(9286,concat(0x5c,0x717a766b71,(select (elt(9286=9286,1))),0x716a626a71))-- kypu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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760
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Chang TS, Ding Y, Freund MK, Johnson R, Schwarz T, Yabu JM, Hazlett C, Chiang JN, Wulf A, Geschwind DH, Butte MJ, Pasaniuc B. Prior diagnoses and medications as risk factors for COVID-19 in a Los Angeles Health System. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.03.20145581. [PMID: 32637977 PMCID: PMC7340203 DOI: 10.1101/2020.07.03.20145581] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With the continuing coronavirus disease 2019 (COVID-19) pandemic coupled with phased reopening, it is critical to identify risk factors associated with susceptibility and severity of disease in a diverse population to help shape government policies, guide clinical decision making, and prioritize future COVID-19 research. In this retrospective case-control study, we used de-identified electronic health records (EHR) from the University of California Los Angeles (UCLA) Health System between March 9th, 2020 and June 14th, 2020 to identify risk factors for COVID-19 susceptibility (severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) PCR test positive), inpatient admission, and severe outcomes (treatment in an intensive care unit or intubation). Of the 26,602 individuals tested by PCR for SARS-CoV-2, 992 were COVID-19 positive (3.7% of Tested), 220 were admitted in the hospital (22% of COVID-19 positive), and 77 had a severe outcome (35% of Inpatient). Consistent with previous studies, males and individuals older than 65 years old had increased risk of inpatient admission. Notably, individuals self-identifying as Hispanic or Latino constituted an increasing percentage of COVID-19 patients as disease severity escalated, comprising 24% of those testing positive, but 40% of those with a severe outcome, a disparity that remained after correcting for medical comorbidities. Cardiovascular disease, hypertension, and renal disease were premorbid risk factors present before SARS-CoV-2 PCR testing associated with COVID-19 susceptibility. Less well-established risk factors for COVID-19 susceptibility included pre-existing dementia (odds ratio (OR) 5.2 [3.2-8.3], p=2.6 x 10-10), mental health conditions (depression OR 2.1 [1.6-2.8], p=1.1 x 10-6) and vitamin D deficiency (OR 1.8 [1.4-2.2], p=5.7 x 10-6). Renal diseases including end-stage renal disease and anemia due to chronic renal disease were the predominant premorbid risk factors for COVID-19 inpatient admission. Other less established risk factors for COVID-19 inpatient admission included previous renal transplant (OR 9.7 [2.8-39], p=3.2x10-4) and disorders of the immune system (OR 6.0 [2.3, 16], p=2.7x10-4). Prior use of oral steroid medications was associated with decreased COVID-19 positive testing risk (OR 0.61 [0.45, 0.81], p=4.3x10-4), but increased inpatient admission risk (OR 4.5 [2.3, 8.9], p=1.8x10-5). We did not observe that prior use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers increased the risk of testing positive for SARS-CoV-2, being admitted to the hospital, or having a severe outcome. This study involving direct EHR extraction identified known and less well-established demographics, and prior diagnoses and medications as risk factors for COVID-19 susceptibility and inpatient admission. Knowledge of these risk factors including marked ethnic disparities observed in disease severity should guide government policies, identify at-risk populations, inform clinical decision making, and prioritize future COVID-19 research.
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Affiliation(s)
- Timothy S Chang
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- These authors contributed equally
| | - Yi Ding
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- These authors contributed equally
| | - Malika K Freund
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- These authors contributed equally
| | - Ruth Johnson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
- These authors contributed equally
| | - Tommer Schwarz
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- These authors contributed equally
| | - Julie M Yabu
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Chad Hazlett
- Department of Political Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Statistics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jeffrey N Chiang
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ami Wulf
- Department of Political Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | | | - Daniel H Geschwind
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Manish J Butte
- Divisions of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA
| | - Bogdan Pasaniuc
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Lead Contact
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761
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Sarzani R, Giulietti F, Di Pentima C, Giordano P, Spannella F. Disequilibrium between the classic renin-angiotensin system and its opposing arm in SARS-CoV-2-related lung injury. Am J Physiol Lung Cell Mol Physiol 2020; 319:L325-L336. [PMID: 32639866 PMCID: PMC7414236 DOI: 10.1152/ajplung.00189.2020] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A dysregulation of the renin-angiotensin system (RAS) has been involved in the genesis of lung injury and acute respiratory distress syndrome from different causes, including several viral infections. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of pneumocytes, the hallmark of the pandemic coronavirus disease 2019 (COVID-19) involving both alveolar interstitium and capillaries, is linked to angiotensin-converting enzyme 2 (ACE2) binding and its functional downregulation. ACE2 is a key enzyme for the balance between the two main arms of the RAS: the ACE/angiotensin (Ang) II/Ang II type 1 receptor axis (“classic RAS”) and the ACE2/Ang(1–7)/Mas receptor (MasR) axis (“anti-RAS”). The ACE2 downregulation, as a result of SARS-coronaviruses binding, enhances the classic RAS, leading to lung damage and inflammation with leaky pulmonary blood vessels and fibrosis, when the attenuation mediated by the anti-RAS arm is reduced. ACE inhibitors (ACE-I) and Ang II type 1 receptor blockers (ARB), effective in cardiovascular diseases, were found to prevent and counteract acute lung injury in several experimental models by restoring the balance between these two opposing arms. The evidence of RAS arm disequilibrium in COVID-19 and the hypothesis of a beneficial role of RAS modulation supported by preclinical and clinical studies are the focus of the present review. Preclinical and clinical studies on drugs balancing RAS arms might be the right way to counter COVID-19.
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Affiliation(s)
- Riccardo Sarzani
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Chiara Di Pentima
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Ricovero e Cura per Anziani, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
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762
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Dublin S, Walker R, Floyd JS, Shortreed SM, Fuller S, Albertson-Junkans L, Harrington LB, Greenwood-Hickman MA, Green BB, Psaty BM. Renin-angiotensin-aldosterone system inhibitors and COVID-19 infection or hospitalization: a cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32676610 PMCID: PMC7359535 DOI: 10.1101/2020.07.06.20120386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There are plausible mechanisms by which angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of COVID-19 infection or affect disease severity. To examine the association between these medications and COVID-19 infection or hospitalization, we conducted a retrospective cohort study within a US integrated healthcare system. Among people aged ≥18 years enrolled in the health plan for at least 4 months as of 2/29/2020, current ACEI and ARB use was identified from pharmacy data, and the estimated daily dose was calculated and standardized across medications. COVID-19 infections were identified through 6/14/2020 from laboratory and hospitalization data. We used logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals. Among 322,044 individuals, 720 developed COVID-19 infection. Among people using ACEI/ARBs, 183/56,105 developed COVID-19 (3.3 per 1000 individuals) compared with 537/265,939 without ACEI/ARB use (2.0 per 1000), yielding an adjusted OR of 0.94 (95% CI 0.75-1.16). For use of < 1 defined daily dose vs. nonuse, the adjusted OR for infection was 0.89 (95% CI 0.62-1.26); for 1 to < 2 defined daily doses, 0.97 (95% CI 0.71-1.31); and for ≥2 defined daily doses, 0.94 (95% CI 0.72-1.23). The OR was similar for ACEIs and ARBs and in subgroups by age and sex. 29% of people with COVID-19 infection were hospitalized; the adjusted OR for hospitalization in relation to ACEI/ARB use was 0.92 (95% CI 0.54-1.57), and there was no association with dose. These findings support current recommendations that individuals on these medications continue their use. People taking angiotensin converting enzyme inhibitors and angiotensin receptor blockers, including those using high doses, can continue to take them without concern about higher risk of COVID 19 infection.
