51
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Sobue Y, Suzuki M, Ohashi Y, Koshima H, Okui N, Funahashi K, Ishikawa H, Inoue H, Kojima M, Asai S, Terabe K, Hattori K, Kishimoto K, Takahashi N, Imagama S, Kojima T. Locomotive syndrome in rheumatoid arthritis patients during the COVID-19 pandemic. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:799-812. [PMID: 36544599 PMCID: PMC9748313 DOI: 10.18999/nagjms.84.4.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to longitudinally evaluate the development of locomotive syndrome (LS) in rheumatoid arthritis (RA) patients during the COVID-19 pandemic using the 25-question Geriatric Locomotive Function Scale (GLFS-25). Subjects were 286 RA patients (female, 70.6%; mean age, 64.2 years) who had GLFS-25 and Clinical Disease Activity Index (CDAI) data available for a 1-year period during the COVID-19 pandemic and who did not have LS at baseline. Associations between subject characteristics and development of LS were determined using logistic regression analysis. Among the 286 patients, 38 (13.3%, LS group) developed LS at 1 year after baseline. In the LS group, scores of the GLFS-25 categories "GLFS-5" and "Social activities" were significantly increased at 1 year relative to baseline. GLFS-5 is a quick 5-item version of the GLFS-25, including questions regarding the difficulty of going up and down stairs, walking briskly, distance able to walk without rest, difficulty carrying objects weighing 2 kg, and ability to carry out load-bearing tasks and housework. A significant correlation was also observed between changes in "Social activities" and that of "GLFS-5." Multivariable logistic regression analysis revealed that the development of LS was significantly associated with BMI (OR: 1.11 [95% confidence interval (CI): 1.00-1.22]) and CDAI (OR: 1.08 [95%CI: 1.00-1.16]) at baseline. Adequate exercise and tight control of RA disease activity are important for preventing the development of LS in view of restrictions on going out imposed during the COVID-19 pandemic. GLFS-5 is useful for evaluating the physical function of RA patients.
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Affiliation(s)
- Yasumori Sobue
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Orthopedic Surgery, Japan Community Health care Organization Kani Tono Hospital, Kani, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Hiroshi Koshima
- Department of Orthopedic Surgery, Japan Community Health care Organization Kani Tono Hospital, Kani, Japan
| | - Nobuyuki Okui
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Koji Funahashi
- Department of Orthopedic Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Hisato Ishikawa
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hidenori Inoue
- Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyosuke Hattori
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Kishimoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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52
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Naito K, Kikuchi K, Watanabe Y, Narita T. Implementation of two novel schemes for patients on dialysis as a response to the COVID-19 surge in Tokyo. Glob Health Med 2022; 4:253-258. [PMID: 36381571 PMCID: PMC9619119 DOI: 10.35772/ghm.2022.01050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
The Japanese government recommended hospitalization of patients on dialysis once they tested positive because of their high COVID-19 mortality rate and definite need for periodic dialysis. However, after experiencing the Delta variant surge, strategic changes towards outpatient care for mild or asymptomatic cases, along with strengthening emergency preparedness were needed. Facing the Omicron surge, the Tokyo Metropolitan Government introduced two novel schemes: i) a temporary medical facility with a dialysis center for infected patients on hemodialysis, which started admitting patients on dialysis on January 20, 2022, to provide additional bed capacity and access to hemodialysis and ii) a transportation scheme for patients who need travel to maintenance dialysis facilities from their homes, which was introduced on February 5. The Tokyo Metropolitan Government, cooperating with some nephrology experts, announced these schemes and urged local dialysis facilities to change strategies, providing information regarding infection prevention measures and treatments in online seminars on February 3 and 7. Consequently, promoting outpatient care did not lead to an increase in the case fatality ratio (CFR) in patients on dialysis with COVID-19 in Tokyo during the first Omicron surge (January 7 to February 10, 8.2%; February 11 to March 31, 5.5%). Furthermore, after an additional online seminar on July 20, the CFR dramatically declined in the second Omicron surge (July 8 to September 8, 1.2%). Implementation of public health intervention and careful communication with local dialysis facilities were both crucial to the strategic changes. To maintain essential health services, emergency preparedness should be cultivated during regular times.
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Affiliation(s)
- Keisuke Naito
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Japan;,Address correspondence to:Keisuke Naito, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, 8-1 Nishi-Shinjuku 2-chome, Shinjuku-ku, Tokyo 163-8001, Japan. E-mail:
| | - Kan Kikuchi
- Division of Nephrology, Shimoochiai Clinic, Tokyo, Japan
| | - Yu Watanabe
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Japan
| | - Tomoyo Narita
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Japan
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53
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Hanafusa M, Nawa N, Goto Y, Kawahara T, Miyamae S, Ueki Y, Nosaka N, Wakabayashi K, Tohda S, Tateishi U, Fujiwara T. Effectiveness of remdesivir with corticosteroids for COVID-19 patients in intensive care unit: A hospital-based observational study. J Med Virol 2022; 95:e28168. [PMID: 36148941 PMCID: PMC9538844 DOI: 10.1002/jmv.28168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023]
Abstract
The effectiveness of remdesivir on survival in coronavirus disease 2019 (COVID-19), especially in cases treated in the intensive care unit (ICU), is controversial. We investigated the effectiveness of remdesivir with corticosteroids on the survival of COVID-19 patients in a real ICU clinical practice. For laboratory-confirmed COVID-19 patients admitted to the ICU of a tertiary hospital in Tokyo (April 2020-November 2021) and who received corticosteroids, the effectiveness of remdesivir for survival, stratified by interval length (within 9 or 10+ days), was retrospectively analyzed using Cox regression model. A total of 168 patients were included: 35 with no remdesivir use (control), 96 with remdesivir use within 9 days, and 37 with remdesivir use with an interval of 10+ days. In-hospital mortality was 45.7%, 10.4%, and 16.2%, respectively. After adjusting for possible covariates including comorbidities, laboratory data, oxygen demand, or level of pneumonia, remdesivir use within 9 days from symptom onset reduced mortality risk (hazard ratio [HR]: 0.10; 95% confidence interval (CI): 0.025-0.428) compared to the control group. However, remdesivir use with an interval of 10+ days showed no significant association with mortality (HR: 0.42; 95% CI: 0.117-1.524). Among COVID-19 patients who received corticosteroids in ICU, remdesivir use within 9 days from symptom onset was associated with reduced in-hospital mortality risk.
