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Houvèssou GM, Leventhal DGP, Silva EVD. Obesity and COVID-19 in-hospital fatality in southern Brazil: impact by age and skin color. Rev Saude Publica 2022; 56:4. [PMID: 35239926 PMCID: PMC8849284 DOI: 10.11606/s1518-8787.2022056004329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To estimate the relative risk (RR) of death associated with obesity, the attributable fraction in the exposed/with obesity (AFo), and the hospitalized population attributable risk (hospitalized PAR) associated with obesity of death among all adults and among Black and non-Black adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. METHODS This retrospective cohort study of prognostic factors analyzed all cases of adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. The occurrence of obesity was measured using secondary data from hospital teams’ surveillance records. The outcome assessed was hospital deaths caused by severe COVID-19. Poisson regression was used to estimate RRs and 95% confidence intervals (95%CI). RESULTS The study sample consisted of 100,099 patients hospitalized for severe COVID-19, most of whom were White (84.7%) and male (54.7%). The effect of obesity was strongly modified by age, being higher in younger age groups. For the 18–39-year-old age group, RR = 2.54 (95%CI: 2.33–2.77), and in individuals 70 years and above, RR = 1.09 (95%CI: 1.05–1.13). For the 18–39-year-old age range, AFo = 60.6% and AFo = 42.5% in individuals 40–59 years old. For all hospitalizations, Hospitalized PAR measuring obesity for individuals 18–39 years old was 25.3%, while in the 40–59-year-old range, the hospitalized PAR = 11.2%. The hospitalized PAR was 31.7% in the Black population aged 18–39 years and 24.8% in non-Blacks. The hospitalized PAR was also larger in Blacks aged 40-59 years. CONCLUSIONS Obesity largely impacted in-hospital case-fatality rates among young adults and Black people contaminated by COVID-19. These data highlight the extent of the risk concerning obesity, a highly prevalent chronic condition.
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Affiliation(s)
- Gbènankpon Mathias Houvèssou
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Daniel G P Leventhal
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Eduardo Viegas da Silva
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.,Centro de Vigilância em Saúde do Estado do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Cosentino F, Moscatt V, Marino A, Pampaloni A, Scuderi D, Ceccarelli M, Benanti F, Gussio M, Larocca L, Boscia V, Vinci G, Zagami A, Onorante A, Lupo G, Torrisi S, Grasso S, Bruno R, Iacobello C, Bonfante S, Guarneri L, Cascio A, Franco A, Del Vecchio R, Di Rosolini M, Pulvirenti A, Larnè D, Nunnari G, Celesia B, Cacopardo B. Clinical characteristics and predictors of death among hospitalized patients infected with SARS‑CoV‑2 in Sicily, Italy: A retrospective observational study. Biomed Rep 2022; 16:34. [PMID: 35386106 PMCID: PMC8972844 DOI: 10.3892/br.2022.1517] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Alessio Pampaloni
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Daniele Scuderi
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Francesco Benanti
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Licia Larocca
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Vincenzo Boscia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Giovanni Vinci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Aldo Zagami
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Anna Onorante
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Gaetano Lupo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Salvatore Torrisi
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Silvana Grasso
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Roberto Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Carmelo Iacobello
- Infectious Disease Unit, Cannizzaro Hospital, I-95126 Catania, Italy
| | - Salvatore Bonfante
- Infectious Diseases Unit, Gravina Hospital, I-95041 Caltagirone, Catania, Italy
| | - Luigi Guarneri
- Infectious Diseases Unit, Enna Hospital, I-94100 Enna, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, I-90127 Palermo, Italy
| | - Antonella Franco
- Infectious Diseases Unit, Siracusa Hospital, I-96100 Siracusa, Italy
| | | | - Maria Di Rosolini
- Infectious and Tropical Diseases Unit, Modica Hospital, I-97015 Ragusa, Italy
| | - Alfredo Pulvirenti
- Bioinformatics Section, Department of Clinical and Experimental Medicine, University of Catania, I-95125 Catania, Italy
| | - Damiano Larnè
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-98124 Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-98124 Messina, Italy
| | - Benedetto Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
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Evaluation of the Potential Risk of Mortality from SARS-CoV-2 Infection in Hospitalized Patients According to the Charlson Comorbidity Index. Healthcare (Basel) 2022; 10:healthcare10020362. [PMID: 35206976 PMCID: PMC8872141 DOI: 10.3390/healthcare10020362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The pandemic of COVID-19 has represented a major threat to global public health in the last century and therefore to identify predictors of mortality among COVID-19 hospitalized patients is widely justified. The aim of this study was to evaluate the possible usefulness of Charlson Comorbidity Index (CCI) as mortality predictor in patients hospitalized because COVID-19. Methods: This study was carried out in Zacatecas, Mexico, and it included 705 hospitalized patients with suspected of SARS-CoV-2 infection. Clinical data were collected, and the CCI score was calculated online using the calculator from the Sociedad Andaluza de Medicina Intensiva y Unidades Coronarias; the result was evaluated as mortality predictor among the patients with COVID-19. Results: 377 patients were positive for SARS-COV-2. Obesity increased the risk of intubation among the study population (odds ratio (OR) = 2.59; 95 CI: 1.36–4.92; p = 0.003). The CCI values were higher in patients who died because of COVID-19 complications than those observed in patients who survived (p < 0.001). Considering a CCI cutoff > 31.69, the area under the ROC curve was 0.75, with a sensitivity and a specificity of 63.6% and 87.7%, respectively. Having a CCI value > 31.69 increased the odds of death by 12.5 times among the study population (95% CI: 7.3–21.4; p < 0.001). Conclusions: The CCI is a suitable tool for the prediction of mortality in patients hospitalized for COVID-19. The presence of comorbidities in hospitalized patients with COVID-19 reflected as CCI > 31.69 increased the risk of death among the study population, so it is important to take precautionary measures in patients due to their condition and their increased vulnerability to SARS-CoV-2 infection.
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Nuevo-Ortega P, Reina-Artacho C, Dominguez-Moreno F, Becerra-Muñoz VM, Ruiz-Del-Fresno L, Estecha-Foncea MA. Prognosis of COVID-19 pneumonia can be early predicted combining Age-adjusted Charlson Comorbidity Index, CRB score and baseline oxygen saturation. Sci Rep 2022; 12:2367. [PMID: 35149742 PMCID: PMC8837655 DOI: 10.1038/s41598-022-06199-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022] Open
Abstract
In potentially severe diseases in general and COVID-19 in particular, it is vital to early identify those patients who are going to progress to severe disease. A recent living systematic review dedicated to predictive models in COVID-19, critically appraises 145 models, 8 of them focused on prediction of severe disease and 23 on mortality. Unfortunately, in all 145 models, they found a risk of bias significant enough to finally "not recommend any for clinical use". Authors suggest concentrating on avoiding biases in sampling and prioritising the study of already identified predictive factors, rather than the identification of new ones that are often dependent on the database. Our objective is to develop a model to predict which patients with COVID-19 pneumonia are at high risk of developing severe illness or dying, using basic and validated clinical tools. We studied a prospective cohort of consecutive patients admitted in a teaching hospital during the "first wave" of the COVID-19 pandemic. Follow-up to discharge from hospital. Multiple logistic regression selecting variables according to clinical and statistical criteria. 404 consecutive patients were evaluated, 392 (97%) completed follow-up. Mean age was 61 years; 59% were men. The median burden of comorbidity was 2 points in the Age-adjusted Charlson Comorbidity Index, CRB was abnormal in 18% of patients and basal oxygen saturation on admission lower than 90% in 18%. A model composed of Age-adjusted Charlson Comorbidity Index, CRB score and basal oxygen saturation can predict unfavorable evolution or death with an area under the ROC curve of 0.85 (95% CI 0.80-0.89), and 0.90 (95% CI 0.86 to 0.94), respectively. Prognosis of COVID-19 pneumonia can be predicted without laboratory tests using two classic clinical tools and a pocket pulse oximeter.
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Affiliation(s)
- Pilar Nuevo-Ortega
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain.
| | - Carmen Reina-Artacho
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Francisco Dominguez-Moreno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Victor Manuel Becerra-Muñoz
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Ruiz-Del-Fresno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Maria Antonia Estecha-Foncea
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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Rosca A, Balcaen T, Lanoix JP, Michaud A, Moyet J, Marcq I, Schmit JL, Bloch F, Deschasse G. Mortality risk and antibiotic use for COVID-19 in hospitalized patients over 80. Biomed Pharmacother 2022; 146:112481. [PMID: 35062049 PMCID: PMC8712262 DOI: 10.1016/j.biopha.2021.112481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Patients over 80 years of age are more prone to develop severe symptoms and die from COVID-19. Antibiotics were massively prescribed in the first days of the pandemic without evidence of super infection. Antibiotics may increase the risk of mortality in cases of viral pneumonia. With age and antibiotic use, the microbiota becomes altered and less protective effect against lethal viral pneumonia. Thus we assessed whether it is safe to prescribe antibiotics for COVID-19 pneumonia to patients over 80 years of age. METHOD We conducted a retrospective monocentric study in a 1240-bed university hospital. Our inclusion criteria were patients aged ≥ 80 years, hospitalized in a COVID-19 unit, with either a positive SARS-CoV-2 RT-PCR from a nasopharyngeal swab or a CT scan within 72 h after or prior to hospitalization in the unit suggestive of infection. RESULTS We included 101 patients who received antibiotics and 48 who did not. The demographics in the two groups were similar. Overall mortality was higher for the group that received antibiotics than for the other group (36.6% vs 14.6%,). According to univariate COX analysis, the risk of mortality was higher (HR = 1.98 [0.926; 4.23]) but non-significantly for the antibiotic group. In multivariate analysis, independent risk factors of mortality were an increased leukocyte count and decreased oxygen saturation (HR = 1.097 [1.022; 1.178] and HR = 0.927 [0.891; 0.964], respectively). CONCLUSION This study raises questions about the interest of antibiotic therapy, its efficacy, and its effect on COVID-19 and encourages further research.