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Affiliation(s)
- Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA
| | - Rod Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - James S Floyd
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA.,Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Biostatistics, University of Washington, Seattle, WA
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura B Harrington
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Bruce M Psaty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA.,Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA.,Department of Health Services, University of Washington, Seattle, WA
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763
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Rothan HA, Acharya A, Reid SP, Kumar M, Byrareddy SN. Molecular Aspects of COVID-19 Differential Pathogenesis. Pathogens 2020; 9:E538. [PMID: 32640525 PMCID: PMC7400297 DOI: 10.3390/pathogens9070538] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
In the absence of therapeutic interventions, and a possible vaccine candidate, the spread of COVID-19 disease and associated fatalities are on the rise. The high mutation frequency in the genomic material of these viruses supports their ability to adapt to new environments, resulting in an efficient alteration in tissue tropism and host range. Therefore, the coronavirus' health threats could be relevant for the long-term. The epidemiological data indicate that age, sex, and cardio-metabolic disease have a significant impact on the spread and severity of COVID-19. In this review, we highlight recent updates on the pathogenesis of SARS-CoV-2 among men and women, including children. We also discuss the role of the cellular receptors and coreceptors used by the virus to enter host cells on differential infection among men, women, and cardio-metabolic patients.
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Affiliation(s)
- Hussin A. Rothan
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Centre, Omaha, NE 68198, USA;
| | - St Patrick Reid
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Mukesh Kumar
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Siddappa N. Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Centre, Omaha, NE 68198, USA;
- Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Centre, Omaha, NE 68198, USA
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Centre, Omaha, NE 68198, USA
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764
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Xu J, Huang C, Fan G, Liu Z, Shang L, Zhou F, Wang Y, Yu J, Yang L, Xie K, Huang Z, Huang L, Gu X, Li H, Zhang Y, Wang Y, Hayden FG, Horby PW, Cao B, Wang C. Use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in context of COVID-19 outbreak: a retrospective analysis. Front Med 2020; 14:601-612. [PMID: 32621202 PMCID: PMC7333369 DOI: 10.1007/s11684-020-0800-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
The possible effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on COVID-19 disease severity have generated considerable debate. We performed a single-center, retrospective analysis of hospitalized adult COVID-19 patients in Wuhan, China, who had definite clinical outcome (dead or discharged) by February 15, 2020. Patients on anti-hypertensive treatment with or without ACEI/ARB were compared on their clinical characteristics and outcomes. The medical records from 702 patients were screened. Among the 101 patients with a history of hypertension and taking at least one anti-hypertensive medication, 40 patients were receiving ACEI/ARB as part of their regimen, and 61 patients were on antihypertensive medication other than ACEI/ARB. We observed no statistically significant differences in percentages of in-hospital mortality (28% vs. 34%, P = 0.46), ICU admission (20% vs. 28%, P = 0.37) or invasive mechanical ventilation (18% vs. 26%, P = 0.31) between patients with or without ACEI/ARB treatment. Further multivariable adjustment of age and gender did not provide evidence for a significant association between ACEI/ARB treatment and severe COVID-19 outcomes. Our findings confirm the lack of an association between chronic receipt of renin-angiotensin system antagonists and severe outcomes of COVID-19. Patients should continue previous anti-hypertensive therapy until further evidence is available.
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Affiliation(s)
- Jiuyang Xu
- Department of Basic Medical Sciences, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Chaolin Huang
- Department of Infectious Diseases, Jinyintan Hospital, Wuhan, 430030, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lianhan Shang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100029, China
| | - Jiapei Yu
- Department of Basic Medical Sciences, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Luning Yang
- Department of Basic Medical Sciences, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Ke Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100029, China
| | - Zhisheng Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lixue Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100029, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Frederick G Hayden
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22904, USA
| | - Peter W Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX1 2JD, UK
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Department of Respiratory Medicine, Capital Medical University, Beijing, 100029, China. .,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, 100084, China.
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China. .,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, 100084, China. .,Chinese Academy of Engineering, Beijing, 100088, China.
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765
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Affiliation(s)
- Nicholas Moore
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France.
| | - Bruce Carleton
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
| | - Pauline Bosco-Levy
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
| | - Cecile Droz
- Bordeaux PharmacoEpi, INSEMR CIC 1401, Universityd of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France
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766
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St. John MH, Barry AR. COVID-19 and the role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Can Pharm J (Ott) 2020; 153:193-197. [PMID: 33193917 PMCID: PMC7605072 DOI: 10.1177/1715163520929373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Megan H. St. John
- Faculty of Pharmaceutical Sciences (St. John, Barry), Lower Mainland Pharmacy Services, Chilliwack, British Columbia
- University of British Columbia, Vancouver, and Chilliwack General Hospital (Barry), Lower Mainland Pharmacy Services, Chilliwack, British Columbia
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767
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Tadic M, Cuspidi C, Grassi G, Mancia G. COVID-19 and arterial hypertension: Hypothesis or evidence? J Clin Hypertens (Greenwich) 2020; 22:1120-1126. [PMID: 32627330 PMCID: PMC7362072 DOI: 10.1111/jch.13925] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
Investigations reported that hypertension, diabetes, and cardiovascular diseases were the most prevalent comorbidities among the patients with coronavirus disease 2019 (COVID-19). Hypertension appeared consistently as the most prevalent risk factors in COVID-19 patients. Some investigations speculated about the association between renin-angiotensin-aldosterone system (RAAS) and susceptibility to COVID-19, as well as the relationship between RAAS inhibitors and increased mortality in these patients. This raised concern about the potential association between hypertension (and its treatment) and propensity for COVID-19. There are only a few follow-up studies that investigated the impact of comorbidities on outcome in these patients with conflicting findings. Hypertension has been proven to be more prevalent in patients with an adverse outcome (admission in intensive care unit, use of mechanical ventilation, or death). So far, there is no study that demonstrated independent predictive value of hypertension on mortality in COVID-19 patients. There are many speculations about this coronavirus and its relation with different risk factors and underlying diseases. The aim of this review was to summarize the current knowledge about the relationship between hypertension and COVID-19 and the role of hypertension on outcome in these patients.