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Affiliation(s)
- Mariko Hanafusa
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Nobutoshi Nawa
- Department of Medical Education Research and DevelopmentTokyo Medical and Dental UniversityTokyoJapan
| | - Yuki Goto
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Tomoki Kawahara
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Shigeru Miyamae
- Disaster Medical Care OfficeTokyo Medical and Dental UniversityTokyoJapan
| | - Yutaka Ueki
- Department of Trauma and Acute Critical Care Medical CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Nobuyuki Nosaka
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kenji Wakabayashi
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Shuji Tohda
- Department of Clinical Laboratory, Medical HospitalTokyo Medical and Dental UniversityTokyoJapan
| | - Ukihide Tateishi
- Department of Diagnostic RadiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takeo Fujiwara
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
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54
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Takeuchi M, Inokuchi S, Kimura T, Eguchi N, Kawakami K, Takahashi T. Descriptive epidemiology of COVID-19 in Japan 2020: insights from a multihospital database. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 5:5-12. [PMID: 38505379 PMCID: PMC10760473 DOI: 10.37737/ace.23002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/17/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND Epidemiological data are essential for developing strategies against the current coronavirus disease 2019 (COVID-19) pandemic. Data on COVID-19 epidemiology in Japan are limited owing to a focus on specific regions and patient groups, particularly in the early phase of the pandemic. METHODS We investigated COVID-19 epidemiology in Japan in 2020 using a large nationwide multihospital database containing insurance claim records and medical records. Inclusion criteria were inpatient and outpatient referrals for COVID-19 in 2020. We analyzed demographic data, comorbidities, drug use, severe COVID-19 risk, and clinical course of hospitalized patients (including death). RESULTS We identified 11,868 COVID-19 cases from 56 institutions: 6,440 outpatients and 5,428 inpatients. Of the patients, 53.2% had comorbid conditions, the most common of which was tumor (22.1%), and 56.4% were classed as having a high risk of COVID-19. Pharmacological management patterns were generally consistent between the first and second half of 2020, except for glucocorticoid use. The use of unauthorized medications (hydroxychloroquine, ivermectin, and favipiravir) was infrequent. For hospitalized patients, the median length of stay was 10 days, and 2.4% of patients were admitted to intensive care units. Post-COVID-19 all-cause mortality, all-cause 30-day mortality, and in-hospital deaths were recorded for 7.9%, 5.4%, and 4.6% of patients, respectively. Patients with high-risk conditions had a lower survival probability. CONCLUSIONS This descriptive study of COVID-19 in 2020 identified differences in care across outpatient and inpatient settings and changes in care delivery as the pandemic progressed. These findings could inform strategies for future infectious disease pandemics.
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Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | | | | | | | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Tai Takahashi
- Department of Social Services and Healthcare Management, School of Health and Welfare, International University of Health and Welfare
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55
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Toratani M, Karasuyama K, Kuriyama K, Inoue A, Hamaguchi K, Fujiwara T, Kishimoto K, Ohnishi M, Higashi M. Semi-quantitative evaluation of chest computed tomography for coronavirus disease 2019 in a critical care unit: A case-control study. Medicine (Baltimore) 2022; 101:e30655. [PMID: 36123837 PMCID: PMC9477707 DOI: 10.1097/md.0000000000030655] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The spread of abnormal opacity on chest computed tomography (CT) has been reported as a predictor of coronavirus disease 2019 (COVID-19) severity; however, the relationship between CT findings and prognosis in patients with severe COVID-19 remains unclear. The objective of this study was to evaluate the extent of abnormal opacity on chest CT and its association with prognosis in patients with COVID-19 in a critical care medical center, using a simple semi-quantitative method. This single-center case-control study included patients diagnosed with severe COVID-19 pneumonia who were admitted to a critical care center. The diagnosis of COVID-19 was based on positive results of a reverse transcription polymerase chain reaction test. All patients underwent non-contrast whole-body CT upon admission. Six representative axial chest CT images were selected for each patient to evaluate the extent of lung lesions. The percentage of the area involved in the representative CT images was visually assessed by 2 radiologists and scored on 4-point scale to obtain the bedside CT score, which was compared between patients who survived and those who died using the Mann-Whitney U test. A total of 63 patients were included in this study: 51 survived and 12 died after intensive treatment. The inter-rater reliability of bedside scores between the 2 radiologists was acceptable. The median bedside CT score of the survival group was 12.5 and that of the mortality group was 16.5; the difference between the 2 groups was statistically significant. The degree of opacity can be easily scored using representative CT images in patients with severe COVID-19 pneumonia, without sophisticated software. A greater extent of abnormal opacity is associated with poorer prognosis. Predicting the prognosis of patients with severe COVID-19 could facilitate prompt and appropriate treatment.
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Affiliation(s)
- Masayasu Toratani
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
- *Correspondence: Masayasu Toratani, MD, PhD, Department of Radiology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka-shi, Osaka 540-0006, Japan (e-mail: )
| | - Kana Karasuyama
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Keiko Kuriyama
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Atsuo Inoue
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Kyoko Hamaguchi
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Takuya Fujiwara
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Kentaro Kishimoto
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Mitsuo Ohnishi
- Department of Acute Medicine & Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka-shi, Osaka, Japan
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56
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Yoshida S, Miyamori D, Ikeda K, Ohge H, Ito M. Effect of COVID-19 inpatients with cognitive decline on discharge after the quarantine period: A retrospective cohort study. J Gen Fam Med 2022; 24:JGF2577. [PMID: 36249865 PMCID: PMC9537993 DOI: 10.1002/jgf2.577] [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: 04/02/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 01/07/2023] Open
Abstract
Background A new SARS-CoV-2 variant, Omicron, was reported on November 14, 2021, and it altered the COVID-19 epidemic with a different peak timing by region in Japan. Residents in the Hiroshima prefecture, especially the vulnerable elderly, were threatened by this wave in advance of many other prefectures. We evaluated the effect of cognitive decline on discharge extension after the quarantine period. Methods Participants of this retrospective cohort study were patients who were admitted to the care unit for COVID-19 treatment at Hiroshima University Hospital between January 1, 2022, and March 1, 2022 (60 days). Our primary outcome was the extended length of stay (LOS) in the hospital after the quarantine period (10 days after onset). A negative binomial regression analysis was performed to assess the extended LOS of patients with cognitive decline, adjusting for age classification, gender, and severity of COVID-19. Results The total number of participants was 74. Per the level of cognitive function, there were 56 independent participants, 5 mild declines, and 13 severe declines. For the negative binomial regression analysis, the exponentiated coefficient of mild cognitive decline was 3.05 (95% confidential interval [CI]: 1.43-6.49) and that of severe cognitive decline was 1.95 (95% CI: 1.09-3.53). Conclusions Mild cognitive decline and severe cognitive decline elevated the risk of extended LOS after COVID-19 patients finished the quarantine period.