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Affiliation(s)
- Andreea Rosca
- Service of Pharmacy, University Hospital Amiens-Picardie, France.
| | - Thibaut Balcaen
- CHU Amiens, Medical Information Department, F-80000 Amiens, France
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, CHU Amiens-Picardie – Hôpital Nord, Place Victor Pauchet, 80000 Amiens, France,UR 4294 AGIR, Université Picardie Jules Verne, CURS, Rond point Pr Cabrol, 80000 Amiens, France
| | - Audrey Michaud
- Department of Clinical Research, Amiens Picardy University Hospital, 80054 Amiens, France
| | - Julien Moyet
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France
| | - Ingrid Marcq
- Groupe de Recherche sur l'Alcool et les Pharmacodépendances INSERM UMR1247, Centre Universitaire de Recherche en Santé CURS, Université de Picardie Jules Verne, CHU Sud, Amiens, France
| | - Jean-Luc Schmit
- Service de Maladies Infectieuses et Tropicales, CHU Amiens-Picardie – Hôpital Nord, Place Victor Pauchet, 80000 Amiens, France,UR 4294 AGIR, Université Picardie Jules Verne, CURS, Rond point Pr Cabrol, 80000 Amiens, France
| | - Frederic Bloch
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France,Laboratory of Functional Neurosciences EA 4559, University of Picardie – Jules-Verne, Amiens, France
| | - Guillaume Deschasse
- Department of Geriatric medicine, University Hospital Amiens-Picardie, France
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Giacomelli A, Ridolfo AL, Bonazzetti C, Oreni L, Conti F, Pezzati L, Siano M, Bassoli C, Casalini G, Schiuma M, Covizzi A, Passerini M, Piscaglia M, Borgonovo F, Galbiati C, Colombo R, Catena E, Rizzardini G, Milazzo L, Galli M, Brucato A, Antinori S. Mortality among Italians and immigrants with COVID-19 hospitalised in Milan, Italy: data from the Luigi Sacco Hospital registry. BMC Infect Dis 2022; 22:63. [PMID: 35045808 PMCID: PMC8766627 DOI: 10.1186/s12879-022-07051-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19. METHODS This retrospective study of prospectively collected data was conducted at the ASST Fatebenefratelli-Sacco Hospital in Milan, Italy, between 21 February and 31 November 2020. Uni- and multivariable Cox proportional hazard models were used to assess the impact of the patients' origin on the probability of COVID-19-related death. RESULTS The study population consisted of 1,179 COVID-19 patients: 921 Italians (78.1%) and 258 immigrants (21.9%) who came from Latin America (99, 38%), Asia (72, 28%), Africa (50, 19%) and central/eastern Europe (37, 14%). The Italians were significantly older than the immigrants (median age 70 years, interquartile range (IQR) 58-79 vs 51 years, IQR 41-60; p < 0.001), and more frequently had one or more co-morbidities (79.1% vs 53.9%; p < 0.001). Mortality was significantly greater among the Italians than the immigrants as a whole (26.6% vs 12.8%; p < 0.001), and significantly greater among the immigrants from Latin America than among those from Asia, Africa or central/eastern Europe (21% vs 8%, 6% and 8%; p = 0.016). Univariable analysis showed that the risk of COVID-19-related death was lower among the immigrants (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.30-0.63; p < 0.0001], but the risk of Latin American immigrants did not significantly differ from that of the Italians (HR 0.74, 95% CI 0.47-1.15; p = 0.183). However, after adjusting for potential confounders, multivariable analysis showed that there was no difference in the risk of death between the immigrants and the Italians (adjusted HR [aHR] 1.04, 95% CI 0.70-1.55; p = 0.831), but being of Latin American origin was independently associated with an increased risk of death (aHR 1.95, 95% CI 1.17-3.23; p = 0.010). CONCLUSIONS Mortality was lower among the immigrants hospitalised with COVID-19 than among their Italian counterparts, but this difference disappeared after adjusting for confounders. However, the increased risk of death among immigrants of Latin American origin suggests that COVID-19 information and prevention initiatives need to be strengthened in this sub-population.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Anna Lisa Ridolfo
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Cecilia Bonazzetti
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Letizia Oreni
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federico Conti
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Laura Pezzati
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Matteo Siano
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Cinzia Bassoli
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Giacomo Casalini
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Marco Schiuma
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Alice Covizzi
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Matteo Passerini
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Piscaglia
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Fabio Borgonovo
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Claudia Galbiati
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Emanuele Catena
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Giuliano Rizzardini
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
- School of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Milazzo
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Massimo Galli
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Spinello Antinori
- III Infectious Diseases Unit, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy.
- Department of Biomedical and Clinical Sciences DIBIC, Luigi Sacco, Università Di Milano, Milan, Italy.
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Yang Y, Wang L, Liu J, Fu S, Zhou L, Wang Y. Obesity or increased body mass index and the risk of severe outcomes in patients with COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28499. [PMID: 35029905 PMCID: PMC8735775 DOI: 10.1097/md.0000000000028499] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To assess the effect of obesity or a high body mass index (BMI) on the risk of severe outcomes in patients with coronavirus disease 2019 (COVID-19). METHODS Studies on the relationship between BMI or obesity and COVID-19 since December 2019. The odds ratio (OR) and weighted mean difference (WMD) with their 95% confidence intervals (CIs) were used to assess the effect size. RESULTS BMI was significantly increased in COVID-19 patients with severe illness (WMD: 1.18; 95% CI: 0.42-1.93), who were admitted to an intensive care unit (ICU) (WMD: 1.46; 95% CI: 0.96-1.97), who required invasive mechanical ventilation (IMV) (WMD: 2.70, 95% CI: 1.05-4.35) and who died (WMD: 0.91, 95% CI: 0.02-1.80). In Western countries, obesity (BMI of ≥30 kg/m2) increased the risk of hospitalization (OR: 2.08; 95% CI: 1.22-3.54), admission to an ICU (OR: 1.54; 95% CI: 1.29-1.84), need for IMV (OR: 1.73, 95% CI: 1.38-2.17), and mortality (OR: 1.43; 95% CI: 1.17-1.74) of patients with COVID-19. In the Asian population, obesity (BMI of ≥28 kg/m2) increased the risk of severe illness (OR: 3.14; 95% CI: 1.83-5.38). Compared with patients with COVID-19 and a BMI of <25 kg/m2, those with a BMI of 25-30 kg/m2 and ≥30 kg/m2 had a higher risk of need for IMV (OR: 2.19, 95% CI: 1.30-3.69 and OR: 3.04; 95% CI: 1.76-5.28, respectively). The risk of ICU admission in patients with COVID-19 and a BMI of ≥30 kg/m2 was significantly higher than in those with a BMI of 25-30 kg/m2 (OR: 1.49; 95% CI: 1.00-2.21). CONCLUSION As BMI increased, the risks of hospitalization, ICU admission, and need for IMV increased, especially in COVID-19 patients with obesity. ETHICS AND DISSEMINATION This systematic review and meta-analysis does not require an ethics approval as it does not collect any primary data from patients.
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Affiliation(s)
- Yaxian Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Liting Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Jingfang Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Songbo Fu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Liyuan Zhou
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Yan Wang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
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Al-Koofee DA, Omara AM, Abulrazzaq AB, Zaid R. The risk factor for instability metabolic health and severity. MATERIALS TODAY: PROCEEDINGS 2022; 60:1606-1610. [PMID: 34976745 PMCID: PMC8715316 DOI: 10.1016/j.matpr.2021.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coronavirus disease -19 (COVID-19) pandemic has extended from late 2019 and continues to this day. The degree of the disease is related to some factors, including age and comorbidities. Obesity is now more widely considered as a main factor of infection, mainly because it has been shown that individuals who are obese have a more severe course of infection with COVID-19. This review study summarized the relationship between the risk of obesity and COVID-19 and detected a difference in reporting from the period of the first pandemic in China to more recent studies. Obesity is a risk factor for developing signs and symptoms of patients with COVID-19 and this review will benefit clinicians by recognizing the role of obesity when giving COVID-19 diagnosis, follow-up, and treatment programs.
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Gattinoni L, Gattarello S, Steinberg I, Busana M, Palermo P, Lazzari S, Romitti F, Quintel M, Meissner K, Marini JJ, Chiumello D, Camporota L. COVID-19 pneumonia: pathophysiology and management. Eur Respir Rev 2021; 30:30/162/210138. [PMID: 34670808 PMCID: PMC8527244 DOI: 10.1183/16000617.0138-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/08/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. The underlying mechanism is primarily altered lung perfusion. The anatomical prerequisites for PEEP (positive end-expiratory pressure) to work (lung oedema, atelectasis, and therefore recruitability) are lacking. In the high-dependency unit: the disease starts to worsen either because of its natural evolution or additional patient self-inflicted lung injury (P-SILI). Oedema and atelectasis may develop, increasing recruitability. Noninvasive supports are indicated if they result in a reversal of hypoxaemia and a decreased inspiratory effort. Otherwise, mechanical ventilation should be considered to avert P-SILI. In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift from oedema or atelectasis to less reversible structural lung alterations to lung fibrosis. These later characteristics are associated with notable impairment of respiratory mechanics, increased arterial carbon dioxide tension (PaCO2), decreased recruitability and lack of response to PEEP and prone positioning. COVID-19 pneumonia cannot be correctly described, analysed and treated if the time-factor is not taken into accounthttps://bit.ly/3AOKxc4
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Affiliation(s)
- Luciano Gattinoni
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Simone Gattarello
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Irene Steinberg
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Mattia Busana
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Paola Palermo
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefano Lazzari
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Federica Romitti
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Quintel
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.,Dept of Anesthesiology, Intensive Care and Emergency Medicine Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany
| | - Konrad Meissner
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - John J Marini
- Dept of Pulmonary and Critical Care Medicine, University of Minnesota and Regions Hospital, St. Paul, MN, USA
| | - Davide Chiumello
- Dept of Anesthesia and Intensive Care, San Paolo Hospital, University of Milan, Milan, Italy
| | - Luigi Camporota
- Dept of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, UK
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Epidemiological Characteristics of Hospitalized Patients with Moderate versus Severe COVID-19 Infection: A Retrospective Cohort Single Centre Study. Diseases 2021; 10:diseases10010001. [PMID: 35076497 PMCID: PMC8788538 DOI: 10.3390/diseases10010001] [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] [Received: 11/16/2021] [Revised: 12/11/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has a devastating impact worldwide. Recognizing factors that cause its progression is important for the utilization of appropriate resources and improving clinical outcomes. In this study, we aimed to identify the epidemiological and clinical characteristics of patients who were hospitalized with moderate versus severe COVID-19 illness. A single-center, retrospective cohort study was conducted between 3 March and 9 September 2020. Following the CDC guidelines, a two-category variable for COVID-19 severity (moderate versus severe) based on length of stay, need for intensive care or mechanical ventilation and mortality was developed. Data including demographic, clinical characteristics, laboratory parameters, therapeutic interventions and clinical outcomes were assessed using descriptive and inferential analysis. A total of 1002 patients were included, the majority were male (n = 646, 64.5%), Omani citizen (n = 770, 76.8%) and with an average age of 54.2 years. At the bivariate level, patients classified as severe were older (Mean = 55.2, SD = 16) than the moderate patients (Mean = 51.5, SD = 15.8). Diabetes mellitus was the only significant comorbidity potential factor that was more prevalent in severe patients than moderate (n = 321, 46.6%; versus n = 178, 42.4%; p < 0.001). Under the laboratory factors; total white cell count (WBC), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D-dimer and corrected calcium were significant. All selected clinical characteristics and therapeutics were significant. At the multivariate level, under demographic factors, only nationality was significant and no significant comorbidity was identified. Three clinical factors were identified, including; sepsis, Acute respiratory disease syndrome (ARDS) and requirement of non-invasive ventilation (NIV). CRP and steroids were also identified under laboratory and therapeutic factors, respectively. Overall, our study identified only five factors from a total of eighteen proposed due to their significant values (p < 0.05) from the bivariate analysis. There are noticeable differences in levels of COVID-19 severity among nationalities. All the selected clinical and therapeutic factors were significant, implying that they should be a key priority when assessing severity in hospitalized COVID-19 patients. An elevated level of CRP may be a valuable early marker in predicting the progression in non-severe patients with COVID-19. Early recognition and intervention of these factors could ease the management of hospitalized COVID-19 patients and reduce case fatalities as well medical expenditure.