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Affiliation(s)
- Marijana Tadic
- Department of CardiologyUniversity Hospital “Dr. Dragisa Misovic–Dedinje”BelgradeSerbia
| | - Cesare Cuspidi
- University of Milan‐BicoccaMilanItaly
- Clinical Research UnitIstituto Auxologico ItalianoMedaItaly
| | | | - Giuseppe Mancia
- University of Milan‐BicoccaMilanItaly
- Policlinico di MonzaMonzaItaly
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768
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Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings. Glob Heart 2020; 15:44. [PMID: 32923338 PMCID: PMC7413193 DOI: 10.5334/gh.823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.
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769
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Sanchis-Gomar F, Lavie CJ, Perez-Quilis C, Henry BM, Lippi G. In reply-Angiotensin-Converting Enzyme 2 and the Resolution of Inflammation: In Support of Continuation of Prescribed Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers. Mayo Clin Proc 2020; 95:1553-1556. [PMID: 32622458 PMCID: PMC7241409 DOI: 10.1016/j.mayocp.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Fabian Sanchis-Gomar
- University of Valencia and INCLIVA Biomedical Research Institute, Spain; Stanford University School of Medicine, Stanford, CA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School The University of Queensland School of Medicine, New Orleans, LA
| | - Carme Perez-Quilis
- University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Brandon M Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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770
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Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26:1017-1032. [PMID: 32651579 DOI: 10.1038/s41591-020-0968-3] [Citation(s) in RCA: 1901] [Impact Index Per Article: 475.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.
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Affiliation(s)
- Aakriti Gupta
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Mahesh V Madhavan
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Kartik Sehgal
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nandini Nair
- Division of Endocrinology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, NY, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tejasav S Sehrawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Neha Ahluwalia
- Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C Ausiello
- Division of Endocrinology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, NY, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Anna S Nordvig
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University and the NewYork-Presbyterian Hospital, New York, NY, USA
| | - Domenico Accili
- Division of Endocrinology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, NY, USA
| | - Joan M Bathon
- Division of Rheumatology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kenneth A Bauer
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University and the NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, Department of Medicine, the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David D Ho
- Aaron Diamond AIDS Research Center, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, NY, USA
| | - Donald W Landry
- Division of Nephrology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
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771
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Kario K, Morisawa Y, Sukonthasarn A, Turana Y, Chia Y, Park S, Wang T, Chen C, Tay JC, Li Y, Wang J. COVID-19 and hypertension-evidence and practical management: Guidance from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2020; 22:1109-1119. [PMID: 32643874 PMCID: PMC7361740 DOI: 10.1111/jch.13917] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
There are several risk factors for worse outcomes in patients with coronavirus 2019 disease (COVID-19). Patients with hypertension appear to have a poor prognosis, but there is no direct evidence that hypertension increases the risk of new infection or adverse outcomes independent of age and other risk factors. There is also concern about use of renin-angiotensin system (RAS) inhibitors due to a key role of angiotensin-converting enzyme 2 receptors in the entry of the SARS-CoV-2 virus into cells. However, there is little evidence that use of RAS inhibitors increases the risk of SARS-CoV-2 virus infection or worsens the course of COVID-19. Therefore, antihypertensive therapy with these agents should be continued. In addition to acute respiratory distress syndrome, patients with severe COVID-19 can develop myocardial injury and cytokine storm, resulting in heart failure, arteriovenous thrombosis, and kidney injury. Troponin, N-terminal pro-B-type natriuretic peptide, D-dimer, and serum creatinine are biomarkers for these complications and can be used to monitor patients with COVID-19 and for risk stratification. Other factors that need to be incorporated into patient management strategies during the pandemic include regular exercise to maintain good health status and monitoring of psychological well-being. For the ongoing management of patients with hypertension, telemedicine-based home blood pressure monitoring strategies can facilitate maintenance of good blood pressure control while social distancing is maintained. Overall, multidisciplinary management of COVID-19 based on a rapidly growing body of evidence will help ensure the best possible outcomes for patients, including those with risk factors such as hypertension.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuji Morisawa
- Division of Infectious DiseasesJichi Medical University HospitalShimotsuke‐shiJapan
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
| | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Tzung‐Dau Wang
- Department of Internal MedicineCardiovascular Center and Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Chen‐Huan Chen
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Yan Li
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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772
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Abstract
Angiotensin-converting enzyme (ACE) inhibitors (ACEIs) and angiotensin II type‑1 receptor blockers (ARBs) are among the most widely prescribed drugs for the treatment of arterial hypertension, heart failure and chronic kidney disease. A number of studies, mainly in animals and not involving the lungs, have indicated that these drugs can increase expression of angiotensin-converting enzyme 2 (ACE2). ACE2 is the cell entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) that is currently battering the globe. This has led to the hypothesis that use of ACEIs and ARBs may increase the risk of developing severe COVID-19. In this point of view paper, possible scenarios regarding the impact of ACEI/ARB pharmacotherapy on COVID-19 are discussed in relation to the currently available evidence. Although further research on the influence of blood-pressure-lowering drugs, including those not targeting the renin-angiotensin system, is warranted, there are presently no compelling clinical data showing that ACEIs and ARBs increase the likelihood of contracting COVID-19 or worsen the outcome of SARS-CoV‑2 infections. Thus, unless contraindicated, use of ACEIs/ARBs in COVID-19 patients should be continued in line with the recent recommendations of medical societies.
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Affiliation(s)
- A A F de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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773
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Arnold RH. COVID-19 - Does This Disease Kill Due to Imbalance of the Renin Angiotensin System (RAS) Caused by Genetic and Gender Differences in the Response to Viral ACE 2 Attack? Heart Lung Circ 2020; 29:964-972. [PMID: 32564908 PMCID: PMC7247492 DOI: 10.1016/j.hlc.2020.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Debate continues in the medical literature on the role of the renin angiotensin system (RAS) in Coronavirus disease 2019 (COVID-19) pathophysiology and the implications for the use of cardiovascular drugs acting on the RAS. Could these drugs - which include angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptors blockers (ARBs) - be harmful or potential key therapeutic agents in COVID-19? And, could potentially helpful measures be available and in plain view on the pharmacy shelf?