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Affiliation(s)
- Shuhei Yoshida
- Department of Community‐Based Medical System, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshima‐kenJapan
- Department of General Internal MedicineHiroshima University HospitalHiroshima‐kenJapan
| | - Daisuke Miyamori
- Department of General Internal MedicineHiroshima University HospitalHiroshima‐kenJapan
| | - Kotaro Ikeda
- Department of General Internal MedicineHiroshima University HospitalHiroshima‐kenJapan
| | - Hiroki Ohge
- Department of Infectious DiseasesHiroshima University HospitalHiroshima‐kenJapan
| | - Masanori Ito
- Department of General Internal MedicineHiroshima University HospitalHiroshima‐kenJapan
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57
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Suzuki T, Iwamoto N, Tsuzuki S, Kakumoto Y, Suzuki M, Ashida S, Oshiro Y, Nemoto T, Kanda K, Okuhama A, Yamada G, Inada M, Sato L, Miyazato Y, Akiyama Y, Saito S, Morioka S, Ujiie M, Hayakawa K, Sugiyama M, Mizokami M, Kodama EN, Ohmagari N. Interferon lambda 3 in the early phase of coronavirus disease-19 can predict oxygen requirement. Eur J Clin Invest 2022; 52:e13808. [PMID: 35506823 PMCID: PMC9541409 DOI: 10.1111/eci.13808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Tetsuya Suzuki
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Emerging and Re‐emerging Infectious Diseases, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Noriko Iwamoto
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Emerging and Re‐emerging Infectious Diseases, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Shinya Tsuzuki
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Yuko Kakumoto
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Michiyo Suzuki
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Shinobu Ashida
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Yusuke Oshiro
- Clinical Laboratory DepartmentNational Center for Global Health and MedicineTokyoJapan
| | - Takeshi Nemoto
- Clinical Laboratory DepartmentNational Center for Global Health and MedicineTokyoJapan
| | - Kohei Kanda
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Ayako Okuhama
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Gen Yamada
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Makoto Inada
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Lubna Sato
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Yusuke Miyazato
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Yutaro Akiyama
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Sho Saito
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Emerging and Re‐emerging Infectious Diseases, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Shinichiro Morioka
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Emerging and Re‐emerging Infectious Diseases, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Mugen Ujiie
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Kayoko Hayakawa
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
| | - Masaya Sugiyama
- Genome Medical Sciences Project, Research InstituteNational Center for Global Health and MedicineIchikawaJapan
- Department of Viral Pathogenesis and ControlsNational Center for Global Health and MedicineIchikawaJapan
| | - Masashi Mizokami
- Genome Medical Sciences Project, Research InstituteNational Center for Global Health and MedicineIchikawaJapan
| | - Eiichi N. Kodama
- Department of Infectious Disease, International Research Institute of Disaster ScienceTohoku UniversitySendaiJapan
| | - Norio Ohmagari
- Disease Control and Prevention CenterNational Center for Global Health and MedicineTokyoJapan
- Emerging and Re‐emerging Infectious Diseases, Graduate School of MedicineTohoku UniversitySendaiJapan
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58
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Hayakawa K, Asai Y, Matsunaga N, Tsuzuki S, Terada M, Suzuki S, Kitajima K, Saito S, Ohmagari N. Evaluation of the representativeness of data in the COVID-19 Registry Japan during the first six waves of the epidemic. Glob Health Med 2022; 4:204-209. [PMID: 36119783 PMCID: PMC9420330 DOI: 10.35772/ghm.2022.01033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 06/10/2023]
Abstract
The COVID-19 Registry Japan (COVIREGI-JP), a registry of patients hospitalized with coronavirus disease (COVID-19), contains the largest national COVID-19 inpatient population. Since COVIREGI-JP invites voluntary participation by facilities, selection bias is inevitable. The current study examined the representativeness of COVIREGI-JP data in comparison to open-source national data. The number of infections and deaths among hospitalized COVID-19 patients in COVIREGI-JP were compared to those in national data recorded during the six waves of the COVID-19 epidemic until March 6, 2022. During the period studied, patients in COVIREGI-JP represented 1% of the total COVID-19 cases according to national data; the proportion was high during the first wave (32.7%) and tended to decrease, especially after the fourth wave. The overall proportion of patients from each region varied from 0.8% to 2.5%, but case fatality rates in COVIREGI-JP tended to be higher than those in the national data, with the exception of a few waves, in several regions. The difference was smallest during the first wave. Although COVIREGI-JP consistently registered cases from all regions of the country, the proportion tended to decline after the beginning of the epidemic. Given the epidemiological persistence and the ever-changing epidemiology of COVID-19, continued case registration and data utilization in COVIREGI-JP is desirable, although selection bias in COVIREGI-JP registration of cases should be carefully interpreted.
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Affiliation(s)
- Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Setsuko Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Kitajima
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
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59
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Effects of mild obesity on outcomes in Japanese patients with COVID-19: a nationwide consortium to investigate COVID-19 host genetics. Nutr Diabetes 2022; 12:38. [PMID: 35945221 PMCID: PMC9360639 DOI: 10.1038/s41387-022-00217-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity is reported to be a risk factor for severe disease in patients with coronavirus disease 2019 (COVID-19). However, there are no specific reports on the risk of severe disease according to body mass index (BMI) in Japan. Thus, this study aimed to investigate the effect of obesity stratified by BMI on the severity of COVID-19 in the general Japanese population. METHODS From February 2020 to May 2021, 1 837 patients aged ≥18 years were enrolled in the Japan COVID-19 Task Force. Patients with known BMI and disease severity were analyzed. Severity was defined as critical if the patient was treated in the intensive care unit, required invasive mechanical ventilation, or died. RESULTS Class 1 obesity (25.0 ≤ BMI < 30.0 kg/m2), class 2 obesity (30.0 ≤ BMI < 35.0 kg/m2), and class 3 or 4 obesity (BMI ≥ 35 kg/m2) were present in 29%, 8%, and 3% of the cases, respectively. Multiple logistic regression analysis with known risk factors for critical illness indicated that class 2 obesity was an independent risk factor for oxygenation (adjusted odds ratio, 4.75) and critical cases (adjusted odds ratio, 1.81). Class 1 obesity and class 3 or 4 obesity were independent risk factors for oxygen administration (adjusted odds ratios 2.01 and 3.12, respectively), but not for critical cases. However, no differences in the mortality rates were observed between the BMI classes (P = 0.5104). CONCLUSION Obesity is a risk factor for respiratory failure in Japanese patients with COVID-19, regardless of the degree of obesity. However, it may not cause severe COVID-19 in a dose-response relationship with BMI. COVID-19 patients with mild obesity may benefit from aggressive intensive care.