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Stevic R, Colic N, Milenkovic B, Masulovic D. Can chest radiographic findings determine disease severity in Covid-19-positive patients? A single-center study. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211064461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives The purpose of this study was to describe the severity of the radiographic findings of COVID-19 over time and to assess their correlation with the duration of symptoms prior to admission, CT scores, and disease severity. Methods A retrospective analysis of patients with COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR) and CXR who were admitted at the university hospital was performed between March 25 and 30 April 2020. Baseline and serial CXRs were reviewed, along with onset and disease time courses. Correlations between CXR scores and CT scores, durations of symptoms and disease severity were evaluated; and also between regression times and disease severity. Results Of 208 total patients, there were 33 mild (15.9%), 103 moderate (49.5%), and 72 severe-critical (34.6%) cases. The most frequent symptoms were fever, cough, fatigue, and dyspnea. Dyspnea was more frequent in patients with severe and critical disease ( p < 0.001). The duration of symptoms experienced prior to admission was longer in patients with severe and critical disease than in moderate cases ( p < 0.05). Abnormalities on CXR were present on admission in 83.2% patients, with reticulations being the most common finding. CXR scores correlated with duration of symptoms prior to admission and CT scores ( p < 0.05 and p < 0.001, respectively). The median radiographic score of the severe-critical-type group was significantly higher than the moderate type ( p < 0.001) and regression time correlated with disease severity ( p < 0.001). Conclusion Our study showed that despite the limitations, CXR remains a very important tool for diagnosing and managing patients with COVID-19.
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Affiliation(s)
- Ruza Stevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and MRI, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nikola Colic
- Center for Radiology and MRI, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dragan Masulovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and MRI, University Clinical Centre of Serbia, Belgrade, Serbia
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van Son J, Oussaada SM, Şekercan A, Beudel M, Dongelmans DA, van Assen S, Eland IA, Moeniralam HS, Dormans TPJ, van Kalkeren CAJ, Douma RA, Rusch D, Simsek S, Liu L, Kootte RS, Wyers CE, IJzerman RG, van den Bergh JP, Stehouwer CDA, Nieuwdorp M, ter Horst KW, Serlie MJ. Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:747732. [PMID: 34970220 PMCID: PMC8713548 DOI: 10.3389/fendo.2021.747732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19. Design Retrospective, observational cohort study. Methods We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes. Results Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients. Conclusion In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.
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Affiliation(s)
- Jamie van Son
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sabrina M. Oussaada
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Aydin Şekercan
- Department of Surgery, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centre (UMC), Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Assen
- Department of Internal Medicine/Infectious Diseases, Treant Zorggroep, Emmen, Netherlands
| | - Ingo A. Eland
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Hazra S. Moeniralam
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Tom P. J. Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Renée A. Douma
- Department of Internal Medicine, Flevo Hospital, Almere, Netherlands
| | - Daisy Rusch
- Department of Intensive Care Medicine, Martini Hospital, Groningen, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centre (UMC), VU (Vrije Universiteit) University Medical Centre, Amsterdam, Netherlands
| | - Limmie Liu
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ruud S. Kootte
- Department of Acute Internal Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Caroline E. Wyers
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Richard G. IJzerman
- Department of Internal Medicine, Amsterdam University Medical Centre (UMC), Diabetes Centre, Vrije Universiteit (VU) University Medical Centre, Amsterdam, Netherlands
| | - Joop P. van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Kasper W. ter Horst
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Mireille J. Serlie
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
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Reddy S, Ganie MA, Koul PA, Sahar T, Showkat S. Obesity, A Risk Factor for Mortality in SARS CoV-2 Infection: A Narrative Systematic Review. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1736506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractSARS CoV-2 is a β-coronavirus responsible for the current COVID-19 pandemic. Although there is increase severity and mortality described in the elderly population and people with co-morbidities, all age groups are susceptible to COVID-19. Recent data showed that obesity has also emerged as a significant risk factor for COVID-19 mortality. As per the WHO, most of the world's population lives in countries where obesity is highly prevalent. In this context, we aimed to review various studies that showed obesity as an independent risk factor for mortality in SARS CoV-2 infection. We followed the PRISMA guidelines to search for two databases including PubMed and Google Scholar using the key terms “COVID-19, OBES* and MORTALITY,” SARS CoV-2, OBES* and MORTALITY” “COVID-19, OBESITY, and MORTALITY,” SARS Cov-2, OBESITY and MORTALITY,” respectively, up to August 3, 2020. Twelve studies were finally included in this review after applying inclusion and exclusion criteria. All 12 studies included in the review consistently showed that obesity is a risk factor for mortality in patients with SARS CoV-2 infection. These studies have also shown evidence that obesity leads to increased hospitalization, ICU admission, increased need for mechanical ventilation, and poor prognosis among patients with SARS CoV-2 infection. Obesity is an independent risk factor for mortality in patients infected with this novel coronavirus. Appropriate triage, monitoring, and vigilance are required while dealing with individuals with obesity with SARS CoV2 infection, especially in the young obese population. More epidemiological studies need to be done taking BMI also into consideration in COVID-19 patients to find the exact cause of increased severity and mortality and develop appropriate preventive and therapeutic strategies.
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Affiliation(s)
- Sekhar Reddy
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Parvaiz A. Koul
- Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Tajali Sahar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shaista Showkat
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Romero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Glob Health 2021; 6:e006434. [PMID: 34916273 PMCID: PMC8678541 DOI: 10.1136/bmjgh-2021-006434] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Increased age has been reported to be a factor for COVID-19 severe outcomes. However, many studies do not consider the age dependency of comorbidities, which influence the course of disease. Protection strategies often target individuals after a certain age, which may not necessarily be evidence based. The aim of this review was to quantify the isolated effect of age on hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death. METHODS This review was based on an umbrella review, in which Pubmed, Embase and preprint databases were searched on 10 December 2020, for relevant reviews on COVID-19 disease severity. Two independent reviewers evaluated the primary studies using predefined inclusion and exclusion criteria. The results were extracted, and each study was assessed for risk of bias. The isolated effect of age was estimated by meta-analysis, and the quality of evidence was assessed using Grades of Recommendations, Assessment, Development, and Evaluation framework. RESULTS Seventy studies met our inclusion criteria (case mortality: n=14, in-hospital mortality: n=44, hospitalisation: n=16, admission to ICU: n=12, mechanical ventilation: n=7). The risk of in-hospital and case mortality increased per age year by 5.7% and 7.4%, respectively (effect size (ES) in-hospital mortality=1.057, 95% CI 1.038 to 1.054; ES case mortality=1.074, 95% CI 1.061 to 1.087), while the risk of hospitalisation increased by 3.4% per age year (ES=1.034, 95% CI 1.021 to 1.048). No increased risk was observed for ICU admission and intubation by age year. There was no evidence of a specific age threshold at which the risk accelerates considerably. The confidence of evidence was high for mortality and hospitalisation. CONCLUSIONS Our results show a best-possible quantification of the increase in COVID-19 disease severity due to age. Rather than implementing age thresholds, prevention programmes should consider the continuous increase in risk. There is a need for continuous, high-quality research and 'living' reviews to evaluate the evidence throughout the pandemic, as results may change due to varying circumstances.
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Affiliation(s)
- Karla Romero Starke
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Technische Universität Chemnitz, Chemnitz, Sachsen, Germany
| | - David Reissig
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety, Regional Government of South Hesse, Wiesbaden, Germany
| | - Stefanie Schmauder
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), Hamburg, Germany
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Andreas Seidler
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
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Trevisan C, Pedone C, Maggi S, Noale M, Di Bari M, Sojic A, Molinaro S, Giacomelli A, Bianchi F, Tavio M, Rusconi S, Pagani G, Galli M, Prinelli F, Adorni F, Antonelli Incalzi R. Accessibility to SARS-CoV-2 swab test during the Covid-19 pandemic: Did age make the difference? Health Policy 2021; 125:1580-1586. [PMID: 34649753 PMCID: PMC8492891 DOI: 10.1016/j.healthpol.2021.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022]
Abstract
Although COVID-19 affects older people more severely, health policies during the first wave of the pandemic often prioritized younger individuals. We investigated whether age had influenced the access to a diagnostic test for SARS-CoV-2 infection and whether clinical complexity and healthcare resources availability could have impacted such differences. This work included 126,741 Italian participants in the EPICOVID19 web-based survey, who reported having had contacts with known/suspected COVID-19 cases (epidemiological criterion) and/or COVID-19-like signs/symptoms (clinical criterion) from February to June 2020. Data on sociodemographic, medical history and access to SARS-CoV-2 nasopharyngeal swab (NPS) were collected. Logistic regressions estimated the probability of accessing NPS as a function of age and the possible modifying effect of chronic diseases' number and residential areas in such association. A total of 6136 (4.8%) participants had undergone an NPS. Older participants had lower NPS frequencies than the younger ones when reporting epidemiological (14.9% vs. 8.8%) or both epidemiological and clinical criteria (17.5% vs. 13.7%). After adjustment for potential confounders, including epidemiological and clinical criteria, the chance of NPS access decreased by 29% (OR=0.71, 95%CI:0.63-0.79) in older vs. younger individuals. Such disparity was accentuated in areas with greater healthcare resources. In conclusion, in the first wave of the pandemic, age may have affected the access to COVID-19 diagnostic testing, disadvantaging older people.
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Affiliation(s)
- Caterina Trevisan
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; Geriatrics Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Geriatric Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
| | - Claudio Pedone
- Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Stefania Maggi
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy
| | - Marianna Noale
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Viale Peraccini 18, 50139 Florence, Italy
| | - Aleksandra Sojic
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Sabrina Molinaro
- National Research Council-Institute of Clinical Physiology, Epidemiology and Health Research Laboratory, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Fabrizio Bianchi
- National Research Council-Institute of Clinical Physiology, Department of Environmental Epidemiology and Disease registries, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Marcello Tavio
- Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Conca, 71, 60020, Ancona, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Gabriele Pagani
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Federica Prinelli
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Fulvio Adorni
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy
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Ge J, Ma Y, Wu Z, Jin J, Sun X. Anticoagulation treatment for patients with coronavirus disease 2019 (COVID-19) and its clinical effectiveness in 2020: A meta-analysis study. Medicine (Baltimore) 2021; 100:e27861. [PMID: 34964754 PMCID: PMC8615308 DOI: 10.1097/md.0000000000027861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To better inform efforts to treat and control the current outbreak with effective anticoagulant treatment strategies for coronavirus disease 2019 patients. METHODS We searched Cochrane Library, Pubmed, EMBASE, MEDLINE, SCIEXPANDED, Web of Science, Google Scholar, CNKI (Chinese Database), WanFang (Chinese Database), CBM (Chinese Database), VIP (Chinese Database) for studies published from November 1, 2019 to October 1, 2020, and we searched references of identified articles. Studies were reviewed for methodological quality. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Publication bias was assessed using funnel plot. RESULTS Fourteen studies involving 7681 patients were included. We meta-analyzed the bleeding, deep vein thrombosis, and pulmonary embolism risk between no anticoagulation and prophylactic anticoagulation, and found no significant difference. The same trend occurred in the comparison between with and without anticoagulation. However, when compared with no anticoagulation, both prophylactic anticoagulation (odd ratio [OR] = 0.80, 95% confidence interval [CI]: 0.69-0.93) and therapeutic anticoagulation (OR = 0.91, 95% CI: 0.80-1.05) had lower risk of mortality. Furthermore, the risk of overall bleeding among patients with therapeutic anticoagulation was 3.11 times (95% CI: 2.29-4.24) than that of patients with prophylactic anticoagulation. On the contrary, therapeutic anticoagulation had lower risk of deep vein thrombosis than prophylactic anticoagulation (OR = 0.34, 95% CI: 0.19-0.63). CONCLUSIONS Among coronavirus disease 2019 patients, preventive and therapeutic anticoagulation were more beneficial than no anticoagulation for reducing mortality rate. The result will inform healthcare providers and public health policy makers in efforts to treat and control the current outbreak.