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774
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Ruilope LM, Garcia Donaire JA, de la Sierra A. [Renin-angiotensin system blockers and COVID-19 infection]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:99-100. [PMID: 32448641 PMCID: PMC7161518 DOI: 10.1016/j.hipert.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/12/2022]
Affiliation(s)
- L M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Europea Madrid, Madrid, España; CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Garcia Donaire
- Unidad de Hipertensión Arterial, Hospital Clínico San Carlos, Madrid, España; Unidad de Hipertensión. Servicio de Medicina Interna, Hospital Mutua Terrassa, Terrassa, Barcelona, España
| | - A de la Sierra
- Departament de Medicina, Universitat de Barcelona, Barcelona, España; Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Mutua Terrassa, Terrassa, España
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775
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Uso terapéutico de los inhibidores de la enzima convertidora de angiotensina en pacientes con COVID-19: las «dos caras de la moneda». REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [PMCID: PMC7365126 DOI: 10.1016/j.rccar.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
La evidencia actual es limitada para determinar el impacto del uso de los inhibidores de la enzima convertidora de angiotensina (IECA) en la predisposición al empeoramiento de la enfermedad del coronavirus 2019 (COVID-19). Inicialmente se reportó que en los pacientes con progresión grave de la COVID-19 existía una mortalidad elevada, los cuales tenían antecedentes de hipertensión arterial, diabetes mellitus, enfermedad cardiovascular y enfermedad renal crónica. Parte de estos pacientes también tenía en común que utilizaban IECA, lo cual alertó a la comunidad médica sobre su riesgo potencial en coexistencia con COVID-19. Sin embargo, estudios más recientes de casos-controles encontraron que los inhibidores del sistema renina-angiotensina, incluyendo los IECA, no incrementan el riesgo de COVID-19 o de requerir admisión hospitalaria por esta causa. Diferentes revistas científicas han facilitado el acceso a reportes preliminares, dejando a discreción de la comunidad médica y científica hacer uso de dicha información para promover el desarrollo de estudios que confirmen experimentalmente dichos hallazgos, preclínicos y epidemiológicos, que finalmente impacten en las decisiones de la práctica clínica para beneficiar a los pacientes con COVID-19. En esta revisión de la literatura se exploran los diferentes efectos mediados por los IECA que podrían estar relacionados con la respuesta inmune durante la infección y la transmisión de COVID-19, compilando evidencia disponible que evalúa si en realidad representan un riesgo o si, por el contrario, confieren un efecto protector.
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776
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Carey RM, Wang JG. Evidence That Renin-Angiotensin System Inhibitors Should Not Be Discontinued Due to the COVID-19 Pandemic. Hypertension 2020; 76:42-43. [PMID: 32436403 PMCID: PMC7268879 DOI: 10.1161/hypertensionaha.120.15263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Robert M. Carey
- From the Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA (R.M.C.)
| | - Ji-Guang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
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777
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Alsatli RA. Cardiovascular Complications Related to COVID-19 Disease. Anesth Essays Res 2020; 14:359-365. [PMID: 34092842 PMCID: PMC8159049 DOI: 10.4103/aer.aer_105_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease-2019 (COVID-19) is a world epidemic disease and is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to the respiratory manifestations, it may also cause cardiovascular complications, such as, myocarditis, arrhythmias, myocardial infarction, heart failure, and venous thromboembolic events. This review article will discuss in detail pathophysiology, manifestations, and management of these cardiac complications. A literature review was performed, it included meta-analyses studies, cohort studies, publications, and case series from the largest COVID-19 outbreak centers around the world. Cardiac complications of COVID-19 disease can lead to significant cardiovascular morbidity and mortality. It is important to recognize and treat these complications as early as possible.
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Affiliation(s)
- Raed A. Alsatli
- Department of Anesthesia, Section Cardiac Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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778
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Quinn KL, Fralick M, Zipursky JS, Stall NM. Good things come in threes (and sometimes fours): Update on renin-angiotensin-aldosterone system inhibitors and COVID-19. CMAJ 2020; 192:E611. [PMID: 32575050 DOI: 10.1503/cmaj.75720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Kieran L Quinn
- Clinical associate, Department of Medicine, University of Toronto; Division of General Internal Medicine and Geriatrics, Sinai Health System; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Michael Fralick
- Assistant professor, Department of Medicine, University of Toronto; Division of General Internal Medicine and Geriatrics, Sinai Health System, Toronto, Ont
| | - Jonathan S Zipursky
- Clinical associate, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto; Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Nathan M Stall
- Clinical associate, Department of Medicine, University of Toronto; Division of General Internal Medicine and Geriatrics, Sinai Health System; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
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779
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Cheung KS, Hung IFN, Leung WK. Association between angiotensin blockade and COVID-19 severity in Hong Kong. CMAJ 2020; 192:E635. [PMID: 32575056 DOI: 10.1503/cmaj.75865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ka Shing Cheung
- Clinical assistant professor, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ivan F N Hung
- Professor, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wai K Leung
- Professor, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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780
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Fernandez-Fernandez B, D’Marco L, Górriz JL, Jacobs-Cachá C, Kanbay M, Luis-Lima S, Porrini E, Sarafidis P, Soler MJ, Ortiz A. Exploring Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors for Organ Protection in COVID-19. J Clin Med 2020; 9:E2030. [PMID: 32605278 PMCID: PMC7409231 DOI: 10.3390/jcm9072030] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Hospital admissions and mortality from the Coronavirus disease 2019 (COVID-19) pandemic are spreading throughout the world, and second and third waves are thought to be likely. Risk factors for severe COVID-19 include diabetes, chronic kidney disease and cardiovascular disease. Currently, there is no vaccine and no approved therapy. Therapeutic approaches are aimed at preventing viral replication and spread, limiting the impact of the inflammatory overdrive (cytokine storm), preventing thromboembolic complications and replacing or supporting organ function. However, despite organ support, mortality is currently 65% for those receiving advanced respiratory support and 78% for those requiring renal replacement therapies. Thus, efforts should be made to provide adjuvant organ protection therapy. This may imply novel therapies in clinical development (e.g., the Fas ligand trap asunercept), but uptake of repurposed drugs already in clinical use may be faster. In this regard, sodium glucose co-transporter-2 (SGLT2) inhibitors were recently shown to protect the heart and kidney both within and outside of a diabetic milieu context. Further, preclinical data support a beneficial effect for the lung. We now discuss the potential benefits and risks of SGLT2 inhibitors in COVID-19 and an ongoing clinical trial testing the impact of dapagliflozin on outcomes in COVID-19 patients with respiratory failure.
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Affiliation(s)
- Beatriz Fernandez-Fernandez
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (B.F.-F.); (S.L.-L.)
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
| | - Luis D’Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, 46010 Valencia, Spain; (L.D.); (J.L.G.)
| | - Jose Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, 46010 Valencia, Spain; (L.D.); (J.L.G.)