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60
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Matsunaga N, Kamata K, Asai Y, Tsuzuki S, Sakamoto Y, Ijichi S, Akiyama T, Yu J, Yamada G, Terada M, Suzuki S, Suzuki K, Saito S, Hayakawa K, Ohmagari N. Predictive model of risk factors of High Flow Nasal Cannula using machine learning in COVID-19. Infect Dis Model 2022; 7:526-534. [PMID: 35945955 PMCID: PMC9352414 DOI: 10.1016/j.idm.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023] Open
Abstract
With the rapid increase in the number of COVID-19 patients in Japan, the number of patients receiving oxygen at home has also increased rapidly, and some of these patients have died. An efficient approach to identify high-risk patients with slowly progressing and rapidly worsening COVID-19, and to avoid missing the timing of therapeutic intervention will improve patient prognosis and prevent medical complications. Patients admitted to medical institutions in Japan from November 14, 2020 to April 11, 2021 and registered in the COVID-19 Registry Japan were included. Risk factors for patients with High Flow Nasal Cannula invasive respiratory management or higher were comprehensively explored using machine learning. Age-specific cohorts were created, and severity prediction was performed for the patient surge period. We were able to obtain a model that was able to predict severe disease with a sensitivity of 57% when the specificity was set at 90% for those aged 40–59 years, and with a specificity of 50% and 43% when the sensitivity was set at 90% for those aged 60–79 years and 80 years and older, respectively. We were able to identify lactate dehydrogenase level (LDH) as an important factor in predicting the severity of illness in all age groups. Using machine learning, we were able to identify risk factors with high accuracy, and predict the severity of the disease. We plan to develop a tool that will be useful in determining the indications for hospitalisation for patients undergoing home care and early hospitalisation.
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Ogawa-Ochiai K, Ishikawa H, Nishimura H, Okajima M, Iinuma Y, Ito M. Clinical and epidemiological features of healthcare workers after a coronavirus disease 2019 cluster infection in Japan and the effects of Kampo formulas-Hochuekkito and Kakkonto: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29748. [PMID: 35839019 PMCID: PMC11132327 DOI: 10.1097/md.0000000000029748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/20/2022] [Indexed: 01/08/2023] Open
Abstract
It is expected that a low-toxicity natural compound like Kampo formulas would exhibit a preventive effect on COVID-19, in a global outbreak of coronavirus disease 2019 (COVID-19). Although the biological properties and safety of the representative Kampo, Hochuekkito (HET), and Kakkonto (KKT) have been confirmed in various animal model experiments and clinical studies, and in a few human studies to induce biological effects on various infectious diseases without significant toxicity, it is unclear whether HET and KKT are safe and effective for COVID-19 prevention. We summarized the clinical characteristics of HCWs and the preventive effects of HET and KKT. We performed a retrospective, single-center, cohort study that included 175 HCWs (aged 21-77 years) from a total number of 217 in a hospital with a history of COVID-19 cluster infection. In total, 175 HCWs were tested for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. We identified 27 patients (median age: 49 ± 10.7 years) who were diagnosed with COVID-19. The patients in the group that had a body mass index ≥ 25 had a high COVID-19 infection risk, while those in the group with a Kampo formula adherence rate ≥ 40% had a low COVID-19 risk. Patients in the group with an adherence rate ≥ 40%, as well as those in the current alcohol consumption group, were at a low risk of developing severe COVID-19. In conclusion, HET and KKT may have prevented the onset or worsening of COVID-19, which could be clinically used. Obesity might have increased the patients' susceptibility to COVID-19 and the disease severity.
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Affiliation(s)
- Keiko Ogawa-Ochiai
- Kampo Clinical Center, Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Osaka, Japan
| | - Hayato Nishimura
- Futatsuya Hospital, Ishikawa, Japan and Hane Pediatric Clinic, Toba-city, Mie, Japan
| | - Masaki Okajima
- Department of Emergency and Disaster Medicine, Faculty of Medicine Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Ishikawa, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
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Kadowaki T, Imajou S, Matsumoto N, Takao S, Yorifuji T. Timing of REGEN-COV administration and progression to severe COVID-19. J Infect Chemother 2022; 28:1459-1463. [PMID: 35817250 PMCID: PMC9265142 DOI: 10.1016/j.jiac.2022.07.002] [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: 04/16/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
Introduction Several clinical trials have demonstrated that REGEN-COV (casirivimab and imdevimab) decreases the risk of hospitalization and death among COVID-19 patients. However, these trials did not evaluate the optimal timing of its administration, and evidence is limited regarding the relationship between the timing of administration and progression to severe COVID-19 among patients who receive REGEN-COV in a real-world setting. We examined the association between the timing of REGEN-COV administration and progression to severe COVID-19 among patients who received REGEN-COV in Japan. Methods We included a total of 342 COVID-19 patients (37 hospitals) who received REGEN-COV between July 19 and September 30, 2021. We calculated the difference between the date of symptom onset and the date of administration as an indicator of the timing of REGEN-COV administration and determined progression to severe COVID-19 after REGEN-COV administration. We conducted a logistic regression analysis, adjusting for potential confounders. Results The proportion of cases progressing to severe COVID-19 increased daily from symptom onset and sharply increased from day 5 of onset. The early administration (days 0–4) decreased the risk of progression to severity compared with late administration (after day 5), with an adjusted odds ratio of 0.29 (95% confidence interval: 0.11–0.56). Conclusions The early administration of REGEN-COV was associated with a decreased risk of progression to severe COVID-19 when the delta variant was dominant. The present epidemiological findings indicate that this monoclonal antibody therapy should be implemented very early in the clinical course probably even for emerging variants such as omicron BA.2.