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Affiliation(s)
- Jingyi Ge
- Department of Respiratory Medicine, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yingmin Ma
- Department of Respiratory and Infections Medicine, Beijing You An Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhipeng Wu
- Department of Respiratory and Infections Medicine, Beijing You An Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jiawei Jin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, The Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiao Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Are sex disparities in COVID-19 a predictable outcome of failing men's health provision? Nat Rev Urol 2021; 19:47-63. [PMID: 34795426 PMCID: PMC8600906 DOI: 10.1038/s41585-021-00535-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, has taken a catastrophic toll on society, health-care systems and the economy. Notably, COVID-19 has been shown to be associated with a higher mortality rate in men than in women. This disparity is likely to be a consequence of a failure to invest in men’s health, as it has also been established that men have a lower life expectancy and poorer outcomes from non-communicable diseases than women. A variety of biological, social and economic factors have contributed to the sex disparities in mortality from COVID-19. A streamlined men’s health programme — with the urologist as the gatekeeper of men’s health — is needed to help prevent future tragedies of this nature. COVID-19 has been shown to be associated with a higher mortality rate in men than in women. In this Perspectives article, the authors posit that this disparity is due to a failure to invest in men’s health and discuss the biological, social and economic factors that have contributed to the sex disparities in mortality from COVID-19, as well as considering how a streamlined men’s health programme with the urologist in a central role could address these issues.
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Wang L, Yang LM, Pei SF, Chong YZ, Guo Y, Gao XL, Tang QY, Li Y, Feng FM. CRP, SAA, LDH, and DD predict poor prognosis of coronavirus disease (COVID-19): a meta-analysis from 7739 patients. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:679-686. [PMID: 34762008 DOI: 10.1080/00365513.2021.2000635] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Understanding factors associated with disease severity and mortality from coronavirus disease (COVID-19) was critical for effective risk stratification. We aimed to investigate the association between biomarkers of clinical laboratory tests, including serum C-reactive protein (CRP), serum amyloid protein (SAA), lactate dehydrogenase (LDH), and D-dimer (DD) and poor prognosis of COVID-19. We have searched many studies on COVID-19 on PubMed (Medline), Web of Science and Cochrane until 1 March 2021. The interest of this study was original articles reporting on laboratory testing projects and outcome of patients with COVID-19 that comprises mortality, acute respiratory distress syndrome (ARDS), need for care in an intensive care unit (ICU), and severe COVID-19. After synthesizing all data, we performed meta-analysis of random effects, and determined mean difference (MD) and standard mean difference at the biomarker level for different disease severity. A total of 7,739 patients with COVID-19 were pooled from 32 studies. CRP was significantly associated with poor prognosis of COVID-19 (SMD = 0.98, 95% CI = (0.85, 1.11), p < .001). Elevated SAA was associated with an increased composite poor outcome in COVID-19 (SMD = 1.06, 95% CI = (0.39, 1.72), p = .002). An elevated LDH was associated with a composite poor outcome (SMD = 1.18, 95% CI = (1.00, 1.36), p < .001). Patients with a composite poor outcome had a higher DD level (SMD = 0.91, 95% CI = (0.79, 1.02), p < .001). This meta-analysis showed that elevated serum CRP, SAA, LDH, and DD were associated with a poor outcome in COVID-19.
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Affiliation(s)
- Lin Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Lu Ming Yang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Sheng Fei Pei
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Ying Zhi Chong
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yu Guo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xue Lei Gao
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Qin Yan Tang
- School of Life Science, North China University of Science and Technology, Tangshan, China
| | - Yue Li
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Fu Min Feng
- School of Public Health, North China University of Science and Technology, Tangshan, China.,School of Life Science, North China University of Science and Technology, Tangshan, China
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Giacomelli A, Bonazzetti C, Conti F, Pezzati L, Oreni L, Micheli V, Mancon A, Vimercati S, Albrecht M, Passerini M, Cossu MV, Capetti AF, Meraviglia P, Antinori S, Rizzardini G, Galli M, Ridolfo AL. Brief Report: Impact of the COVID-19 Pandemic on Virological Suppression in People Living With HIV Attending a Large Italian HIV Clinic. J Acquir Immune Defic Syndr 2021; 88:299-304. [PMID: 34651605 PMCID: PMC8518206 DOI: 10.1097/qai.0000000000002754] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV suppression rates in people living with HIV (PLWH) attending a large Italian HIV clinic. SETTING The HIV outpatient clinic of the Infectious Diseases Department of Luigi Sacco Hospital, Milan, Italy, which serves more than 5000 PLWH per year. METHODS A before and after quasi-experimental study design was used to make a retrospective assessment of the monthly trend of HIV-RNA determinations of ≥50 among the PLWH attending our clinic, with "before" being the period from January 1, 2016 to February 20, 2020, and "after" being the period from February 21, 2020 to December 31, 2020 (the COVID-19 period). Interrupted time series analysis was used to evaluate any changes in the trend. RESULTS During the study period, 70,349 HIV-RNA viral load determinations were made, and the percentage of HIV-RNA viral load determinations of <50 copies/mL increased from 88.4% in 2016 to 93.2% in 2020 (P < 0.0001). There was a significant monthly trend toward a decrease in the number of HIV-RNA determinations of ≥50 copies/mL before the pandemic (β -0.084; standard error 0.015; P < 0.001), and this did not significantly change after it started (β -0.039, standard error 0.161; P = 0.811). CONCLUSIONS A high prevalence of viral suppression was maintained among the PLWH referring to our clinic, despite the structural barriers raised by the COVID-19 pandemic. The use of simplified methods of delivering care (such as teleconsultations and multiple antiretroviral treatment prescriptions) may have contributed to preserving this continuum.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Federico Conti
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Laura Pezzati
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Letizia Oreni
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli- Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli- Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | - Maria Albrecht
- Pharmaceutical Department, ASST Fatebenefratelli-Sacco, Milan, Italy;
| | - Matteo Passerini
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Amedeo Ferdinando Capetti
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Paola Meraviglia
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Spinello Antinori
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Giuliano Rizzardini
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
- School of Medicine, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Massimo Galli
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Anna Lisa Ridolfo
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Current malaria infection, previous malaria exposure, and clinical profiles and outcomes of COVID-19 in a setting of high malaria transmission: an exploratory cohort study in Uganda. LANCET MICROBE 2021; 3:e62-e71. [PMID: 34723228 PMCID: PMC8545833 DOI: 10.1016/s2666-5247(21)00240-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The potential effects of SARS-CoV-2 and Plasmodium falciparum co-infection on host susceptibility and pathogenesis remain unknown. We aimed to establish the prevalence of malaria and describe the clinical characteristics of SARS-CoV-2 and P falciparum co-infection in a high-burden malaria setting. Methods This was an exploratory prospective, cohort study of patients with COVID-19 who were admitted to hospital in Uganda. Patients of all ages with a PCR-confirmed diagnosis of SARS-CoV-2 infection who had provided informed consent or assent were consecutively enrolled from treatment centres in eight hospitals across the country and followed up until discharge or death. Clinical assessments and blood sampling were done at admission for all patients. Malaria diagnosis in all patients was done by rapid diagnostic tests, microscopy, and molecular methods. Previous P falciparum exposure was determined with serological responses to a panel of P falciparum antigens assessed using a multiplex bead assay. Additional evaluations included complete blood count, markers of inflammation, and serum biochemistries. The main outcome was overall prevalence of malaria infection and malaria prevalence by age (including age categories of 0–20 years, 21–40 years, 41–60 years, and >60 years). The frequency of symptoms was compared between patients with COVID-19 with P falciparum infection versus those without P falciparum infection. The frequency of comorbidities and COVID-19 clinical severity and outcomes was compared between patients with low previous exposure to P falciparum versus those with high previous exposure to P falciparum. The effect of previous exposure to P falciparum on COVID-19 clinical severity and outcomes was also assessed among patients with and those without comorbidities. Findings Of 600 people with PCR-confirmed SARS-CoV-2 infection enrolled from April 15, to Oct 30, 2020, 597 (>99%) had complete information and were included in our analyses. The majority (502 [84%] of 597) were male individuals with a median age of 36 years (IQR 28–47). Overall prevalence of P falciparum infection was 12% (95% CI 9·4–14·6; 70 of 597 participants), with highest prevalence in the age groups of 0–20 years (22%, 8·7–44·8; five of 23 patients) and older than 60 years (20%, 10·2–34·1; nine of 46 patients). Confusion (four [6%] of 70 patients vs eight [2%] of 527 patients; p=0·040) and vomiting (four [6%] of 70 patients vs five [1%] of 527 patients; p=0·014] were more frequent among patients with P falciparum infection than those without. Patients with low versus those with high previous P falciparum exposure had a increased frequency of severe or critical COVID-19 clinical presentation (16 [30%] of 53 patients vs three [5%] of 56 patients; p=0·0010) and a higher burden of comorbidities, including diabetes (12 [23%] of 53 patients vs two [4%] of 56 patients; p=0·0010) and heart disease (seven [13%] of 53 patients vs zero [0%] of 56 patients; p=0·0030). Among patients with no comorbidities, those with low previous P falciparum exposure still had a higher proportion of cases of severe or critical COVID-19 than did those with high P falciparum exposure (six [18%] of 33 patients vs one [2%] of 49 patients; p=0·015). Multivariate analysis showed higher odds of unfavourable outcomes in patients who were older than 60 years (adjusted OR 8·7, 95% CI 1·0–75·5; p=0·049). Interpretation Although patients with COVID-19 with P falciparum co-infection had a higher frequency of confusion and vomiting, co-infection did not seem deleterious. The association between low previous malaria exposure and severe or critical COVID-19 and other adverse outcomes will require further study. These preliminary descriptive observations highlight the importance of understanding the potential clinical and therapeutic implications of overlapping co-infections. Funding Malaria Consortium (USA).
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71
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Mahamat-Saleh Y, Fiolet T, Rebeaud ME, Mulot M, Guihur A, El Fatouhi D, Laouali N, Peiffer-Smadja N, Aune D, Severi G. Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies. BMJ Open 2021; 11:e052777. [PMID: 34697120 PMCID: PMC8557249 DOI: 10.1136/bmjopen-2021-052777] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. METHODS Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. CONCLUSION Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER CRD42020218115.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Thibault Fiolet
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Douae El Fatouhi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nathan Peiffer-Smadja
- Universite de Paris, IAME, INSERM, Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
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Bruneau L, Lenclume V, Maillot A, Rousseau A, Lagrange-Xélot M, Allou N, Gérardin P. Exhaustive assessment of Reunion Island inpatients with COVID-19 during the first wave. Infect Dis Now 2021; 52:112-116. [PMID: 34706299 PMCID: PMC8542257 DOI: 10.1016/j.idnow.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/18/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022]
Affiliation(s)
- L Bruneau
- National institute of Health and Medical Research (INSERM) Center for Clinical Investigation (CIC) 1410 Clinical Epidemiology, Centre Hospitalier Universitaire, Saint Pierre, Reunion Island, France; Department of Public health and Research Support, Methodological Support and Biostatistics Unit, Centre Hospitalier Universitaire, Saint Denis, Reunion Island, France.
| | - V Lenclume
- National institute of Health and Medical Research (INSERM) Center for Clinical Investigation (CIC) 1410 Clinical Epidemiology, Centre Hospitalier Universitaire, Saint Pierre, Reunion Island, France.
| | - A Maillot
- National institute of Health and Medical Research (INSERM) Center for Clinical Investigation (CIC) 1410 Clinical Epidemiology, Centre Hospitalier Universitaire, Saint Pierre, Reunion Island, France.
| | - A Rousseau
- Department of Public health and Research Support, Methodological Support and Biostatistics Unit, Centre Hospitalier Universitaire, Saint Denis, Reunion Island, France.
| | - M Lagrange-Xélot
- Department of Infectious Diseases, Centre Hospitalier Universitaire, Saint Denis, Reunion Island, France.
| | - N Allou
- Intensive Care Unit, Centre Hospitalier Universitaire, Saint Denis, Reunion Island, France.
| | - P Gérardin
- National institute of Health and Medical Research (INSERM) Center for Clinical Investigation (CIC) 1410 Clinical Epidemiology, Centre Hospitalier Universitaire, Saint Pierre, Reunion Island, France.