- Medicine Department, Universidad de Valencia, 46010 Valencia, Spain
| | - Conxita Jacobs-Cachá
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
- Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Nephrology Research Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 43010 Istanbul, Turkey;
| | - Sergio Luis-Lima
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (B.F.-F.); (S.L.-L.)
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
| | - Esteban Porrini
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
- Department of Medicine, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Instituto de Tecnologías Biomédicas, University of La Laguna, 38320 Tenerife, Spain
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - María José Soler
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
- Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Nephrology Research Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (B.F.-F.); (S.L.-L.)
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28040 Madrid, Spain; (C.J.-C.); (E.P.); (M.J.S.)
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781
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Rohn H, Feldkamp T, Witzke O. [COVID-19 and the kidneys]. ACTA ACUST UNITED AC 2020; 15:210-215. [PMID: 32837571 PMCID: PMC7318905 DOI: 10.1007/s11560-020-00444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Welche drastischen Folgen neue Infektionskrankheiten für Mensch und Gesellschaft haben können, wird aktuell an COVID-19 („coronavirus disease 2019“) deutlich. Seit seiner Erstbeschreibung im Dezember 2019 beherrscht SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) das aktuelle wissenschaftliche und öffentliche Interesse.
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Affiliation(s)
- H Rohn
- Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie (WZI), Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Deutschland
| | - T Feldkamp
- Klinik für Nieren- und Hochdruckkrankheiten, Innere Medizin IV, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - O Witzke
- Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie (WZI), Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Deutschland
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782
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Golpe R, Pérez-de-Llano LA, Dacal D, Guerrero-Sande H, Pombo-Vide B, Ventura-Valcárcel P. [Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors]. Med Clin (Barc) 2020; 155:488-490. [PMID: 32651067 PMCID: PMC7316050 DOI: 10.1016/j.medcli.2020.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
Introduction There is controversy concerning the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type-I receptor blockers (ARB) for treating hypertensive patients with Covid-19. It has been hypothesized that these drugs might increase the risk of severe Covid-19, but some authors suggested that blocking the renin-angiotensin system might actually decrease this risk. Methods Retrospective cohort study of all the consecutive hypertensive patients with confirmed SARS-CoV-2 infection in a health area. The outcome variable was hospitalization because of severe Covid-19. Results 539 subjects were diagnosed of SARS-CoV-2 infection. Of these, 157 (29.1%) had hypertension and were included in the study. Sixty-nine cases (43.9%) were hospitalized because of severe Covid-19. In multivariable analysis older age, diabetes and hypertensive myocadiopathy were related to a higher risk of hospital admission. ARB treatment was associated with a significantly lower risk of hospitalization (HR: 0.29, 95% CI: 0.10 – 0.88). A similar albeit not significant trend was observed for ACEI. Conclusion ARB or ACEI treatment was not associated with a worse clinical outcome in consecutive hypertensive patients infected by SARS-CoV-2.
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Affiliation(s)
- Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | | | - David Dacal
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - Beatriz Pombo-Vide
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
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783
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Midulla F, Cristiani L, Mancino E. Will children reveal their secret? The coronavirus dilemma. Eur Respir J 2020; 55:13993003.01617-2020. [PMID: 32430424 PMCID: PMC7241107 DOI: 10.1183/13993003.01617-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/22/2023]
Abstract
We thank G.J. Porter for his comments on our recently published editorial: “Will children reveal their secret? The coronavirus dilemma” [1]. In the editorial, we reviewed some of the strongest evidence that may support our perspective. It was beyond the purpose of our manuscript to provide a full description of the renin–angiotensin–aldosterone system (RAAS) and angiotensin-converting enzyme 2 (ACE2) receptor. We strongly agree that evidence about the role of ACE2 in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is conflicting and our putative perspective was clearly pointed out in the paper. The debate around the role of ACE2 in SARS-CoV-2 infection is ongoing and we appreciate the chance that G.J. Porter has given us to better elucidate some of its main aspects. The role of ACE2 receptor in SARS-CoV-2 infection and in COVID-19 outcomes is still debated, especially in childrenhttps://bit.ly/35ZLf7V
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Affiliation(s)
- Fabio Midulla
- Dept of Maternal Science, Paediatric Emergency Service, Sapienza University of Rome, Rome, Italy
| | - Luca Cristiani
- Dept of Maternal Science, Paediatric Emergency Service, Sapienza University of Rome, Rome, Italy
| | - Enrica Mancino
- Dept of Maternal Science, Paediatric Emergency Service, Sapienza University of Rome, Rome, Italy
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784
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Bravi F, Flacco ME, Carradori T, Volta CA, Cosenza G, De Togni A, Acuti Martellucci C, Parruti G, Mantovani L, Manzoli L. Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens. PLoS One 2020; 15:e0235248. [PMID: 32579597 PMCID: PMC7314008 DOI: 10.1371/journal.pone.0235248] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Aims This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). Methods and results All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. Conclusion No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.
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Affiliation(s)
| | | | | | - Carlo Alberto Volta
- "Sant'Anna" University Hospital of Ferrara, Ferrara, Italy
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | | | | | | | - Lorenzo Mantovani
- Center for Public Health Research, University of Milan—Bicocca, Milan, Italy
- IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Lamberto Manzoli
- "Sant'Anna" University Hospital of Ferrara, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- * E-mail:
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785
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Tomasoni D, Italia L, Adamo M, Inciardi RM, Lombardi CM, Solomon SD, Metra M. COVID-19 and heart failure: from infection to inflammation and angiotensin II stimulation. Searching for evidence from a new disease. Eur J Heart Fail 2020; 22:957-966. [PMID: 32412156 PMCID: PMC7273093 DOI: 10.1002/ejhf.1871] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with cardiovascular disease and, namely, heart failure are more susceptible to coronavirus disease 2019 (COVID‐19) and have a more severe clinical course once infected. Heart failure and myocardial damage, shown by increased troponin plasma levels, occur in at least 10% of patients hospitalized for COVID‐19 with higher percentages, 25% to 35% or more, when patients critically ill or with concomitant cardiac disease are considered. Myocardial injury may be elicited by multiple mechanisms, including those occurring with all severe infections, such as fever, tachycardia, adrenergic stimulation, as well as those caused by an exaggerated inflammatory response, endotheliitis and, in some cases, myocarditis that have been shown in patients with COVID‐19. A key role may be that of the renin–angiotensin–aldosterone system. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infects human cells binding to angiotensin‐converting enzyme 2 (ACE2), an enzyme responsible for the cleavage of angiotensin II into angiotensin 1–7, which has vasodilating and anti‐inflammatory effects. Virus‐mediated down‐regulation of ACE2 may increase angiotensin II stimulation and contribute to the deleterious hyper‐inflammatory reaction of COVID‐19. On the other hand, ACE2 may be up‐regulated in patients with cardiac disease and treated with ACE inhibitors or angiotensin receptor blockers. ACE2 up‐regulation may increase the susceptibility to COVID‐19 but may be also protective vs. angiotensin II‐mediated vasoconstriction and inflammatory activation. Recent data show the lack of untoward effects of ACE inhibitors or angiotensin receptor blockers for COVID‐19 infection and severity. Prospective trials are needed to ascertain whether these drugs may have protective effects.