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Affiliation(s)
- Tomoka Kadowaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Sato Imajou
- COVID-19 Infection Control Group, Okayama Prefecture Department of Health and Social Welfare, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Soshi Takao
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Yoroidaka A, Kurita S, Kita T. HbA1c measurement may save COVID-19 inpatients from overlooked diabetes. J Diabetes Investig 2022; 13:1925-1933. [PMID: 35704430 PMCID: PMC9350257 DOI: 10.1111/jdi.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 01/08/2023] Open
Abstract
Aims/Introduction To investigate overlooked diabetes in patients with coronavirus disease 2019 (COVID‐19). Materials and Methods In total, 462 COVID‐19 inpatients were included in this retrospective study. The presence of diabetes before COVID‐19 admission, and the HbA1c and blood glucose levels at admission were examined. Results Of the 462 patients, 116 had diabetes. Seventy‐six patients had been diagnosed with diabetes before COVID‐19 admission, and 40 patients were diagnosed for the first time. Of the patients with diabetes 72% required insulin. Patients with diabetes were significantly (P < 0.05) older, more likely to be male, heavier, and showed a lower eGFR. Patients with overlooked diabetes showed a lower HbA1c (average 7.1% vs 7.5%), a lower casual blood glucose (average 157 vs 179 mg/dL), and they used less insulin per day during hospitalization (average 16.0 units vs 34.5 units) than patients with previously diagnosed diabetes. Patients with overlooked diabetes tended to have more severe COVID‐19 than those with pre‐diagnosed diabetes. Multivariable logistic regression analyses showed that the increased odds ratios (ORs) of aggravation in all patients with COVID‐19 were associated with age [OR 1.04], BMI [OR 1.05], and diabetes [OR 2.15]. The risk factors for aggravation in patients with COVID‐19 and diabetes were age [OR 1.05] and HbA1c [OR 1.45]. Conclusions Diabetes is a predictor of COVID‐19 aggravation. Furthermore, in COVID‐19 patients with diabetes, high HbA1c levels are a risk factor for severe COVID‐19. A total of 8.7% of COVID‐19 inpatients were diagnosed with diabetes after HbA1c was measured on admission. Therefore, it is important to measure HbA1c in COVID‐19 patients.
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Affiliation(s)
- Ayaka Yoroidaka
- Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Seiichiro Kurita
- Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Toshiyuki Kita
- Department of Pulmonology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
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Hayakawa K, Morioka S, Asai Y, Tsuzuki S, Yamada G, Suzuki S, Matsunaga N, Ohmagari N. Predictors of silent hypoxia in hospitalized patients with COVID-19 in Japan. J Infect Chemother 2022; 28:1436-1438. [PMID: 35725530 PMCID: PMC9189118 DOI: 10.1016/j.jiac.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Silent hypoxia (SH) is common in patients with coronavirus disease (COVID-19) in Japan and other countries. Early identification of SH is important as more treatment options for COVID-19 have become available. This study aimed to identify predictors of SH using a nationwide COVID-19 registry of hospitalized patients. METHODS Adult patients who were admitted to hospital with COVID-19 between January 2020 and June 2021 and who were hypoxic on admission (SpO2: 70-93%), not transferred from another facility, and who did not have disturbance of consciousness, confusion, or dementia, were included. SH was defined as hypoxia in the absence of shortness of breath/dyspnea upon admission. Predictors of SH were identified using univariable and multivariable logistic regression. RESULTS The study included 1904 patients, of whom 990 (52%) satisfied the criteria for SH. Compared to patients without SH, patients with SH were older, more likely to be female, and had a slightly higher SpO2 on admission. Compared to patients without SH, patients with SH had a lower prevalence of chronic lung disease (CLD) other than chronic obstructive pulmonary disease (COPD), asthma, and obesity. Multivariable analysis revealed that the independent predictors of SH were older age, a shorter interval from symptom onset to admission, higher SpO2, and an absence of CLD or COPD. CONCLUSIONS The absence of underlying lung disease and older age were important predictors of SH. The results of this study, which is the largest such study reported to date in Japan, may help clarify the mechanism of SH.
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Affiliation(s)
- Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Setsuko Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
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Sakamoto Y, Satoh K, Tanaka T, Yamaguchi T, Miyamoto T, Sawaki K, Miyajima M, Nakaharai K, Hoshina T, Horino T, Nakazawa Y, Ikenoue T, Yoshida M. Risk factors associated with hospitalization in patients with asymptomatic or mild COVID-19 in public accommodation facilities in Tokyo. J Infect Chemother 2022; 28:1439-1444. [PMID: 35717438 PMCID: PMC9189095 DOI: 10.1016/j.jiac.2022.06.002] [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: 03/14/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022]
Abstract
Introduction In Japan, patients with coronavirus disease 2019 (COVID-19) who do not require medical intervention are provided care in recovery accommodation facilities (RAFs). However, some patients may require hospitalization if their symptoms become more severe during their stay. We conducted an observational study using epidemiological data of patients with COVID-19 admitted to RAFs in Tokyo. Methods This was an observational cohort study using data from COVID-19 patients admitted to one of the RAFs in Tokyo from December 2020 to November 2021. Admissions to the facilities were limited to patients with asymptomatic or mild COVID-19 with no underlying disease or at least stable underlying disease at the time of admission. Patients were hospitalized when they required oxygen administration or when they had, or persistent fever, or severe respiratory symptoms. We evaluated the association between hospitalization and the risk factors for hospitalization using a Cox regression model. Results The number of patients with COVID-19 admitted to the RAF was 6176. The number of hospitalized patients was 393 (6.4%), and the median length of stay was 5.50 days (IQR: 4.50, 6.50). In the Cox regression analysis, the hazard ratio increased with age and was significantly higher among patients aged >60 years (HR = 10.23, 95% CI: 6.72–15.57) than those in other age groups. This trend is similar to that observed in the sensitivity analysis. Conclusion Patients with diabetes, the elderly, obesity, and medications for gout and psychiatric diseases may be at a high risk of hospitalization. In particular, an age over 60 years was strongly associated with hospitalization.