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YAKAR MN, ERGAN B, ERGÜN B, KÜÇÜK M, CANTÜRK A, ERGON MC, GEZER NS, YAKA E, CÖMERT B, GÖKMEN AN. Clinical characteristics and risk factors for 28-day mortality in critically ill patients with COVID-19: a retrospective cohort study. Turk J Med Sci 2021; 51:2285-2295. [PMID: 34461684 PMCID: PMC8742492 DOI: 10.3906/sag-2104-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background To date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality. Materials and methods In this retrospective cohort study, critically ill patients (≥ 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study. Results A total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66–81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96–58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55–14.46, p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84–51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality. Conclusion Early detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.
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Affiliation(s)
- Mehmet Nuri YAKAR
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Begüm ERGAN
- Department of Chest Diseases, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Bişar ERGÜN
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Murat KÜÇÜK
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Ali CANTÜRK
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Mahmut Cem ERGON
- Department of Medical Microbiology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Naciye Sinem GEZER
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Erdem YAKA
- Department of Neurology, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Bilgin CÖMERT
- Department of Internal Medicine and Critical Care, Medicana International Hospital, İzmirTurkey
| | - Ali Necati GÖKMEN
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
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Gershengorn HB. Editorial: Critical care outcomes in the context of a pandemic. Curr Opin Crit Care 2021; 27:497-499. [PMID: 34334625 DOI: 10.1097/mcc.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Albert Einstein College of Medicine, New York, New York, USA
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Xu J, Xiao W, Shi L, Wang Y, Yang H. Is Cancer an Independent Risk Factor for Fatal Outcomes of Coronavirus Disease 2019 Patients? Arch Med Res 2021; 52:755-760. [PMID: 34074544 PMCID: PMC8142843 DOI: 10.1016/j.arcmed.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by a novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought new challenges for global health systems. OBJECTIVE The objective of this study was to investigate whether pre-diagnosed cancer was an independent risk factor for fatal outcomes of coronavirus disease 2019 (COVID-19) patients. METHOD A comprehensive search was conducted in major databases of PubMed, Web of Science, and EMBASE to identify all published full-text studies as of January 20, 2021. Inter-study heterogeneity was assessed using Cochran's Q-statistic and I² test. A meta-analysis of random- or fixed-effects model was used to estimate the effect size. Publication bias, sensitivity analysis and subgroup analysis were also carried out. RESULTS The confounders-adjusted pooled effects (pooled odds ratio [OR] = 1.47, 95% confidence interval [CI]: 1.31-1.65; pooled hazard ratio [HR] = 1.37, 95% CI: 1.21-1.54) indicated that COVID-19 patients with pre-diagnosed cancer were more likely to progress to fatal outcomes based on 96 articles with 6,518,992 COVID-19 patients. Further subgroup analyses by age, sample size, the proportion of males, region, study design and quality rating exhibited consistent findings with the overall effect size. CONCLUSION Our analysis provides the objective findings based on the adjusted effect estimates that pre-diagnosed cancer is an independent risk factor for fatal outcome of COVID-19 patients. During the current COVID-19 pandemic, health workers should pay particular attention to cancer care for cancer patients and should prioritize cancer patients for vaccination.
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Affiliation(s)
- Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wenwei Xiao
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Li Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China,Address reprint requests to: Haiyan Yang, Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou 450001, China; Phone: (+86) (371) 67781248; FAX: (+86) (371) 67781248
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76
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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77
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Epidemiologic and Clinic Characteristics of the First Wave of the COVID-19 Pandemic in Hospitalized Patients from Galați County. J Clin Med 2021; 10:jcm10184210. [PMID: 34575321 PMCID: PMC8467201 DOI: 10.3390/jcm10184210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The first cases of COVID-19 were reported in Wuhan Province, in China, in December 2019, spreading rapidly around the world. The World Health Organization (WHO) declared this pandemic at the beginning of March 2020 and, at the same time, the first patient in Galați County was confirmed. Both the global and the regional epidemiological evolutions have taken place with variations in incidence, which have been graphically recorded in several “waves”. We conducted a retrospective study on cases of COVID-19 infection, hospitalized between March and June 2020 in an infectious diseases clinic from Galati, in the south-east of Romania. The present paper describes the “first-wave” regional epidemiological and clinical-biological features and the evolution of the COVID-19 pandemic. A poor outcome was related to late presentation to hospital, old age, and over six comorbid conditions including Alzheimer’s disease. The high death rate among people from long-term care institutions is the consequence of the cumulative risk factors associated with immune senescence and inflammation, while COVID-19 is more likely a contributing factor to lower life expectancy.
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78
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Fjelltveit EB, Cox RJ, Kittang BR, Blomberg B, Buanes EA, Langeland N, Mohn KGI. Lower antibiotic prescription rates in hospitalized COVID-19 patients than influenza patients, a prospective study. Infect Dis (Lond) 2021; 54:79-89. [PMID: 34525895 DOI: 10.1080/23744235.2021.1974539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND COVID-19 patients are extensively treated with antibiotics despite few bacterial complications. We aimed to study antibiotic use in hospitalized COVID-19 patients compared to influenza patients in two consecutive years. Furthermore, we investigated changes in antibiotic use from the first to second pandemic wave. METHODS This prospective study included both patients from two referral hospitals in Bergen, Norway, admitted with influenza (n = 215) during the 2018/2019 epidemic and with COVID-19 (n = 82) during spring/summer 2020, and national data on registered Norwegian COVID-19 hospital admissions from March 2020 to January 2021 (n = 2300). Patient characteristics were compared, and logistic regression analysis was used to identify risk factors for antibiotic use. RESULTS National and local COVID-19 patients received significantly less antibiotics (53% and 49%) than influenza patients (69%, p < .001). Early antibiotics contributed to >90% of antibiotic prescriptions in the two local hospitals, and >70% of prescriptions nationally. When adjusted for age, comorbidities, symptom duration, chest X-ray infiltrates and oxygen treatment, local COVID-19 patients still had significantly lower odds of antibiotic prescription than influenza patients (aOR 0.21, 95%CI 0.09-0.50). At the national level, we observed a significant reduction in antibiotic prescription rates in the second pandemic wave compared to the first (aOR 0.35, 95% CI 0.29-0.43). CONCLUSION Fewer COVID-19 patients received antibiotics compared to influenza patients admitted to the two local hospitals one year earlier. The antibiotic prescription rate was lower during the second pandemic wave, possibly due to increased clinical experience and published evidence refuting the efficacy of antibiotics in treating COVID-19 pneumonia.
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Affiliation(s)
- Elisabeth B Fjelltveit
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Eirik A Buanes
- Norwegian Intensive Care and Pandemic Registry (NIPaR), Haukeland University Hospital, Bergen, Norway.,Helse Bergen Health Trust, Haukeland University Hospital, Bergen, Norway
| | | | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kristin G-I Mohn
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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79
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Alsagaff MY, Mulia EPB, Maghfirah I, Luke K, Nugraha D, Rachmi DA, Septianda I, A'yun MQ. Association of calcium channel blocker use with clinical outcome of COVID-19: A meta-analysis. Diabetes Metab Syndr 2021; 15:102210. [PMID: 34298269 PMCID: PMC8282943 DOI: 10.1016/j.dsx.2021.102210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
AIMS This meta-analysis aims to analyze the association of calcium channel blocker (CCB) use with COVID-19 clinical outcomes. METHODS PubMed, ProQuest, Science Direct, Scopus, and medRxiv databases were searched systematically in a limited period. The primary outcome was mortality. RESULTS A total of 119,298 patients from 31 eligible studies were included. Pooled analysis of the random-effect model revealed CCB was not associated with reduced mortality (OR = 1.21 [95%CI: 0.98-1.49], p = 0.08). Interestingly, subgroup analysis in hypertensive patients revealed significantly reduced mortality (OR = 0.69 [95%CI: 0.52-0.91], p = 0.009). CONCLUSION CCB usage was not associated with the outcome of COVID-19. However, CCB was associated with a decreased mortality rate in hypertensive COVID-19 patients.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia; Universitas Airlangga Hospital, Surabaya, Indonesia.
| | - Eka Prasetya Budi Mulia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Irma Maghfirah
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David Nugraha
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dita Aulia Rachmi
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Imanita Septianda
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Maya Qurota A'yun
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
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80
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Pitre T, Jones A, Su J, Helmeczi W, Xu G, Lee C, Shamsuddin A, Mir A, MacGregor S, Duong M, Ho T, Beauchamp MK, Costa AP, Kruisselbrink R. Inflammatory biomarkers as independent prognosticators of 28-day mortality for COVID-19 patients admitted to general medicine or ICU wards: a retrospective cohort study. Intern Emerg Med 2021; 16:1573-1582. [PMID: 33496923 PMCID: PMC7836340 DOI: 10.1007/s11739-021-02637-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/08/2023]
Abstract
Inflammatory biomarkers may be associated with disease severity and increased mortality in COVID-19 patients but have not been studied in North American populations. We sought to determine whether a set of commonly ordered inflammatory biomarkers can predict 28-day mortality. We analyzed a multi-centered (four) COVID-19 registry cohort from March 4th to December 7th, 2020. This cohort included COVID-19-positive patients admitted to medical wards or intensive care units. Patients presenting to the emergency department for COVID-19 symptoms and then subsequently discharged were also included. We performed Cox-regression analysis to measure whether commonly used biomarkers were associated with an increased 28-day mortality. Of 336 COVID-19-positive patients, 267 required hospital admission, and 69 were seen in the emergency room and discharged. The median age was 63 years (IQR 80-50) and the female-to-male ratio was 49:51. Derivation of internally validated cut-offs suggested that C-reactive protein ≥ 78.4 mg/L, neutrophil-to-lymphocyte ratio ≥ 6.1, lymphocyte-to-white blood cell ratio < 0.127, and a modified Glasgow prognostic score equal to 2 vs. 1 or 0 were associated with the highest increased risk of 28-day mortality. We provide early estimates of cut-off values for inflammatory biomarkers and indices measured at the time of admission that may be useful to clinicians for predicting 28-day mortality in North American COVID-19 patients.
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Affiliation(s)
- Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Canada.