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Affiliation(s)
- Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo Italia
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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786
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Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension 2020; 76:366-372. [PMID: 32564693 DOI: 10.1161/hypertensionaha.120.15324] [Citation(s) in RCA: 279] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Several factors have been proposed to explain the high death rate of the coronavirus disease 2019 (COVID-19) outbreak, including hypertension and hypertension-related treatment with Renin Angiotensin System inhibitors. Also, age and multimorbidity might be confounders. No sufficient data are available to demonstrate their independent role. We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to verify whether renin-angiotensin system inhibitors are related to COVID-19 severe outcomes. We analyzed information from Italian patients diagnosed with COVID-19, admitted in 26 hospitals. One thousand five hundred ninety-one charts (male, 64.1%; 66±0.4 years) were recorded. At least 1 preexisting condition was observed in 73.4% of patients, with hypertension being the most represented (54.9%). One hundred eighty-eight deaths were recorded (11.8%; mean age, 79.6±0.9 years). In nonsurvivors, older age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery diseases, and heart failure were more represented than in survivors. The Charlson Comorbidity Index was significantly higher in nonsurvivors compared with survivors (4.3±0.15 versus 2.6±0.05; P<0.001). ACE (angiotensin-converting enzyme) inhibitors, diuretics, and β-blockers were more frequently used in nonsurvivors than in survivors. After correction by multivariate analysis, only age (P=0.0001), diabetes mellitus (P=0.004), chronic obstructive pulmonary disease (P=0.011), and chronic kidney disease (P=0.004) but not hypertension predicted mortality. Charlson Comorbidity Index, which cumulates age and comorbidities, predicts mortality with an exponential increase in the odds ratio by each point of score. In the COVID-19 outbreak, mortality is predicted by age and the presence of comorbidities. Our data do not support a significant interference of hypertension and antihypertensive therapy on COVID-19 lethality. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT04331574.
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Affiliation(s)
- Guido Iaccarino
- From the Department of Advanced Biomedical Sciences, Federico II University, Italy (G.I.)
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.G.)
| | - Claudio Borghi
- Department of Medicine and Surgery Sciences, Alma Mater Studiorum University of Bologna, Italy (C.B.)
| | - Claudio Ferri
- Department of Clinical Medicine, Public Health, Life and Environment Sciences, University of L'Aquila, Italy (C.F.)
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Medicina 2, ASST Spedali Civili Brescia, Italy (M.S.)
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Sapienza University Sant'Andrea Hospital, Rome and IRCCS Neuromed, Pozzilli (IS), Italy (M.V.)
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787
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Abstract
According to five new studies, therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) is not associated with an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or with an increased risk of severe disease or in-hospital death among patients with COVID-19.
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788
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(Treatment with ACE inhibitors and AT1-blockers during the COVID-19 pandemic). COR ET VASA 2020. [DOI: 10.33678/cor.2020.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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789
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Sfera A, Osorio C, Jafri N, Diaz EL, Campo Maldonado JE. Intoxication With Endogenous Angiotensin II: A COVID-19 Hypothesis. Front Immunol 2020; 11:1472. [PMID: 32655579 PMCID: PMC7325923 DOI: 10.3389/fimmu.2020.01472] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 has spread rapidly around the globe. However, despite its high pathogenicity and transmissibility, the severity of the associated disease, COVID-19, varies widely. While the prognosis is favorable in most patients, critical illness, manifested by respiratory distress, thromboembolism, shock, and multi-organ failure, has been reported in about 5% of cases. Several studies have associated poor COVID-19 outcomes with the exhaustion of natural killer cells and cytotoxic T cells, lymphopenia, and elevated serum levels of D-dimer. In this article, we propose a common pathophysiological denominator for these negative prognostic markers, endogenous, angiotensin II toxicity. We hypothesize that, like in avian influenza, the outlook of COVID-19 is negatively correlated with the intracellular accumulation of angiotensin II promoted by the viral blockade of its degrading enzyme receptors. In this model, upregulated angiotensin II causes premature vascular senescence, leading to dysfunctional coagulation, and immunity. We further hypothesize that angiotensin II blockers and immune checkpoint inhibitors may be salutary for COVID-19 patients with critical illness by reversing both the clotting and immune defects (Graphical Abstract).
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Affiliation(s)
- Adonis Sfera
- Patton State Hospital, San Bernardino, CA, United States
| | - Carolina Osorio
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
| | - Nyla Jafri
- Patton State Hospital, San Bernardino, CA, United States
| | - Eddie Lee Diaz
- Patton State Hospital, San Bernardino, CA, United States
| | - Jose E Campo Maldonado
- Department of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States
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790
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Jarcho JA, Ingelfinger JR, Hamel MB, D'Agostino RB, Harrington DP. Inhibitors of the Renin-Angiotensin-Aldosterone System and Covid-19. N Engl J Med 2020; 382:2462-2464. [PMID: 32356625 PMCID: PMC7224604 DOI: 10.1056/nejme2012924] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- John A Jarcho
- From the Department of Mathematics and Statistics, Boston University (R.B.D.), the Department of Biostatistics, Harvard T.H. Chan School of Public Health (D.P.H.), and the Department of Data Sciences, Dana-Farber Cancer Institute (D.P.H.) - all in Boston
| | - Julie R Ingelfinger
- From the Department of Mathematics and Statistics, Boston University (R.B.D.), the Department of Biostatistics, Harvard T.H. Chan School of Public Health (D.P.H.), and the Department of Data Sciences, Dana-Farber Cancer Institute (D.P.H.) - all in Boston
| | - Mary Beth Hamel
- From the Department of Mathematics and Statistics, Boston University (R.B.D.), the Department of Biostatistics, Harvard T.H. Chan School of Public Health (D.P.H.), and the Department of Data Sciences, Dana-Farber Cancer Institute (D.P.H.) - all in Boston
| | - Ralph B D'Agostino
- From the Department of Mathematics and Statistics, Boston University (R.B.D.), the Department of Biostatistics, Harvard T.H. Chan School of Public Health (D.P.H.), and the Department of Data Sciences, Dana-Farber Cancer Institute (D.P.H.) - all in Boston
| | - David P Harrington
- From the Department of Mathematics and Statistics, Boston University (R.B.D.), the Department of Biostatistics, Harvard T.H. Chan School of Public Health (D.P.H.), and the Department of Data Sciences, Dana-Farber Cancer Institute (D.P.H.) - all in Boston
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791
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Pelayo J, Lo KB, Bhargav R, Gul F, Peterson E, DeJoy Iii R, Salacup GF, Albano J, Gopalakrishnan A, Azmaiparashvili Z, Patarroyo-Aponte G, Rangaswami J. Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System. Cardiorenal Med 2020; 10:223-231. [PMID: 32554965 PMCID: PMC7360498 DOI: 10.1159/000509182] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. METHODS This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. RESULTS Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032). CONCLUSION We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.