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Affiliation(s)
- Yohei Sakamoto
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kenichi Satoh
- Data Science and AI Innovation Research Promotion Center, Shiga University, 1-1-1 Banba, Hikone, 522-8522, Japan
| | - Takuma Tanaka
- Data Science and AI Innovation Research Promotion Center, Shiga University, 1-1-1 Banba, Hikone, 522-8522, Japan
| | - Takayuki Yamaguchi
- Data Science and AI Innovation Research Promotion Center, Shiga University, 1-1-1 Banba, Hikone, 522-8522, Japan
| | - Tomomi Miyamoto
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenji Sawaki
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Makiko Miyajima
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuhiko Nakaharai
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tokio Hoshina
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tetsuya Horino
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasushi Nakazawa
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tatsuyoshi Ikenoue
- Data Science and AI Innovation Research Promotion Center, Shiga University, 1-1-1 Banba, Hikone, 522-8522, Japan
| | - Masaki Yoshida
- The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
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Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
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BMI, sex and outcomes in hospitalised patients in western Sweden during the COVID-19 pandemic. Sci Rep 2022; 12:4918. [PMID: 35318438 PMCID: PMC8939489 DOI: 10.1038/s41598-022-09027-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
High body mass index (BMI) is associated with severe COVID-19 but findings regarding the need of intensive care (IC) and mortality are mixed. Using electronic health records, we identified all patients in western Sweden hospitalised with COVID-19 to evaluate 30-day mortality or assignment to IC. Adjusted logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for outcomes. Of totally 9761 patients, BMI was available in 7325 (75%), included in the study. There was a marked inverse association between BMI and age (underweight and normal weight patients were on average 78 and 75 years, whereas overweight and obese were 68 and 62 years). While older age, male sex and several comorbidities associated with higher mortality after multivariable adjustment, BMI did not. However, BMI ≥ 30 kg/m2 (OR 1.46, 95% CI 1.21–1.75) was associated with need of IC; this association was restricted to women (BMI ≥ 30; OR 1.96 (95% CI 1.41–2.73), and not significant in men; OR 1.22 (95% CI 0.97–1.54). In this comprehensive hospital population with COVID-19, BMI was not associated with 30-day mortality risk. Among the obese, women, but not men, had a higher risk of assignment to IC.
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Matsunaga N, Hayakawa K, Asai Y, Tsuzuki S, Terada M, Suzuki S, Ohtsu H, Kitajima K, Toyoda A, Suzuki K, Suzuki M, Saito S, Uemura Y, Shibata T, Kondo M, Nakamura-Uchiyama F, Yokota K, Saito F, Izumi K, Sugiura W, Ohmagari N. Clinical characteristics of the first three waves of hospitalised patients with COVID-19 in Japan prior to the widespread use of vaccination: a nationwide observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100421. [PMID: 35300186 PMCID: PMC8923875 DOI: 10.1016/j.lanwpc.2022.100421] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Before widespread coronavirus disease (COVID-19) vaccinations, Japan experienced three COVID-19 epidemic waves. This study aimed to evaluate the characteristics of hospitalised COVID-19 patients and reveal temporal changes. Methods This study included 33,554 hospitalised patients with COVID-19 from 553 healthcare facilities. Data were analysed by age group and epidemic wave (first wave, 01/01/2020–05/31/2020; second wave, 06/01/2020–10/31/2020; and third wave, 11/01/2020–03/31/2021). Findings By age group, 3% (under 18), 22% (young), 34% (middle-aged), and 41% (older patients) were aged 0-17, 18-39, 40-64, and >65 years; while 16%, 35%, and 49% were in the first, second, and third wave, respectively. The patients’ overall median age (58 years; interquartile range, 39–74) was lowest and highest during the second and third waves, respectively. The frequency of any comorbidity was lowest and highest during the second (44·5%) and third (63·6%) waves, respectively. The symptoms at admission and exposure history differed considerably with age. The overall case fatality rate (5%) was highest among older patients (11·4%). Case fatality rate was highest and lowest during the first (7·3%) and second (2·8%) waves, respectively. Medication use changed over time. Interpretation Although the overall case fatality rate remained relatively low, it was more than twice as high among older patients. After adjusting for age and comorbidities, the risk of death was highest in the first wave. Funding This work was supported by the Ministry of Health, Labour and Welfare “Research on Emerging and Re-emerging Infectious Diseases and Immunization” 19HA1003].
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Affiliation(s)
- Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.,Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.,Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Setsuko Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Ohtsu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Kitajima
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ako Toyoda
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kumiko Suzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Michiyo Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Masashi Kondo
- Center for Clinical Trial and Research Support, Fujita Health University, Aichi, Japan
| | | | - Kazuhisa Yokota
- Department of Infectious Diseases, Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Kazuo Izumi
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.,Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Zhang CXW, Okeke JC, Levitan RD, Murphy KE, Foshay K, Lye SJ, Knight JA, Matthews SG. Evaluating depression and anxiety throughout pregnancy and after birth: impact of the COVID-19 pandemic. Am J Obstet Gynecol MFM 2022; 4:100605. [PMID: 35257937 PMCID: PMC8895717 DOI: 10.1016/j.ajogmf.2022.100605] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic presents unique social, economic, and psychological challenges for individuals globally. Thus, women who are pregnant face unprecedented mental health challenges. OBJECTIVE We sought to determine the impact of the pandemic on perinatal depression and anxiety in a longitudinal pregnancy cohort. We hypothesized increased depression and anxiety scores in women during pregnancy and after birth in the pandemic at all time points. STUDY DESIGN Participants were enrolled in the Ontario Birth Study, a pregnancy cohort embedded in clinical care at Mount Sinai Hospital, Toronto, Canada. Perinatal depression and anxiety were assessed using the 2-Item Patient Health Questionnaire and 2-Item Generalized Anxiety Disorder Questionnaire in early pregnancy, whereas the Edinburgh Postnatal Depression Scale and 2-Item Generalized Anxiety Disorder Questionnaire were used in late pregnancy and after birth. Logistic regression models were created to examine the association of the pandemic with clinically elevated mental health scores in the prepandemic group vs pandemic group while adjusting for covariates. RESULTS A total of 1159 survey responses from 649 participants between March 1, 2019, and February 28, 2021, were used to conduct this study. Participants were assessed in early pregnancy (n=416), in late pregnancy (n=373), and after birth (n=370). Responses received on or before February 29, 2020, were considered the “prepandemic” responses, whereas responses after the aforementioned date were considered the “pandemic” responses. Mean rank scores of depression and anxiety were significantly higher in the pandemic group (P=.02 and P=.003, respectively) in the postpartum period. There was no significant association between pandemic time and antenatal scores. However, postnatally, mothers were 2.6 times more likely to score ≥13 on the Edinburgh Postnatal Depression Scale during the pandemic than before the pandemic (95% confidence interval, 1.2–5.7; P=.02). Adjustment for ethnicity and income strengthened this association as the odds ratio increased to 3.3 (95% confidence interval, 1.4–8.0; P=.007). CONCLUSION Pandemic-associated increases in depression and anxiety scores were confined to the postpartum period, highlighting a need for increased screening and interventions for perinatal mood and anxiety disorders postnatally as this pandemic continues.