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Aaron Jones
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Johnny Su
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Wryan Helmeczi
- Department of Internal Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Grace Xu
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Catherine Lee
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adib Shamsuddin
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adhora Mir
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sarah MacGregor
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Terence Ho
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Marla K Beauchamp
- Department of Medicine, McMaster University, Hamilton, Canada
- School of rehabiliation science, McMaster University, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rebecca Kruisselbrink
- Department of Medicine, McMaster University, Hamilton, Canada
- Waterloo regional campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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81
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Treskova-Schwarzbach M, Haas L, Reda S, Pilic A, Borodova A, Karimi K, Koch J, Nygren T, Scholz S, Schönfeld V, Vygen-Bonnet S, Wichmann O, Harder T. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med 2021; 19:212. [PMID: 34446016 PMCID: PMC8390115 DOI: 10.1186/s12916-021-02058-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. METHODS Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. RESULTS In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2-2.0 (CI range 1.1-2.8)), obesity (OR range 1.5-1.75 (CI range 1.1-2.3)), heart failure (HR range 1.3-3.3 (CI range 0.9-8.2)), COPD (HR range 1.12-2.2 (CI range 1.1-3.2)) and dementia (HR range 1.4-7.7 (CI range 1.2-39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2-5.9 (CI range 0.9-27.7)) and active cancer (OR range 1.6-4.7 (CI range 0.5-14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3-2.2)). GRADE certainty was moderate to high for most associations. CONCLUSION Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
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Affiliation(s)
| | - Laura Haas
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sarah Reda
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Antonia Pilic
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Anna Borodova
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Kasra Karimi
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Judith Koch
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Teresa Nygren
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Stefan Scholz
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sabine Vygen-Bonnet
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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82
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Zhu Z, Wang M, Lin W, Cai Q, Zhang L, Chen D, Liu F, Xiong X, Chu J, Peng J, Chen K. Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1071-1100. [PMID: 34405950 PMCID: PMC8427124 DOI: 10.1002/iid3.471] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022]
Abstract
Aims To explore the correlation between cardiac‐related comorbidities, cardiac biomarkers, acute myocardial injury, and severity level, outcomes in COVID‐19 patients. Method Pubmed, Web of Science, Embase, CNKI, VIP, Wanfang, Cochrane Library databases, medRxiv, and Sinomed were reviewed systemically. Various types of clinical research reporting cardiac‐related comorbidities, cardiac biomarkers including lactate dehydrogenase (LDH), troponin I (TnI), high sensitivity troponin I (hs‐TnI), creatine kinase (CK), creatine kinase–MB (CK‐MB), myoglobin (Myo), N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) and acute cardiac injury grouped by severity of COVID‐19 were included. Outcome measures were events and total sample size for comorbidities, acute cardiac injury, and laboratory parameters of these biomarkers. The study was performed with Stata version 15.1. Results Seventy studies, with a total of 15,354 cases were identified. The results showed that COVID‐19's severity was related to cardiovascular disease. Similar odds ratios (ORs) were achieved in hypertension except for severe versus critical group (OR = 1.406; 95% CI, 0.942–2.097; p = .095). The relative risk (RR) of acute cardiac injury is 7.01 (95% CI, 5.64–8.71) in non‐survivor cases. When compared with the different severity of cardiac biomarkers, the pool OR of CK, CK‐MB, TnI, Myo and LDH were 2.683 (95% CI, 0.83–8.671; p = .106; I2 = 0%), 2.263 (95% CI, 0.939–5.457; p = .069), 1.242 (95% CI, 0.628–2.457; p = .534), 1.756 (95% CI, 0.608–5.071; p = .298; I2 = 42.3%), 1.387 (95% CI, 0.707–2.721; p = .341; I2 = 0%) in the critical versus severe group, whose trends were not similar to other groups. The standard mean differences (SMD) of CK and TnI in the critical versus severe group were 0.09 (95% CI, −0.33 to 0.50; p = .685; I2 = 65.2%), 0.478 (95% CI, −0.183 to 1.138; p = .156; I2 = 76.7%), which means no difference was observed in the serum level of these indicators. Conclusion Most of the findings clearly indicate that hypertension, cardiovascular disease, acute cardiac injury, and related laboratory indicators are associated with the severity of COVID‐19. What is now needed are cross‐national prospectively designed observational or clinical trials that will help improve the certainty of the available evidence and treatment decisions for patients.
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Affiliation(s)
- Zhengchuan Zhu
- Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Lin
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Qiaoyan Cai
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Ling Zhang
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Daxin Chen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Fei Liu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiaoman Xiong
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jianfeng Chu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jun Peng
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Keji Chen
- Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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83
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Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis. BMC Public Health 2021; 21:1554. [PMID: 34399729 PMCID: PMC8366155 DOI: 10.1186/s12889-021-11579-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Smoking impairs lung immune function and damages upper airways, increasing risks of contracting and severity of infectious diseases. This paper quantifies the association between smoking and COVID-19 disease progression. METHODS We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used random effects meta-analysis, meta-regression and locally weighted regression and smoothing to examine relationships in the data. RESULTS We identified 46 peer-reviewed papers with a total of 22,939 COVID-19 patients, 5421 (23.6%) experienced disease progression and 2914 (12.7%) with a history of smoking (current and former smokers). Among those with a history of smoking, 33.5% experienced disease progression, compared with 21.9% of non-smokers. The meta-analysis confirmed an association between ever smoking and COVID-19 progression (OR 1.59, 95% CI 1.33-1.89, p = 0.001). Ever smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.02-1.39, p = 0.003). We found no significant difference (p = 0.864) between the effects of ever smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression higher among younger adults (p = 0.001), with the effect most pronounced among younger adults under about 45 years old. CONCLUSIONS Smoking is an independent risk for having progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.
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Affiliation(s)
- Roengrudee Patanavanich
- Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143-1390, USA
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143-1390, USA.
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84
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Phan F, Boussouar S, Lucidarme O, Zarai M, Salem JE, Kachenoura N, Bouazizi K, Charpentier E, Niati Y, Bekkaoui H, Amoura Z, Mathian A, Benveniste O, Cacoub P, Allenbach Y, Saadoun D, Lacorte JM, Fourati S, Laroche S, Hartemann A, Bourron O, Andreelli F, Redheuil A. Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients. Cardiovasc Diabetol 2021; 20:165. [PMID: 34384426 PMCID: PMC8358546 DOI: 10.1186/s12933-021-01327-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. METHODS Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. RESULTS Of the enrolled patients (median age 66 years [IQR: 59-74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24-31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). CONCLUSIONS Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.
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Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Olivier Lucidarme
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Mohamed Zarai
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, CIC-1901, INSERM, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Khaoula Bouazizi
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Etienne Charpentier
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France.,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Yasmine Niati
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Hasnae Bekkaoui
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Patrice Cacoub
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Yves Allenbach
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Saadoun
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Marc Lacorte
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Salma Fourati
- Department of Endocrine and Oncologic Biochemistry, Inserm, UMR_S 1166, Research Institute of Cardiovascular Disease, Metabolism and Nutrition, Paris, France
| | - Suzanne Laroche
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France
| | - Agnes Hartemann
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Fabrizio Andreelli
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.,Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France
| | - Alban Redheuil
- Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France. .,Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France. .,Service d'imagerie Spécialisée et d'urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.
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85
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Cai Z, Yang Y, Zhang J. Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis. BMC Public Health 2021; 21:1505. [PMID: 34348687 PMCID: PMC8334342 DOI: 10.1186/s12889-021-11546-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/23/2021] [Indexed: 02/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to global research to predict those who are at greatest risk of developing severe disease and mortality. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Meta-regression analyses were conducted to estimate regression coefficients. Results Forty-six studies involving 625,153 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection. (OR 2.73, 95% CI 1.53–4.87; I2 = 96.8%), hospitalization (OR 1.72, 95% CI 1.55–1.92; I2 = 47.4%), clinically severe disease (OR 3.81, 95% CI 1.97–7.35; I2 = 57.4%), mechanical ventilation (OR 1.66, 95% CI 1.42–1.94; I2 = 41.3%), intensive care unit (ICU) admission (OR 2.25, 95% CI 1.55–3.27; I2 = 71.5%), and mortality (OR 1.61, 95% CI 1.29–2.01; I2 = 83.1%). Conclusion Patients with obesity may have a greater risk of infection, hospitalization, clinically severe disease, mechanical ventilation, ICU admission, and mortality due to COVID-19. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11546-6.
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Affiliation(s)
- Zixin Cai
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yan Yang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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86
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Kallet RH. 2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic. Respir Care 2021; 66:1341-1362. [PMID: 33972456 PMCID: PMC9994377 DOI: 10.4187/respcare.09257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic respiratory failure it caused did not appear to fit conveniently or consistently into our classification of ARDS. This not only re-ignited a half-century's long simmering debate over taxonomy, but also fueled similar debates over how PEEP and lung-protective ventilation should be titrated, as well as the appropriate role of noninvasive ventilation in ARDS. COVID-19 ignited other debates on emerging concepts such as ARDS phenotypes and patient self-inflicted lung injury from vigorous spontaneous breathing. Over a year later, these early perplexities have receded into the background without having been reviewed or resolved. With a full year of evidence having been published, this narrative review systematically analyzes whether COVID-19-associated respiratory failure is essentially ARDS, with perhaps a somewhat different course of presentation. This includes a review of the severity of hypoxemia and derangements in pulmonary mechanics, PEEP requirements, recruitment potential, ability to achieve lung-protective ventilation goals, duration of mechanical ventilation, associated mortality, and response to noninvasive ventilation. This paper also reviews the concepts of ARDS phenotypes and patient self-inflicted lung injury as these are crucial to understanding the contentious debate over the nature and management of COVID-19.
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Affiliation(s)
- Richard H Kallet
- Department of Anesthesia and Perioperative Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
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87
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Katzenschlager S, Zimmer AJ, Gottschalk C, Grafeneder J, Schmitz S, Kraker S, Ganslmeier M, Muth A, Seitel A, Maier-Hein L, Benedetti A, Larmann J, Weigand MA, McGrath S, Denkinger CM. Can we predict the severe course of COVID-19 - a systematic review and meta-analysis of indicators of clinical outcome? PLoS One 2021; 16:e0255154. [PMID: 34324560 PMCID: PMC8321230 DOI: 10.1371/journal.pone.0255154] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19. METHODS This systematic review was registered at PROSPERO under CRD42020177154. We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies. RESULTS Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10 mg/L, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49 U/L, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88 pg/mL, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 to 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73). DISCUSSION This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors that predict severe COVID-19 outcomes and will inform clinical scores to support early decision-making.
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Affiliation(s)
| | - Alexandra J. Zimmer
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Claudius Gottschalk
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stephani Schmitz
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Sara Kraker
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marlene Ganslmeier
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Amelie Muth
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Benedetti
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sean McGrath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Claudia M. Denkinger
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg, Heidelberg, Germany
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88
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Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis. Shock 2021; 56:215-228. [PMID: 33555845 DOI: 10.1097/shk.0000000000001738] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The response to glucocorticoids treatment may be different between coronavirus disease 2019 (Covid-19) and severe acute respiratory syndrome (SARS). METHODS In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, International Clinical Trials Registry Platform from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively. RESULTS Ten trials and 71 observational studies, with a total of 45,935 patients, were identified. Glucocorticoids treatment was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88; 95% confidence interval, 0.82-0.94; I2 = 26%) and SARS (0.48; 0.29-0.79; 10%), based on high-quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89; 0.82-0.98; 0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids, taking dexamethasone or methylprednisolone, and with the increased inflammatory state; but for SARS, lower mortality was observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking methylprednisolone or prednisolone. CONCLUSIONS Glucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity; however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses, and use timing of glucocorticoids.