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Affiliation(s)
- Jerald Pelayo
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA,
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ruchika Bhargav
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Fahad Gul
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert DeJoy Iii
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Grace Faith Salacup
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeri Albano
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Zurab Azmaiparashvili
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gabriel Patarroyo-Aponte
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Pulmonary and Critical Care and Sleep Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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792
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Rubin EJ. Expression of Concern: Mehra MR et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621. N Engl J Med 2020; 382:2464. [PMID: 32484612 PMCID: PMC7269012 DOI: 10.1056/nejme2020822] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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793
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Acuti Martellucci C, Flacco ME, Cappadona R, Bravi F, Mantovani L, Manzoli L. SARS-CoV-2 pandemic: An overview. Adv Biol Regul 2020; 77:100736. [PMID: 32773099 PMCID: PMC7832554 DOI: 10.1016/j.jbior.2020.100736] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies.
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Affiliation(s)
- Cecilia Acuti Martellucci
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Public Health, University of the Marche Region, Via Conca, 60126, Ancona, Italy
| | - Maria Elena Flacco
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Francesca Bravi
- "Sant'Anna" University Hospital of Ferrara, Via Aldo Moro 8, 44124, Cona (Fe), Italy
| | - Lorenzo Mantovani
- University Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy.
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794
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Affiliation(s)
| | | | - Amer Harky
- University of Liverpool, Liverpool, UK.,Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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795
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Drager LF, Pio-Abreu A, Lopes RD, Bortolotto LA. Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic? Curr Hypertens Rep 2020; 22:43. [PMID: 32535705 PMCID: PMC7292934 DOI: 10.1007/s11906-020-01057-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest because it is common in adults and there are concerns related to the use of renin-angiotensin system (RAS) inhibitors in patients with hypertension infected with COVID-19. Levels of angiotensin-converting enzyme 2 (ACE2), a protein that facilitates entry of coronavirus into cells, may increase in patients using RAS inhibitors. Thus, chronic use of RAS inhibition could potentially lead to a more severe and fatal form of COVID-19. In this review, we provide a critical review to the following questions: (1) Does hypertension influence immunity or ACE2 expression favoring viral infections? (2) Are the risks of complications in hypertension mediated by its treatment? (3) Is aging a major factor associated with worse prognosis in patients with COVID-19 and hypertension? RECENT FINDINGS Despite the potential involvement of immune responses in the pathogenesis of hypertension, there is no evidence supporting that hypothesis that hypertension or RAS inhibitors contributes to unfavorable outcomes in viral infections. Future investigations adopting a strict protocol for confirming hypertension status as well as assessing associated comorbidities that may influence outcomes are necessary. From the therapeutic perspective, recombinant ACE2 may serve as a potential therapy, but relevant studies in humans are lacking. Definitive evidence regarding the use of RAS inhibitors in patients with COVID-19 is needed; 5 randomized trials examining this issue are currently underway. There is no current scientific support for claiming that hypertension or its treatment with RAS inhibitors contribute to unfavorable outcomes in COVID-19.
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Affiliation(s)
- Luciano F Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil.
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Avenida Dr Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-900, Brazil.
| | - Andrea Pio-Abreu
- Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Avenida Dr Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-900, Brazil
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796
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Morales DR, Conover MM, You SC, Pratt N, Kostka K, Duarte-Salles T, Fernández-Bertolín S, Aragón M, DuVall SL, Lynch K, Falconer T, van Bochove K, Sung C, Matheny ME, Lambert CG, Nyberg F, Alshammari TM, Williams AE, Park RW, Weaver J, Sena AG, Schuemie MJ, Rijnbeek PR, Williams RD, Lane JCE, Prats-Uribe A, Zhang L, Areia C, Krumholz HM, Prieto-Alhambra D, Ryan PB, Hripcsak G, Suchard MA. Renin-angiotensin system blockers and susceptibility to COVID-19: a multinational open science cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.11.20125849. [PMID: 32587982 PMCID: PMC7310640 DOI: 10.1101/2020.06.11.20125849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) could influence infection risk of coronavirus disease (COVID-19). Observational studies to date lack pre-specification, transparency, rigorous ascertainment adjustment and international generalizability, with contradictory results. METHODS Using electronic health records from Spain (SIDIAP) and the United States (Columbia University Irving Medical Center and Department of Veterans Affairs), we conducted a systematic cohort study with prevalent ACE, ARB, calcium channel blocker (CCB) and thiazide diuretic (THZ) use to determine relative risk of COVID-19 diagnosis and related hospitalization outcomes. The study addressed confounding through large-scale propensity score adjustment and negative control experiments. RESULTS Following over 1.1 million antihypertensive users identified between November 2019 and January 2020, we observed no significant difference in relative COVID-19 diagnosis risk comparing ACE/ARB vs CCB/THZ monotherapy (hazard ratio: 0.98; 95% CI 0.84 - 1.14), nor any difference for mono/combination use (1.01; 0.90 - 1.15). ACE alone and ARB alone similarly showed no relative risk difference when compared to CCB/THZ monotherapy or mono/combination use. Directly comparing ACE vs. ARB demonstrated a moderately lower risk with ACE, non-significant for monotherapy (0.85; 0.69 - 1.05) and marginally significant for mono/combination users (0.88; 0.79 - 0.99). We observed, however, no significant difference between drug- classes for COVID-19 hospitalization or pneumonia risk across all comparisons. CONCLUSION There is no clinically significant increased risk of COVID-19 diagnosis or hospitalization with ACE or ARB use. Users should not discontinue or change their treatment to avoid COVID-19.