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Affiliation(s)
- Cindy X W Zhang
- Department of Physiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Ms Zhang, Dr Murphy, Ms Foshay, and Drs Lye and Matthews).
| | - Justin C Okeke
- Department of Obstetrics and Gynecology, Sinai Health System, New York City, NY (Mr Okeke and Drs Murphy, Lye, and Matthews)
| | - Robert D Levitan
- Mood and Anxiety Disorders Program, Centre for Addiction and Mental Health, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Levitan); Department of Psychiatry, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Levitan)
| | - Kellie E Murphy
- Department of Physiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Ms Zhang, Dr Murphy, Ms Foshay, and Drs Lye and Matthews); Department of Obstetrics and Gynecology, Sinai Health System, New York City, NY (Mr Okeke and Drs Murphy, Lye, and Matthews)
| | - Kim Foshay
- Department of Physiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Ms Zhang, Dr Murphy, Ms Foshay, and Drs Lye and Matthews)
| | - Stephen J Lye
- Department of Physiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Ms Zhang, Dr Murphy, Ms Foshay, and Drs Lye and Matthews); Department of Obstetrics and Gynecology, Sinai Health System, New York City, NY (Mr Okeke and Drs Murphy, Lye, and Matthews); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Mount Sinai Hospital, Ontario, Canada (Drs Lye, Knight, and Matthews); and Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Mount Sinai Hospital, Ontario, Canada (Drs Lye, Knight, and Matthews); Dalla Lana School of Public Health, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Knight)
| | - Stephen G Matthews
- Department of Physiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada (Ms Zhang, Dr Murphy, Ms Foshay, and Drs Lye and Matthews); Department of Obstetrics and Gynecology, Sinai Health System, New York City, NY (Mr Okeke and Drs Murphy, Lye, and Matthews); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Mount Sinai Hospital, Ontario, Canada (Drs Lye, Knight, and Matthews); and Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Matsuo R, Matsumoto N, Kadowaki T, Mitsuhashi T, Takao S, Yorifuji T. Effect of mRNA Vaccines in Preventing COVID-19 Severe Pneumonia Among COVID-19 Patients in Japan. J Epidemiol 2022; 32:151-152. [PMID: 35013024 PMCID: PMC8824662 DOI: 10.2188/jea.je20210487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rumi Matsuo
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Tomoka Kadowaki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Toshiharu Mitsuhashi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Soshi Takao
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
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Miyashita N, Nakamori Y, Ogata M, Fukuda N, Yamura A, Ishiura Y, Nomura S. Clinical features of nursing and healthcare-associated pneumonia due to COVID-19. J Infect Chemother 2022; 28:902-906. [PMID: 35317976 PMCID: PMC8934135 DOI: 10.1016/j.jiac.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
Introduction The objective of this study was to clarify the clinical differences between nursing and healthcare-associated pneumonia (NHCAP) and community-acquired pneumonia (CAP) due to COVID-19. We also investigated the clinical characteristics to determine whether there is a difference between the variant and non-variant strain in patients with NHCAP due to COVID-19. In addition, we analyzed the clinical outcomes in NHCAP patients with mental disorders who were hospitalized in a medical institution for treatment of mental illness. Methods This study was conducted at five institutions and assessed a total of 836 patients with COVID-19 pneumonia (154 cases were classified as NHCAP and 335 had lineage B.1.1.7.). Results No differences in patient background, clinical findings, disease severity, or outcomes were observed in patients with NHCAP between the non-B.1.1.7 group and B.1.1.7 group. The median age, frequency of comorbid illness, rates of intensive care unit stay, and mortality rate were significantly higher in patients with NHCAP than in those with CAP. Among the patients with NHCAP, the mortality rate was highest at 37.5% in patients with recent cancer treatment, followed by elderly or disabled patients receiving nursing care (24.3%), residents of care facilities (23.0%), patients receiving dialysis (13.6%), and patients in mental hospitals (9.4%). Conclusions Our results demonstrated that there were many differences in the clinical characteristics between NHCAP patients and CAP patients due to COVID-19. It is necessary to consider the prevention and treatment content depending on the presence or absence of applicable criteria for NHCAP.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
| | - Yasushi Nakamori
- Department of Emergency Medicine, Kansai Medical University Medical Center, Japan
| | - Makoto Ogata
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
| | - Naoki Fukuda
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
| | - Akihisa Yamura
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Division of Respiratory Medicine, Oncology and Allergology, Kansai Medical University Medical Center, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
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Hiroi Y, Ohtsu H, Uemura Y, Hayakawa K, Asai Y, Kutsuna S, Terada M, Sugiura W, Ohmagari N. Cardiovascular Complications of Hospitalized Patients With Coronavirus Disease 2019 in a Japanese Registry in 2020. Circ J 2022; 86:464-471. [DOI: 10.1253/circj.cj-21-0687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine
| | - Hiroshi Ohtsu
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine
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Impact of regional heterogeneity on the severity of COVID-19. J Infect Chemother 2022; 28:554-557. [PMID: 35034854 PMCID: PMC8730489 DOI: 10.1016/j.jiac.2021.12.032] [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: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023]
Abstract
The main objective of the study is to assess the impact of regional heterogeneity on the severity of COVID-19 in Japan. We included 27,865 cases registered between January 2020 and February 2021 in the COVID-19 Registry of Japan, to examine the relationship between the National Early Warning Score (NEWS) of COVID-19 patients on the day of admission and the prefecture where the patients live. A hierarchical Bayesian model was used to examine the random effect of each prefecture in addition to the patients' backgrounds. Additionally, we compared the results of two models; one model included the number of beds secured for COVID-19 patients in each prefecture as one of the fixed effects, and the other model did not. The results indicated that the prefecture had a substantial impact on the severity of COVID-19 on admission, even when considering the effect of the number of beds separately. Our analysis revealed a possible association between regional heterogeneity and increased/decreased risk of severe COVID-19 infection on admission. This heterogeneity was derived not only from the number of beds secured in each prefecture but also from other factors.