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89
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Hariyanto TI, Lugito NPH, Yanto TA, Siregar JI, Kurniawan A. Insulin therapy and outcome from coronavirus disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and Meta-Regression. Endocr Metab Immune Disord Drug Targets 2021; 22:481-489. [PMID: 34250875 DOI: 10.2174/1871530321666210709164925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Currently, the relationship between insulin therapy and COVID-19 outcome is not yet established. Our study aims to evaluate the possible association between insulin and the poor composite development of COVID-19. METHODS We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 12th, 2020. All articles published on COVID-19 and insulin were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. RESULTS Our pooled analysis showed that insulin use was associated with poor composite development of COVID-19 [OR 2.06 (95% CI 1.70 - 2.48), p < 0.00001, I2 = 83%, random-effect modelling], and its subgroup which comprised of risk of COVID-19 [OR 1.70 (95% CI 1.40 - 2.08), p < 0.00001, I2 = 34%, random-effect modelling], severe COVID-19 [OR 2.30 (95% CI 1.60 - 3.30), p < 0.00001, I2 = 88%, random-effect modelling], and mortality [OR 2.14 (95% CI 1.47 - 3.10), p < 0.0001, I2 = 85%, random-effect modelling]. Meta-regression showed that the association was influenced by age (p = 0.008), but not by diabetes (p = 0.423), and cardiovascular disease (p = 0.086). CONCLUSION Physicians should be more aware and take extra precautions with diabetes patients who use insulin therapy.
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Affiliation(s)
- Timotius Ivan Hariyanto
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Nata Pratama Hardjo Lugito
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Theo Audi Yanto
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Jeremia Immanuel Siregar
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
| | - Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Indonesia
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90
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Mahat RK, Panda S, Rathore V, Swain S, Yadav L, Sah SP. The dynamics of inflammatory markers in coronavirus disease-2019 (COVID-19) patients: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100727. [PMID: 33778183 PMCID: PMC7979575 DOI: 10.1016/j.cegh.2021.100727] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) is a global pandemic and high mortality rate among severe or critical COVID-19 is linked with SARS-CoV-2 infection-induced hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. This paper attempts to conduct a systematic review and meta-analysis of published articles, to evaluate the association of inflammatory parameters with the severity and mortality in COVID-19 patients. METHODS A comprehensive systematic literature search of medical electronic databases including Pubmed/Medline, Europe PMC, and Google Scholar was performed for relevant data published from January 1, 2020 to June 26, 2020. Observational studies reporting clear extractable data on inflammatory parameters in laboratory-confirmed COVID-19 patients were included. Screening of articles, data extraction and quality assessment were carried out by two authors independently. Standardized mean difference (SMD)/mean difference (MD/WMD) and 95% confidence intervals (CIs) were calculated using random or fixed-effects models. RESULTS A total of 83 studies were included in the meta-analysis. Of which, 54 studies were grouped by severity, 25 studies were grouped by mortality, and 04 studies were grouped by both severity and mortality. Random effect model results demonstrated that patients with severe COVID-19 group had significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA) and neutrophil-to-lymphocyte ratio (NLR) compared to those in the non-severe group. Similarly, the fixed-effect model revealed significant higher ferritin level in the severe group when compared with the non-severe group. Furthermore, the random effect model results demonstrated that the non-survivor group had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR when compared with the survivor group. CONCLUSION In conclusion, the measurement of these inflammatory parameters could help the physicians to rapidly identify severe COVID-19 patients, hence facilitating the early initiation of effective treatment. PROSPERO REGISTRATION NUMBER CRD42020193169.
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Affiliation(s)
- Roshan Kumar Mahat
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Suchismita Panda
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Vedika Rathore
- Department of Biochemistry, Shyam Shah Medical College, Rewa, Madhya Pradesh, 486001, India
| | - Sharmistha Swain
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Lalendra Yadav
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, 244001, India
| | - Sumesh Prasad Sah
- Department of Biochemistry, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, 251203, India
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91
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Chauhan NK, Shadrach BJ, Garg MK, Bhatia P, Bhardwaj P, Gupta MK, Dutt N, Jalandra RN, Garg P, Nag VL, Sharma P, Bohra GK, Kumar D, Elhence PA, Banerjee M, Mathur D, Purohit AH, Gadepalli R, Sureka B, Misra S. Predictors of Clinical Outcomes in Adult COVID-19 Patients Admitted to a Tertiary Care Hospital in India: an analytical cross-sectional study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021024. [PMID: 34212921 PMCID: PMC8343753 DOI: 10.23750/abm.v92i3.10630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The outbreak ofsevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted inexponential rise in the number of patients getting hospitalised with corona virus disease 2019 (COVID-19). There is a paucity of data from South East Asian Region related to the predictors of clinical outcomes in these patients. This formed the basis of conducting our study. METHODS This was an analytical cross-sectional study. Demographic, clinical, radiological and laboratory data of 125 patients was collected on admission. The study outcome was death or discharge after recovery. For univariate analysis, unpaired t-test, Chi-square and Fisher's Exact test were used. Receiver operating characteristic (ROC) curves were plotted for Sequential Organ Failure Assessment (SOFA) score and few laboratory parameters. Logistic regression was applied for multivariate analysis. RESULTS Elderly age, ischemic heart disease and smoking were significantly associated with mortality. Elevated levels of D-dimer and lactate dehydrogenase (LDH) and reduced lymphocyte counts were the predictors of mortality. The ROCs for SOFA score curve showed a cut-off value ≥ 3.5 (sensitivity- 91.7% and specificity- 87.5%), for IL-6 the cut-off value was ≥ 37.9 (sensitivity- 96% and specificity- 78%) and for lymphocyte counts, a cut off was calculated to be less than and equal to 1.46 x 109per litre (sensitivity-75.2%and specificity- 83.3%). CONCLUSION Old age, smoking history, ischemic heart disease and laboratory parameters including elevated D-dimer, raised LDH and low lymphocyte counts at baseline are associated with COVID-19 mortality. A higher SOFA score at admission is a poor prognosticator in COVID-19 patients.
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Affiliation(s)
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine,All India Institute of Medical Sciences, Jodhpur.
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur.
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Ram Niwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur.
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur.
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur.
| | - Gopal Krishna Bohra
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur.
| | | | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur.
| | - Deepti Mathur
- Research assistant, All India Institute of Medical Sciences, Jodhpur.
| | | | | | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur.
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur.
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92
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Armiñanzas C, Arnaiz de Las Revillas F, Gutiérrez Cuadra M, Arnaiz A, Fernández Sampedro M, González-Rico C, Ferrer D, Mora V, Suberviola B, Latorre M, Calvo J, Olmos JM, Cifrián JM, Fariñas MC. Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19. Int J Infect Dis 2021; 108:282-288. [PMID: 34044145 PMCID: PMC8142713 DOI: 10.1016/j.ijid.2021.05.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/23/2022] Open
Abstract
AIM The aim of this study was to determine the usefulness of COVID-GRAM and CURB-65 scores as predictors of the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Caucasian patients. METHODS This was a retrospective observational study including all adults with SARS-CoV-2 infection admitted to Hospital Universitario Marqués de Valdecilla from February to May 2020. Patients were stratified according to COVID-GRAM and CURB-65 scores as being at low-medium or high risk of critical illness. Univariate analysis, multivariate logistic regression models, receiver operating characteristic curve, and area under the curve (AUC) were calculated. RESULTS A total of 523 patients were included (51.8% male, 48.2% female; mean age 65.63 years (standard deviation 17.89 years)), of whom 110 (21%) presented a critical illness (intensive care unit admission 10.3%, 30-day mortality 13.8%). According to the COVID-GRAM score, 122 (23.33%) patients were classified as high risk; 197 (37.7%) presented a CURB-65 score ≥2. A significantly greater proportion of patients with critical illness had a high COVID-GRAM score (64.5% vs 30.5%; P < 0.001). The COVID-GRAM score emerged as an independent predictor of critical illness (odds ratio 9.40, 95% confidence interval 5.51-16.04; P < 0.001), with an AUC of 0.779. A high COVID-GRAM score showed an AUC of 0.88 for the prediction of 30-day mortality, while a CURB-65 ≥2 showed an AUC of 0.83. CONCLUSIONS The COVID-GRAM score may be a useful tool for evaluating the risk of critical illness in Caucasian patients with SARS-CoV-2 infection. The CURB-65 score could be considered as an alternative.
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Affiliation(s)
- Carlos Armiñanzas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Francisco Arnaiz de Las Revillas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Manuel Gutiérrez Cuadra
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Ana Arnaiz
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Marta Fernández Sampedro
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Claudia González-Rico
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Diego Ferrer
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Víctor Mora
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Borja Suberviola
- Service of Intensive Care, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Maite Latorre
- Service of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Jorge Calvo
- Service of Microbiology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - José Manuel Olmos
- Service of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Manuel Cifrián
- Service of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - María Carmen Fariñas
- Service of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
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93
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Remdesivir in moderate to severe COVID-19: A matter of time? Pharmacol Res 2021; 170:105711. [PMID: 34089865 PMCID: PMC8172330 DOI: 10.1016/j.phrs.2021.105711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
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94
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Marcolino MS, Ziegelmann PK, Souza-Silva MVR, Nascimento IJB, Oliveira LM, Monteiro LS, Sales TLS, Ruschel KB, Martins KPMP, Etges APBS, Molina I, Polanczyk CA. Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil: Results from the Brazilian COVID-19 registry. Int J Infect Dis 2021; 107:300-310. [PMID: 33444752 PMCID: PMC7801187 DOI: 10.1016/j.ijid.2021.01.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To describe the clinical characteristics, laboratory results, imaging findings, and in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. METHODS A cohort study of laboratory-confirmed COVID-19 patients who were hospitalized from March 2020 to September 2020 in 25 hospitals. Data were collected from medical records using Research Electronic Data Capture (REDCap) tools. A multivariate Poisson regression model was used to assess the risk factors for in-hospital mortality. RESULTS For a total of 2,054 patients (52.6% male; median age of 58 years), the in-hospital mortality was 22.0%; this rose to 47.6% for those treated in the intensive care unit (ICU). Hypertension (52.9%), diabetes (29.2%), and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation, and 12.1% required kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1%, and acute heart failure in 3.6%. Age >= 65 years, chronic kidney disease, hypertension, C-reactive protein ≥ 100mg/dL, platelet count < 100×109/L, oxygen saturation < 90%, the need for supplemental oxygen, and invasive mechanical ventilation at admission were independently associated with a higher risk of in-hospital mortality. The overall use of antimicrobials was 87.9%. CONCLUSIONS This study reveals the characteristics and in-hospital outcomes of hospitalized patients with confirmed COVID-19 in Brazil. Certain easily assessed parameters at hospital admission were independently associated with a higher risk of death. The high frequency of antibiotic use points to an over-use of antimicrobials in COVID-19 patients.
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Affiliation(s)
- Milena S Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Patricia K Ziegelmann
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Maira V R Souza-Silva
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - I J B Nascimento
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Luana M Oliveira
- Center for Research and Graduate Studies in Business Administration, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Luanna S Monteiro
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Thaís L S Sales
- Universidade Federal de São João del-Rey, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil.
| | - Karen B Ruschel
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Karina P M P Martins
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190 sala 246, Belo Horizonte, Brazil.
| | - Ana Paula B S Etges
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
| | - Israel Molina
- Vall d'Hebron University Hospital, PROSICS Barcelona, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Av. Augusto de Lima, 1715, Belo Horizonte, Brazil.
| | - Carisi A Polanczyk
- Universidade Federal do Rio Grande do Sul and Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359. Prédio 21, Sala 507, Porto Alegre, Brazil.