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Affiliation(s)
- Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, UK
| | - Mitchell M Conover
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Scott L DuVall
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristine Lynch
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, USA
| | | | - Cynthia Sung
- Translational Discovery, Bill & Melinda Gates Medical Research Institute, Seattle, WA, USA
| | - Michael E Matheny
- Geriatric Research Education, and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christophe G Lambert
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | | | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - James Weaver
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G Sena
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martijn J Schuemie
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ross D Williams
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jennifer C E Lane
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Lin Zhang
- School of Public Health, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Melbourne School of Public Health, The University of Melbourne, Victoria, Australia
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Patrick B Ryan
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - Marc A Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
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797
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Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med 2020; 46:1339-1348. [PMID: 32533197 PMCID: PMC7290076 DOI: 10.1007/s00134-020-06153-9] [Citation(s) in RCA: 317] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI) has been reported in up to 25% of critically-ill patients with SARS-CoV-2 infection, especially in those with underlying comorbidities. AKI is associated with high mortality rates in this setting, especially when renal replacement therapy is required. Several studies have highlighted changes in urinary sediment, including proteinuria and hematuria, and evidence of urinary SARS-CoV-2 excretion, suggesting the presence of a renal reservoir for the virus. The pathophysiology of COVID-19 associated AKI could be related to unspecific mechanisms but also to COVID-specific mechanisms such as direct cellular injury resulting from viral entry through the receptor (ACE2) which is highly expressed in the kidney, an imbalanced renin-angotensin-aldosteron system, pro-inflammatory cytokines elicited by the viral infection and thrombotic events. Non-specific mechanisms include haemodynamic alterations, right heart failure, high levels of PEEP in patients requiring mechanical ventilation, hypovolemia, administration of nephrotoxic drugs and nosocomial sepsis. To date, there is no specific treatment for COVID-19 induced AKI. A number of investigational agents are being explored for antiviral/immunomodulatory treatment of COVID-19 and their impact on AKI is still unknown. Indications, timing and modalities of renal replacement therapy currently rely on non-specific data focusing on patients with sepsis. Further studies focusing on AKI in COVID-19 patients are urgently warranted in order to predict the risk of AKI, to identify the exact mechanisms of renal injury and to suggest targeted interventions.
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798
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Zhang X, Li S, Niu S. ACE2 and COVID-19 and the resulting ARDS. Postgrad Med J 2020; 96:403-407. [PMID: 32522846 DOI: 10.1136/postgradmedj-2020-137935] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
This article reviews the correlation between ACE2 and COVID-19 and the resulting acute respiratory distress syndrome (ARDS). ACE2 is a crucial component of the renin-angiotensin system (RAS). The classical ACE-angiotensin Ⅱ (Ang II)-angiotensin type 1 receptor (AT1R) axis and the ACE2-Ang(1-7)-Mas counter-regulatory axis play an essential role in RAS system. ACE2 antagonises the activation of the classical RAS ACE-Ang II-AT1R axis and protects against lung injury. Similar to severe acute respiratory syndrome-related coronavirus, 2019 novel coronavirus (2019-nCoV) also uses ACE2 for cell entry. ARDS is a clinical high-mortality disease which is probably due to the excessive activation of RAS caused by 2019-nCoV infection, and ACE2 has a protective effect on ARDS caused by COVID-19. Because of these protective effects of ACE2 on ARDS, the development of drugs enhancing ACE2 activity may become one of the most promising approaches for the treatment of COVID-19 in the near future. In the meantime, however, the use of RAS blockers such as ACE inhibitors and angiotensin II receptor blockers that inhibit the damaging (ACE-Ang II) arm of the RAS cascade in the lung may also be promising. Trial registration number: NCT04287686.
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Affiliation(s)
- Xiaoqing Zhang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China.,Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Shuren Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Shaoqian Niu
- Graduate School of Hebei Medical University, Shijiazhuang, China
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799
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Lopera Maya EA, van der Graaf A, Lanting P, van der Geest M, Fu J, Swertz M, Franke L, Wijmenga C, Deelen P, Zhernakova A, Sanna S. Lack of Association Between Genetic Variants at ACE2 and TMPRSS2 Genes Involved in SARS-CoV-2 Infection and Human Quantitative Phenotypes. Front Genet 2020; 11:613. [PMID: 32582302 PMCID: PMC7295011 DOI: 10.3389/fgene.2020.00613] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) shows a wide variation in expression and severity of symptoms, from very mild or no symptoms, to flu-like symptoms, and in more severe cases, to pneumonia, acute respiratory distress syndrome, and even death. Large differences in outcome have also been observed between males and females. The causes for this variability are likely to be multifactorial, and to include genetics. The SARS-CoV-2 virus responsible for the infection depends on two human genes: the human receptor angiotensin converting enzyme 2 (ACE2) for cell invasion, and the serine protease TMPRSS2 for S protein priming. Genetic variation in these two genes may thus modulate an individual's genetic predisposition to infection and virus clearance. While genetic data on COVID-19 patients is being gathered, we carried out a phenome-wide association scan (PheWAS) to investigate the role of these genes in other human phenotypes in the general population. We examined 178 quantitative phenotypes including cytokines and cardio-metabolic biomarkers, as well as usage of 58 medications in 36,339 volunteers from the Lifelines population cohort, in relation to 1,273 genetic variants located in or near ACE2 and TMPRSS2. While none reached our threshold for significance, we observed several interesting suggestive associations. For example, single nucleotide polymorphisms (SNPs) near the TMPRSS2 genes were associated with thrombocytes count (p = 1.8 × 10-5). SNPs within the ACE2 gene were associated with (1) the use of angiotensin II receptor blockers (ARBs) combination therapies (p = 5.7 × 10-4), an association that is significantly stronger in females (p dif f = 0.01), and (2) with the use of non-steroid anti-inflammatory and antirheumatic products (p = 5.5 × 10-4). While these associations need to be confirmed in larger sample sizes, they suggest that these variants could play a role in diseases such as thrombocytopenia, hypertension, and chronic inflammation that are often observed in the more severe COVID-19 cases. Further investigation of these genetic variants in the context of COVID-19 is thus promising for better understanding of disease variability. Full results are available at https://covid19research.nl.
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Affiliation(s)
- Esteban A. Lopera Maya
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Adriaan van der Graaf
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Pauline Lanting
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marije van der Geest
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jingyuan Fu
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Morris Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lude Franke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Cisca Wijmenga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patrick Deelen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Genetics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alexandra Zhernakova
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Serena Sanna
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Institute for Genetics and Biomedical Research (IRGB), Consiglio Nazionale delle Ricerche (CNR), Monserrato, Italy
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800
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Pericàs JM, Hernandez-Meneses M, Sheahan TP, Quintana E, Ambrosioni J, Sandoval E, Falces C, Marcos MA, Tuset M, Vilella A, Moreno A, Miro JM. COVID-19: from epidemiology to treatment. Eur Heart J 2020; 41:2092-2112. [PMID: 32511724 PMCID: PMC7279517 DOI: 10.1093/eurheartj/ehaa462] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.
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Affiliation(s)
- J M Pericàs
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Hernandez-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - T P Sheahan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Quintana
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - J Ambrosioni
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Sandoval
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - C Falces
- Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Microbiology Service, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - M Tuset
- Farmacy Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Vilella
- Preventive Medicine Service, Hospital Clinic-ISGlobal, University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miro
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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