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Oda Y, Shimada M, Shiraishi S, Kurai O. Treatment and outcome of COVID-19 patients in a specialized hospital during the third wave: advance of age and increased mortality compared with the first/second waves. JA Clin Rep 2021; 7:85. [PMID: 34905146 PMCID: PMC8669418 DOI: 10.1186/s40981-021-00489-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose To elucidate the clinical course of patients with coronavirus disease 2019 (COVID-19) treated at a specialized hospital mainly for those with mild and moderate severity during the third wave, and to compare that with the first and second (1st/2nd) waves. Methods We retrospectively reviewed the severity on admission, treatment, and outcome of a total of 581 patients from September, 2020, to March, 2021, and examined the risk factors for deterioration of respiratory condition, defined as requiring oxygen ≥ 7 L/min for 12 h. Results The median age was 78 (interquartile range 62−83) years, older than in the 1st/2nd waves (53 years), and 50% of the patients was male. The number of patients classified as mild (peripheral oxygen saturation (SpO2) ≥ 96%), moderate I, II, and severe (requiring admission to the ICU or mechanical ventilation) was 121, 324, 132, and 4, respectively. Favipiravir, ciclesonide, dexamethasone, and/or heparin were administered for treatment. Respiratory condition recovered in 496 (85%) patients. It worsened in 81 patients (14%); 51 (9%) of whom were transferred to tertiary hospitals and 30 (5%) died. Mortality rate increased by fivefold compared during the 1st/2nd waves. Age, male sex, increased body mass index, and C-reactive protein (CRP) on admission were responsible for worsening of the respiratory condition. Conclusion Patients were older in the third wave compared with the 1st/2nd waves. Respiratory condition recovered in 85%; whereas 5% of the patients died. Old age, male sex, increased body mass index, and CRP would be responsible for worsening of the respiratory condition.
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Affiliation(s)
- Yutaka Oda
- Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27 Nonaka-kita, Yodogawa-ku, Osaka, 532-0034, Japan.
| | - Motoko Shimada
- Department of Anesthesiology, Osaka City Juso Hospital, 2-12-27 Nonaka-kita, Yodogawa-ku, Osaka, 532-0034, Japan
| | - Satoshi Shiraishi
- Department of Respiratory Medicine, Osaka City Juso Hospital, Osaka, Japan
| | - Osamu Kurai
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Osaka, Japan
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Effectiveness of monoclonal antibody therapy for COVID-19 patients using a risk scoring system. J Infect Chemother 2021; 28:352-355. [PMID: 34863647 PMCID: PMC8629723 DOI: 10.1016/j.jiac.2021.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction Monoclonal antibody therapy has been reported to be highly effective for preventing hospitalisation and severe cases in patients with Coronavirus Disease 2019 (COVID-19). However, since the drug is not readily available, it is important to rapidly and appropriately identify high-risk patients who can benefit most from therapy. Therefore, we designed a risk scoring system to identify at-risk COVID-19 patients in our region during the largest surge of COVID-19, from July to September 2021. Methods According to the risk scores, confirmed COVID-19 patients were introduced to receive REGN-CoV-2 to our hospital by regional health centre from 18th August (Term 3). The primary outcome was the comparison of the number of hospitalisation and severe condition with other periods, the 4th wave (Term 1) and the early part of the 5th wave (Term 2) in Japan. Results During Term 3, 115 patients were stratified with the scoring system and administered REGN-COV-2. The number of hospitalisation vs severe cases were 60 (5.2%) vs 14 (1.2%), 8 (1.5%) vs 3 (0.6%) and 21 (1.2%) vs 2 (0.1%), in term 1, 2 and 3, respectively. Among those aged <60 years, compared with term 1, the relative risk of hospitalisation and severe condition were 0.25 (95% CI: 0.12–0.53) and 0.10 (95% CI: 0.01–0.80), respectively, in term 3. Drug adverse events were fever (3: 2.6%), headache (1: 0.9%) and neck rash (1: 0.9%), all events were resolved within 24 h wth no serious adverse event. Conclusions The administration of monoclonal antibody therapy using a risk scoring system significantly reduced the number of hospitalisation and disease severity of COVID-19 without any serious adverse events and avoided regional medical collapse.
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Association between physical activity status and severity of COVID-19 in older adults. Epidemiol Infect 2021; 150:e189. [PMID: 36325838 PMCID: PMC9744453 DOI: 10.1017/s0950268822001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk factors specific to the elderly population for severe coronavirus disease 2019 (COVID-19) caused by the Omicron variant of concern (VOC) are not yet clear. We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive severe acute respiratory coronavirus 2 (SARS-CoV-2) test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors - dementia, admission from a long-term care facility and poor physical activity status - and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Of the 4,868 cases analysed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility and poor physical activity status was -0.04 (95% confidence interval -0.07 to -0.01), 0.09 (0.06 to 0.12) and 0.17 (0.14 to 0.19), respectively. Our results suggest that poor physical activity status and living in a long-term care facility have a substantial association with the risk of severe COVID-19 caused by the Omicron VOC, while dementia may be associated with non-severe illness.
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Hegaard HK, Rom AL, Christensen KB, Broberg L, Høgh S, Christiansen CH, Nathan NO, de Wolff MG, Damm P. Lifestyle Habits among Pregnant Women in Denmark during the First COVID-19 Lockdown Compared with a Historical Period-A Hospital-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7128. [PMID: 34281064 PMCID: PMC8297181 DOI: 10.3390/ijerph18137128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 01/25/2023]
Abstract
The first national lockdown in Denmark due to the COVID-19 pandemic was declared on 11 March 2020. From this date, national restrictions were imposed. We aimed to assess the potential influence of this first nationwide lockdown on exercise, alcohol consumption, and smoking in early pregnancy. Using a cross-sectional study based on routinely collected patient-reported data, we compared the lifestyle habits of women who were pregnant during the first phase of the pandemic (COVID-19 group) (n = 685) with those of women who were pregnant the year before (Historical group) (n = 787). We found a reduction in any exercise (PR = 0.91, 95% CI (0.84 to 0.99), in adherence to national recommendations of exercise (PR = 0.89, 95% CI (0.80 to 0.99), in cycling (15% vs. 28%, p < 0.0001), and swimming (0.3% vs. 3%, p = 0.0002) in the COVID-19 group compared with the Historical group. The prevalence of binge drinking was reduced in the COVID-19 group compared with the Historical group (PR = 0.80, 95% CI (0.68 to 0.93). In contrast, the prevalence of any weekly alcohol consumption and smoking cessation during pregnancy was similar between groups. Our findings indicate that national restrictions due to the COVID-19 pandemic influenced the lifestyle habits of pregnant women and should be addressed in antenatal counseling.
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Affiliation(s)
- Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ane Lilleøre Rom
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, J.B Winsløws Vej 4, 5000 Odense, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Østre Farimagsgade 5, 1353 K Copenhagen, Denmark;
| | - Lotte Broberg
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Stinne Høgh
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Cecilie Holm Christiansen
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Nina Olsen Nathan
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- The Juliane Marie Centre, The Research Unit for Women’s and Children’s Health, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Peter Damm
- Department of Obstetrics, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (A.L.R.); (L.B.); (S.H.); (N.O.N.); (M.G.d.W.); (P.D.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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