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95
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Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS. Sci Rep 2021; 11:11524. [PMID: 34075155 PMCID: PMC8169693 DOI: 10.1038/s41598-021-91043-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11–38) vs. 11 (6–26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0–5.2) versus 1.9 (1.0–5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = − 0.60; p = 0.001) and within-subjects correlation (r = − 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.
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96
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Simons D, Shahab L, Brown J, Perski O. The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7). Addiction 2021; 116:1319-1368. [PMID: 33007104 PMCID: PMC7590402 DOI: 10.1111/add.15276] [Citation(s) in RCA: 235] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/08/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
AIMS To estimate the association of smoking status with rates of (i) infection, (ii) hospitalization, (iii) disease severity and (iv) mortality from SARS-CoV-2/COVID-19 disease. DESIGN Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv. SETTING Community or hospital, no restrictions on location. PARTICIPANTS Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis. MEASUREMENTS Outcomes were SARS-CoV-2 infection, hospitalization, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. 'good', 'fair' and 'poor'). FINDINGS Version 7 (searches up to 25 August 2020) included 233 studies with 32 'good' and 'fair' quality studies included in meta-analyses. Fifty-seven studies (24.5%) reported current, former and never smoking status. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection [relative risk (RR) = 0.74, 95% credible interval (CrI) = 0.58-0.93, τ = 0.41]. Data for former smokers were inconclusive (RR = 1.05, 95% CrI = 0.95-1.17, τ = 0.17), but favoured there being no important association (21% probability of RR ≥ 1.1). Former compared with never smokers were at somewhat increased risk of hospitalization (RR = 1.20, CrI = 1.03-1.44, τ = 0.17), greater disease severity (RR = 1.52, CrI = 1.13-2.07, τ = 0.29) and mortality (RR = 1.39, 95% CrI = 1.09-1.87, τ = 0.27). Data for current smokers were inconclusive (RR = 1.06, CrI = 0.82-1.35, τ = 0.27; RR = 1.25, CrI = 0.85-1.93, τ = 0.34; RR = 1.22, 95% CrI = 0.78-1.94, τ = 0.49, respectively), but favoured there being no important associations with hospitalization and mortality (35% and 70% probability of RR ≥ 1.1, respectively) and a small but important association with disease severity (79% probability of RR ≥ 1.1). CONCLUSIONS Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection, while former smokers appear to be at increased risk of hospitalization, increased disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal.
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Affiliation(s)
- David Simons
- Centre for Emerging, Endemic and Exotic DiseasesRoyal Veterinary CollegeLondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Olga Perski
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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97
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Almas A, Mushtaq Z, Moller J. Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan. BMJ Open 2021; 11:e045414. [PMID: 34049912 PMCID: PMC8166477 DOI: 10.1136/bmjopen-2020-045414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19. DESIGN A hospital-based observational follow-up study. SETTING Internal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020. PARTICIPANTS Adult patients with confirmed COVID-19, aged ≥18 years. METHODS ALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and length of stay. RESULTS A total of 822 patients with COVID-19 were admitted during the study period and 699 met inclusion criteria. The mean age was 54.5 years and 67% were males; 50.4% were triaged to low, 42.5% to intermediate and 7.2% to high acuity care. The overall case-fatality rate was 11.6%, with the highest (52%) in high acuity level followed by 16.2% in intermediate and 2% in low acuity care. Acuity level was associated with case fatality, with an HR (95% CI) of 5.0 (2.0 to 12.1) for high versus low acuity care and an HR of 2.7 (1.2, 6.4) for intermediate versus low acuity care, after adjusting for age, sex and common comorbidities including diabetes, hypertension, ischaemic heart disease and chronic lung disease. Similarly, acuity level was also associated with length of hospital stay. CONCLUSION High and intermediate acuity level is associated with higher case fatality rate and prolonged length of hospital stay in patients admitted with COVID-19. In resource-limited settings where the provision of high acuity care is limited, the intermediate care acuity could serve as a useful strategy to treat relatively less critical patients with COVID-19.
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Affiliation(s)
- Aysha Almas
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Zain Mushtaq
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Jette Moller
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
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98
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Li Y, Deng Y, Ye L, Sun H, Du S, Huang H, Zeng F, Chen X, Deng G. Clinical Significance of Plasma D-Dimer in COVID-19 Mortality. Front Med (Lausanne) 2021; 8:638097. [PMID: 34113629 PMCID: PMC8185282 DOI: 10.3389/fmed.2021.638097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
It is not clear whether D-dimer can be an independent predictor of coronavirus disease 2019 (COVID-19) mortality, and the cut-off of D-dimer for clinical use remains to be determined. Therefore, a comprehensive analysis is still necessary to illuminate the clinical significance of plasma D-dimer in COVID-19 mortality. We searched PubMed, Embase, Cochrane Library, and Scopus databases until November 2020. STATA software was used for all the statistical analyses. The identifier of systematic review registration was PROSPERO CRD42020220927. A total of 66 studies involving 40,614 COVID-19 patients were included in our meta-analysis. Pooled data showed that patients in high D-dimer group had poor prognosis than those in low D-dimer group [OR = 4.52, 95% CI = (3.61, 5.67), P < 0.001; HR = 2.81, 95% CI = (1.85, 4.27), P < 0.001]. Sensitivity analysis, pooled data based on different effect models and the Duval and Tweedie trim-and-fill method did not change the conclusions. Subgroup analyses stratified by different countries, cutoffs, sample size, study design, and analysis of OR/HR still keep consistent conclusions. D-dimer was identified as an independent predictor for COVID-19 mortality. A series of values including 0.5 μg/ml, 1 μg/ml, and 2 μg/ml could be determined as cutoff of D-dimer for clinic use. Measurement and monitoring of D-dimer might assist clinicians to take immediate medical actions and predict the prognosis of COVID-19.
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Affiliation(s)
- Yayun Li
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuhao Deng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Ye
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Huiyan Sun
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Songtao Du
- Department of Colorectal Surgical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Huining Huang
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Furong Zeng
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guangtong Deng
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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99
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Radovanovic D, Coppola S, Franceschi E, Gervasoni F, Duscio E, Chiumello DA, Santus P. Mortality and clinical outcomes in patients with COVID-19 pneumonia treated with non-invasive respiratory support: A rapid review. J Crit Care 2021; 65:1-8. [PMID: 34052780 PMCID: PMC8137355 DOI: 10.1016/j.jcrc.2021.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/23/2021] [Accepted: 05/15/2021] [Indexed: 01/08/2023]
Abstract
Introduction and aim Non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) have been widely employed to treat acute respiratory failure secondary to COVID-19 pneumonia, but their role in terms of efficacy and safety are still debated. The aim of this review was to analyse mortality and intubation rates in COVID-19 patients treated with NIV/CPAP. Methods Rapid review methodology was applied to include all the studies published since December-2019 until November-2020 with available data on in-hospital mortality in COVID-19 patients treated with NIV or CPAP. Results 23 manuscripts were included (4776 patients, 66% males, 46% with hypertension). 46% of patients received non-invasive respiratory support, of which 48.4% with CPAP, 46% with NIV, and 4% with either CPAP or NIV. Non-invasive respiratory support failed in 47.7% of patients, of which 26.5% were intubated and 40.9% died. In-hospital mortality was higher in patients treated with NIV compared with CPAP (35.1% vs. 22.2%). Complications were under-reported, but mostly not related to CPAP/NIV treatment. Conclusion CPAP and NIV appear equally and frequently applied in patients with COVID-19 pneumonia, but associated with high mortality. Robust evidence is urgently needed to confirm the clinical efficacy of non-invasive respiratory support in COVID-19-related ARDS.
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Affiliation(s)
- Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Elisa Franceschi
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy; Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Fabrizio Gervasoni
- Rehabilitation Unit, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy
| | - Eleonora Duscio
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Davide Alberto Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy; Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy.
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy; Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
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Romero-Duarte Á, Rivera-Izquierdo M, Guerrero-Fernández de Alba I, Pérez-Contreras M, Fernández-Martínez NF, Ruiz-Montero R, Serrano-Ortiz Á, González-Serna RO, Salcedo-Leal I, Jiménez-Mejías E, Cárdenas-Cruz A. Sequelae, persistent symptomatology and outcomes after COVID-19 hospitalization: the ANCOHVID multicentre 6-month follow-up study. BMC Med 2021; 19:129. [PMID: 34011359 PMCID: PMC8134820 DOI: 10.1186/s12916-021-02003-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term effects of COVID-19, also called Long COVID, affect more than 10% of patients. The most severe cases (i.e. those requiring hospitalization) present a higher frequency of sequelae, but detailed information on these effects is still lacking. The objective of this study is to identify and quantify the frequency and outcomes associated with the presence of sequelae or persistent symptomatology (SPS) during the 6 months after discharge for COVID-19. METHODS Retrospective observational 6-month follow-up study conducted in four hospitals of Spain. A cohort of all 969 patients who were hospitalized with PCR-confirmed SARS-CoV-2 from March 1 to April 15, 2020, was included. We collected all the SPS during the 6 months after discharge reported by patients during follow-up from primary care records. Cluster analyses were performed to validate the measures. The main outcome measures were return to the Emergency Services, hospital readmission and post-discharge death. Surviving patients' outcomes were collected through clinical histories and primary care reports. Multiple logistic regression models were applied. RESULTS The 797 (82.2%) patients who survived constituted the sample followed, while the rest died from COVID-19. The mean age was 63.0 years, 53.7% of them were men and 509 (63.9%) reported some sequelae during the first 6 months after discharge. These sequelae were very diverse, but the most frequent were respiratory (42.0%), systemic (36.1%), neurological (20.8%), mental health (12.2%) and infectious (7.9%) SPS, with some differences by sex. Women presented higher frequencies of headache and mental health SPS, among others. A total of 160 (20.1%) patients returned to the Emergency Services, 35 (4.4%) required hospital readmission and 8 (1.0%) died during follow-up. The main factors independently associated with the return to Emergency Services were persistent fever, dermatological SPS, arrythmia or palpitations, thoracic pain and pneumonia. CONCLUSIONS COVID-19 cases requiring hospitalization during the first wave of the pandemic developed a significant range of mid- to long-term SPS. A detailed list of symptoms and outcomes is provided in this multicentre study. Identification of possible factors associated with these SPS could be useful to optimize preventive follow-up strategies in primary care for the coming months of the pandemic.
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Affiliation(s)
| | - Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio, Granada, Spain.
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.
| | - Inmaculada Guerrero-Fernández de Alba
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Service of Preventive Medicine and Public Health, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Marina Pérez-Contreras
- Service of Preventive Medicine and Public Health, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, Spain
| | - Nicolás Francisco Fernández-Martínez
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Rafael Ruiz-Montero
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Álvaro Serrano-Ortiz
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Rocío Ortiz González-Serna
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Inmaculada Salcedo-Leal
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, 18016, Granada, Spain
- Chair of Teaching and Research in Family Medicine, SEMERGEN-UGR, University of Granada, Granada, Spain
| | - Antonio Cárdenas-Cruz
- School of Medicine, University of Granada, Granada, Spain
- Intensive Care Unit, Hospital de Poniente, El Ejido, Almería, Spain
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